Issue link: https://viewer.e-digitaledition.com/i/674098
" We think about cancer as being deadly, but in many ways, the most common forms of prostate cancer can be treated like a chronic disease instead of an acute illness." MICHAEL P. HERMAN, MD, DIRECTOR OF UROLOGIC ONCOLOGY AT SOUTH NASSAU COMMUNITIES HOSPITAL most important role, however, is in radi- cal prostatectomy. "Following removal of the prostate, physicians must reconstruct the bladder and the junction between the urethra and bladder," Dr. Herman says. "In order to optimize outcomes, surgeons must have the ability to perform fine dissection and suturing." The da Vinci Surgical System's 3-D visualization and wristed instrumenta- tion o•ers greater precision and dexterity, easily facilitating fine-tissue manipulation. Because the surgical robot has enhanced the feasibility of minimally invasive pros- tatectomy, a greater number of physicians o•er the less-invasive approach. "Minimally invasive robotic prosta- tectomy significantly reduces lengths of stay and recovery times," Dr. Ring says. "Patient discomfort and blood loss are also considerably reduced." A growing body of data suggests that robot-assisted prostatectomy may leave fewer positive margins and o•er improved potency and continence outcomes. 3 TREATING RECURRENT DISEASE Cryosurgery, also known as cryotherapy or cryoablation, can be used as a primary pros- tate cancer therapy for men who require treatment and aren't good candidates for prostatectomy or radiation therapy — a patient population that may include older men, men in otherwise poor health and men who have previously undergone radiation therapy for unrelated conditions. Men who simply wish to avoid prostatectomy or radia- tion therapy may a lso qualify for cryosurgery. However, one of its big- gest indications is for treating radiorecurrent disease — localized can- cer that recurs following radiation therapy. C r y o s u r g e r y i s a m i n i m a l l y i n v a s i v e procedure per formed w it h TRUS g uida nce that uses pressurized argon gas to freeze and destroy the prostate gland. In cases of radiorecurrent disease, men have several options, including salvage prostatectomy, salvage cryosurgery, hormonal therapy or watchful waiting. Because neither hormonal therapy nor watchful waiting are curative, they are typically indicated for men whose overall life expectancy is less than 10 years. Sa lva ge prost at ect omy fol low i n g brachytherapy or radiation therapy is a dif- ficult surgery that can significantly impact continence and sexual function. Salvage cr yosurger y offers better functiona l outcomes than salvage prostatectomy and can even be repeated as needed. "From robotic surgery to radiation therapy and cryosurgery, we can provide individualized, state-of-the-art treatment for patients with all stages of prostate cancer," Dr. Herman says. "Our goal at South Nassau Communities Hospital is to deliver the best outcomes possible in a caring environment." Fo r m o re i nfo r m a t i o n a b o u t th e Ce nte r for P rostate Health at S outh N a s s a u C o m m u n i t i e s H o s p i t a l , v i s i t s o u t h n a s s a u . o r g / s e r v i c e s / prostatehealth.cfm. ■ References: 1. 4-Kallikrein Test and Kallikrein Markers in Prostate Cancer Screening. McDonald M L , Parsons J K . Urol C lin Nor th Am . 2 016 Fe b ; 4 3 (1): 3 9 - 4 6 . d o i : 10 . 1016/j . ucl.2015.08.004. 2. Active surveillance for low-risk prostate can- cer. Klotz L. Curr Urol Rep. 2015 Apr;16(4):24. doi: 10.1007/s11934-015-0492-z. 3. Minerva Urol Nefrol. 2015 Mar;67(1):47-53. Epub 2014 Nov 26. Robot assisted radical prostatectomy: the new standard? Laviana AA 1 , Williams SB, King ED, Chuang RJ, Hu JC. Aswin Williams, CST, assists in performing a robot-assisted prostatectomy. Dr. Herman and Powell discuss a patient's treatment protocol. 1 0 C O V E R F E A T U R E 1 0