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Top Option for Prostate Cancer Also Little Used

By Greg Eure, M.D.

One in six men in the United States will develop prostate cancer. It is one of the most commonly diagnosed cancers and the second-leading cause of cancer deaths. Yet, a recent survey suggests that many men at risk for prostate cancer are unaware of the leading treatment option available; robot-assisted surgery to remove the cancerous prostate.

The survey was conducted by Intuitive Surgical, Inc., maker of the daVinci® robotic surgery system that we use at Sentara Norfolk General Hospital. A cynical reader might conclude the survey was biased in favor of daVinci, but it revealed useful data about prostate cancer awareness.

For instance, the survey among 1,000 online information seekers found that 39% of men would go to their primary care physician for prostate cancer concerns rather than a urologist. While your PCP is certainly your first line of defense against prostate and colorectal cancers through examination and screening during your annual physical, any resulting suspicion of cancer should prompt your PCP to write a referral to a urologist. If he or she doesn’t, ask.

The survey also found, alarmingly, that 34% of men would begin researching treatment options only after they started showing symptoms of prostate cancer. These include blood in the urine or semen or difficulty urinating, though urinary issues are more often a sign of an enlarged prostate called benign prostatic hyperplasia (BPH.) If you do begin showing symptoms of prostate cancer, it often means it has already spread, or metastasized, beyond the prostate gland and it may be too late to achieve the ‘cure’ offered by early detection and robot-assisted prostatectomy while you are still symptom-free.

As younger men with family histories of prostate cancer are screened at earlier ages, and sometimes diagnosed, quality-of-life issues following prostatectomy become increasingly important. These include incontinence and erectile dysfunction and these concerns often lead men to adopt an Active Surveillance approach to prostate cancer, which involves monitoring the progress of the disease and having surgical intervention as late as possible or not at all.

Current research, published in medical literature and the news, questions whether robot-assisted surgery offers better long-term quality-of-life outcomes than traditional open surgery. While the jury is still out on that question, there is no doubt that men who have minimally invasive, robot-assisted prostatectomy enjoy much faster recovery times, far fewer transfusions due to minimal blood loss and far less pain than men having traditional open surgery. Meantime, the post-surgery quality-of-life questions remain the subject of ongoing research. I’m proud to say we at SMG Urology of Virginia and Eastern Virginia Medical School have been national leaders in working to improve quality-of-life outcomes for daVinci prostatectomy patients.

One aspect of prostate cancer in favor of survivability is the fact that it grows very slowly. While Active Surveillance is certainly a valid option for some men, each patient is unique and there is no single solution for prostate cancer. A relationship with a urologist is important if you have a family history of prostate cancer or BPH or you are having any urinary issues. Together, we can design a treatment plan that’s right for you.

The best way to approach prostate cancer is with information, long before you think you need it, and early detection. This includes testing through digital rectal examination (DRE) and/or a prostate-specific antigen (PSA) test of your blood during your annual physical.

Gregg Eure, M.D., is a board certified Urologist with Urology of Virginia, a member practice of Sentara Medical Group. He is also a Fellow of the American College of Surgeons, Research Chairman for Urology of Virginia and an assistant professor at Eastern Virginia Medical School. Dr. Eure is an investigator on many clinical trials including the treatment of BPH.

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