Prostate Cancer

DEFINITION: Prostate cancer is the most commonly diagnosed life-threatening malignancy in American men. As with many malignancies, by the time a patient has symptoms associated with his cancer, it is frequently too late to intervene with curative therapies. The signs and symptoms of prostate cancer are difficulty urinating, getting up frequently at nighttime, daytime frequency, urgency, or the need to hurry at the first sign that one needs to urinate. However, these are symptoms more usually associated with benign enlargements of the prostate (BPH). More commonly, prostate cancer is diagnosed in men without symptoms on the basis of an abnormal digital rectal examination or on the basis of an abnormal blood test for prostate specific antigen (PSA).

TREATMENTS Patients who are diagnosed with clinically localized prostate cancer who opt for definitive curative therapy may choose from a variety of options including nerve sparing radical prostatectomy, laparoscopic radical prostatectomy, and radiation seed implantation. In addition, in collaboration with the Division of Plastic Surgery, patients may choose sural nerve grafting to enhance the possibility to retain potency following a radical prostatectomy during which the nerves might have been removed. Sural nerve grafting is a routine technique used to reconstruct nerves all over the body, but only recently has it been used to reconstruct the nerves to the penis. In addition, our physicians are working closely with medical oncologists in the design of new protocols for the treatment of various forms of regional and systemic disease. These include the use of agents that inhibit the growth and development of new blood vessels (which can "starve" the tumor of its nutrients and thereby possibly prevent its progression), the use of various types of chemotherapy with decreased morbidity/toxicity and increased efficacy, and the combined use of various agents in concert with vaccine therapy in treating hormone-refractory metastatic prostate cancer.


BENEFITS Laparoscopic radical prostatectomy offers many advantages over traditional open surgery. Although the hospital stay is roughly equivalent to that in open surgery and the operating time is longer, the patient benefits from a much quicker full recovery and heals with only five small incisions, each less than an inch. As a result, the patient is able to return to normal activities much more quickly. Moreover, with the improved visualization, there may be less blood loss during a laparoscopic radical prostatectomy. Thus, the patient does not need to donate blood preoperatively, and the cell-saver machine (which recycles a patient's blood) does not need to be used during the surgery. Additionally, more sutures can be placed to attach the bladder to the urethra, thereby often allowing the urinary catheter to be removed more quickly. This advance usually translates into less patient post-operative discomfort, and oftentimes into earlier recovery of continence.

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