Clinically localized prostate cancer Prostatectomy David D Thiel

  • Slides: 36
Download presentation
Clinically localized prostate cancer: Prostatectomy David D. Thiel, MD Mayo Clinic Florida Department of

Clinically localized prostate cancer: Prostatectomy David D. Thiel, MD Mayo Clinic Florida Department of Urology

Prostate Cancer in Perspective Estimated risk per 1, 000 men

Prostate Cancer in Perspective Estimated risk per 1, 000 men

Cancer Deaths, U. S. Prostate Breast 1995 40, 400 46, 000 2007 27, 050

Cancer Deaths, U. S. Prostate Breast 1995 40, 400 46, 000 2007 27, 050 40, 460 % Decrease 33% 12%

Prostate Cancer Therapy Goals • Eradicate Cancer • Preserve Continence • Prevent Regret •

Prostate Cancer Therapy Goals • Eradicate Cancer • Preserve Continence • Prevent Regret • Preserve Erections Quality of Life

Prostate Cancer Options • Watchful waiting • Active surveillance • Surgery • Retropubic •

Prostate Cancer Options • Watchful waiting • Active surveillance • Surgery • Retropubic • Perineal • Robotic • Radiation Therapy • External beam • Brachytherapy • Proton Beam • Cryotherapy • HIFU • Cyber knife • Androgen deprivation (ADT)

Da Vinci • Fred Moll (surgeon) approached by SRI international • Develop Field Robot

Da Vinci • Fred Moll (surgeon) approached by SRI international • Develop Field Robot for wounded soldiers • Too expensive and not practical • Together with engingeers and Venture Cap money – Started Intuitive Corp.

• $127 Million in Venture cap money • 1999 posted $18. 4 million

• $127 Million in Venture cap money • 1999 posted $18. 4 million loss • Marketed for Gall Bladders • 2000 prospectus made no mention of prostate surgery

General Numbers • 8000 RALP in 2004 • 10 -17% of prostates in 2006

General Numbers • 8000 RALP in 2004 • 10 -17% of prostates in 2006 RALP • 80% in 2009 - Contemp Urology 2007 19(2). - J Endourology 2006 20(11).

da Vinci® Surgical System

da Vinci® Surgical System

da Vinci® System Console

da Vinci® System Console

Hand controls

Hand controls

Five degrees of Freedom

Five degrees of Freedom

Patient Positioning

Patient Positioning

Operative Data • Blood Transfusion < 1% • Conversion to open < 1% •

Operative Data • Blood Transfusion < 1% • Conversion to open < 1% • Rectal injury < 0. 1% • Deaths – 0%

QOL data • Incontinence < 1% • Erections – long talk • Best treatment

QOL data • Incontinence < 1% • Erections – long talk • Best treatment to preserve long term erections

Reasons for young men to have prosatectomy (What is young? ) • • •

Reasons for young men to have prosatectomy (What is young? ) • • • 1. Potential voiding dysfunction 2. Adjuvant therapy if failure 3. Secondary malignancy

Prostatectomy Non-debatable disadvantages • 100% ejaculatory failure • Possible blood transfusion • 0. 03%

Prostatectomy Non-debatable disadvantages • 100% ejaculatory failure • Possible blood transfusion • 0. 03% surgical mortality • Surgical risk • Infx • PE • MI • Etc.

Prostatectomy Non-debatable advantages • Definitive staging • Pt cured if tumor pathologically confined •

Prostatectomy Non-debatable advantages • Definitive staging • Pt cured if tumor pathologically confined • Tx simultaneous LUTS/BPH • Easy monitoring • Decrease PSA anxiety over follow-up