There are different types of treatment for patients with prostate cancer.
- Robotic Prostatectomy (Robotic Prostate Cancer Surgery): Typically referred to as robotic surgery for prostate cancer or robotic prostatectomy, Moffitt's da Vinci® prostatectomy is a robot-assisted, minimally invasive surgery that is quickly becoming a popular treatment for removal of the prostate following early diagnosis of prostate cancer. With da Vinci prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been. Moffitt’s Dr. Julio Pow-Sang, a worldwide leader in the field of prostate cancer treatment, now blazes a new trail in treatment for the disease - robotic prostate surgery. Dr. Pow-Sang is chairman of genitourinary oncology at Moffitt, as well as chief of surgery and director of the robotics program.
- Laparoscopic Radical Prostatectomy (LRP): Unlike radical prostatectomy, in which the surgeon makes an open incision in the lower abdomen in order to reach deep into the pelvis and view the operative area, laparoscopic radical prostatectomy (LRP) does not require an abdominal incision. Instead, LRP relies on four tiny incisions called entry sites, most of which are no longer than of an inch. These entry sites are used for inserting surgical instruments into the body. The laparoscope, a pencil-sized video camera, is inserted into one of the entry sites and is used to guide the operation. The laparoscope transmits images to a monitor that can be viewed by everyone in the room. This provides more precise and identical views of the operative action, which promotes greater coordination among team members. LRP is a much less invasive procedure than open radical prostatectomy. The elimination of the open abdominal incision results in minimal blood loss during surgery, less pain after surgery, higher potency rates, quicker return to regular bladder control and ultimately, higher cure rates.
- Nerve-Sparing Surgery: This surgery is performed during a prostatectomy in order to preserve the two neurovascular bundles outside the prostate that are responsible for erections. Before 1980, these nerves were routinely taken to make sure all cells were removed, but the unfortunate result was sexual impotence. Today, surgical and diagnostic advances have allowed Moffitt surgeons to spare one or both nerves in 75% of prostatectomies, giving the patient a better chance of retaining sexual function. If both nerves are spared (bilateral), the patient has an 80% chance of maintaining sexual potency; if one nerve is spared (unilateral), the rate is about 30%. The decision for nerve-sparing surgery is largely up to the patient, but controlling the cancer is the surgeon’s primary goal. The best candidates for nerve-sparing surgery are men with:
• Localized tumors
• A PSA level of 10 or less
• A Gleason score of 6 to 7 or less
• No prior use of erectile dysfunction (ED) drugs
Nerve-sparing is not recommended for men with large tumors or high-grade disease, or for those who have previous erectile dysfunction unrelated to cancer treatment.
For some patients, urologic cancers are treated by radiation alone. Other patients are helped by surgery combined with appropriate radiation therapy. The Genitourinary Oncology Program includes a radiation oncologist who has developed specific treatment techniques for the needs of prostate and bladder cancer patients. Radiation services are available on site and usually administered on an outpatient basis.
Chemotherapy and Biological Therapy
Some urologic cancers, such as testicular cancer, now are treated successfully with chemotherapy. Others, such as bladder cancer are showing better response to new combinations of chemotherapy. New treatments for kidney cancer include biological therapy, which uses the body’s own immune system to fight cancer. Moffitt has facilities for both outpatient and inpatient administration of chemotherapy.
Additional Team Support
The Supportive Care Medicine Program offers ongoing emotional and social support as well as referrals to other Moffitt and community resources for patients and their families. The Man-To-Man Prostate Cancer Support Group, for example, helps patients with prostate cancer. This group is an American Cancer Society program that provides education and support for men with prostate cancer and their spouses/partners. Meetings are the fourth Thursday of every month at alternating hospitals within Hillsborough County.