According to the Centers for Disease Control and Prevention (CDC), aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States.
Henry Mayo is has brought the latest minimally invasive surgery system to the Santa Clarita Valley. It's the da Vinci Xi® surgical system, and it allows physicians to operate through small incisions while enhancing their vision, precision and control and minimizing complications and recovery time for patients.
In this segment, you will hear important tips for good prostate health and the latest advances in robotics for prostate cancer from Dr. Jaspreet Parihar. He is a urologic oncologist and a member of the medical staff at Henry Mayo Newhall Hospital.
Selected Podcast
Prostate Cancer and The Henry Mayo Robotic Program
Featured Speaker:
Dr. Parihar received his medical degree from Drexel University College of Medicine in Philadelphia. He completed his internship and residency at Rutgers-Robert Wood Johnson Medical School in New Brunswick, NJ and came to City of Hope to complete his fellowship in urology oncology/robotics.
Learn more about Jaspreet Parihar, MD
Jaspreet Parihar, MD
Dr. Jaspreet Parihar is a urologic oncologist and a member of the medical staff at Henry Mayo Newhall Hospital.Dr. Parihar received his medical degree from Drexel University College of Medicine in Philadelphia. He completed his internship and residency at Rutgers-Robert Wood Johnson Medical School in New Brunswick, NJ and came to City of Hope to complete his fellowship in urology oncology/robotics.
Learn more about Jaspreet Parihar, MD
Transcription:
Prostate Cancer and The Henry Mayo Robotic Program
Melanie Cole (Host): According to the CDC, aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. The good news is that prostate cancer is very treatable and physicians now have many tools in their toolbox to successfully diagnose and treat this very common cancer. My guest today is Dr. Jaspreet Parihar. He’s a urologic oncologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show. Who is at risk for prostate cancer and are there certain groups of men that are at higher risk than others?
Dr. Jaspreet Parihar, MD (Guest): Prostate cancer is a very important topic for men to understand and to monitor throughout their lifespan. The reason for that is one in every seven men will get diagnosed with prostate cancer. Not everybody passes away from prostate cancer, but some people still do. In fact, if you take away skin cancer, the most common cancer in a man is prostate cancer, and if you take away lung cancer mortality, one of the most lethal cancers, the second, for men is prostate cancer. In that sense, this is a very important topic to be talking about and to understand the do's and don’ts.
Melanie: Let’s talk about diagnosis then because men have to go see their urologist, they don’t want to go, it’s not easy to get them to go because they're afraid of that digital, but speak about the PSA and what you guys are looking for when you're doing both the digital and the PSA.
Dr. Parihar: It is not the most comfortable thing for a man to undergo a rectal exam. What we’re feeling for is the prostate and it’s, in fact, one of the internal organs that we can feel and get an idea and detect simply with a rectal exam. The second part of the screening entails a blood test of PSA. This is a prostate cancer tumor marker and if there are any abnormalities of the PSA, this can be easily detected in a simple blood test. Normally, the PSA is recommended along with the rectal exam, starting at age 55 up to age 69. Of course, there are caveats to that if a patient has a family history or based on certain ethnicities, these guidelines can certainly be tailored according to the patient's needs.
Melanie: If you’ve done these tests and you determine that a man does have prostate cancer and you have to stage this and discuss treatments, how do that work?
Dr. Parihar: Staging again comes back to the clinical examination, which is based upon your rectal exam findings, the blood tests, the PSA levels. In addition, if warranted, we test any spread of the disease using CT scan of the abdomen/pelvis, sometimes MRI, in conjunction with a bone scan which is looking for any spread of the tumor to the bones.
Melanie: Then the treatment options, you have so many tools as I said in the introduction. There's watchful waiting, there's radiation hormone, targeted therapies, there's also surgery. Tell us a little bit about the surgical interventional for prostate cancer and the robotic surgery at Henry Mayo Newhall Hospital.
Dr. Parihar: I'm very excited that Henry Mayo Hospital has acquired the robotic systems. This really revolutionizes the pelvic operations. Robotic surgery, in general, started in the field of urology in about 2001 and before then, the majority of the prostatectomies were being done in an open fashion with longer recovery time, more incisional pain, as well as longer hospitalizations, usually three to four days for patients to be in the hospital from the surgery. After robotics was started, these days, up to 85% to 90% of cases are being done robotic fashion, usually, the patient can be discharged the following day with minimal incisional pain and a much faster recovery.
Melanie: Tell us a little bit about the robotic surgery itself. Is it difficult to learn as Henry Mayo has acquired this Da Vinci? Tell us what's involved for you surgeons in learning to use it.
Dr. Parihar: Surgery and human anatomy is anatomy. Obviously, the surgeons need to have basic surgical skills and knowledge of the region that they're working in, but performing robotic surgery certainly takes a special skill set. A lot of us have fellowship training in this field specifically in where we trained over hundreds and thousands of cases in complex cases. I think if you're looking for robotic surgery, it’s probably in your best interest to seek out of the special fellowship trained doctors who perform this on a daily basis and are much more familiar with the technology. There is certainly a learning curve to this and as with anything, the more of those procedures you do, the better the outcomes will be.
Melanie: You mentioned that it would be shorter recovery time and smaller incisions. What does this mean for the man as far as afterward and possible side effects because again men are very concerned when they hear the words prostate cancer about those side effects that could be incontinence or erectile dysfunction? Does that help with any of these make it just a little bit easier on the man?
Dr. Parihar: The prostate is situated deep into the pelvis where it is difficult to see behind the pubic bone and to delineate some of these nerve structures as you're referring to for erectile function, it is the use of robotics in this type of surgery that has really revolutionized prostate surgery. We have less blood loss, improved visualization, magnified view, and wristed endoscopic surgical tools that can allow us to dissect more finely, and also to separate and preserve some of these nerve structures so that men can have a chance for erections following surgery. Same thing goes with continence. The osmosis that is done between the bladder and the urethra, in my opinion, can certainly much better visualized and much better performed when doing this with a robot.
Melanie: How do they know if the treatment is working after surgery? Side effects may or may not happen and you'll deal with them as that occurs, but how do they know this prostate cancer is either limited to the organ itself or hasn’t metastasized or hasn’t come back? How do they know afterward?
Dr. Parihar: That's a good question and a very commonly asked question. What happens after the prostate is removed, the entire gland is looked at under a microscope by a pathologist and they really search for all these tumor cells within the prostate and try to detect whether these tumor cells have escaped the prostate or not. The second portion of the prostatectomy is usually a lymph node dissection. These lymph nodes are almost like filters in your body which help catch infections or cancers, and as part of the surgery, they're commonly sampled as well. With the sampling of the lymph nodes and the prostate, the entire tissue is looked at under a microscope and if there's any evidence of spread, then further treatments may be recommended.
Melanie: What else would you like to add, and your best advice, information that you would like people to know about the new robotic system at Henry Mayo Newhall Hospital for prostate cancer and for other types of cancers and procedures what you really want them to know and possible prevention, and/or screening?
Dr. Parihar: As I mentioned, screening is of the utmost importance. Prostate cancer is one of those things that patients may have and not have any symptoms from, or they may have a lot of urinary symptoms and may not have any problems with their prostate. It really has to be delineated with a variety of testing, cystoscopy and also the blood tests. Following this, the proper diagnosis and treatment recommendations can be made. It's really exciting that Henry Mayo Hospital and community hospitals have acquired these robotic systems so that patients can see the specialists in the area as well as get the surgery done in the area where the friends and family and be part of their ongoing care. I think it speaks volume of the investments that the hospitals are making to improve patient's access to care and the quality of care being delivered.
Melanie: That certainly is wonderful that they have such experienced surgeons such as yourself and thank you so much for being with us today. You're listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole. Thanks for tuning in.
Prostate Cancer and The Henry Mayo Robotic Program
Melanie Cole (Host): According to the CDC, aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. The good news is that prostate cancer is very treatable and physicians now have many tools in their toolbox to successfully diagnose and treat this very common cancer. My guest today is Dr. Jaspreet Parihar. He’s a urologic oncologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show. Who is at risk for prostate cancer and are there certain groups of men that are at higher risk than others?
Dr. Jaspreet Parihar, MD (Guest): Prostate cancer is a very important topic for men to understand and to monitor throughout their lifespan. The reason for that is one in every seven men will get diagnosed with prostate cancer. Not everybody passes away from prostate cancer, but some people still do. In fact, if you take away skin cancer, the most common cancer in a man is prostate cancer, and if you take away lung cancer mortality, one of the most lethal cancers, the second, for men is prostate cancer. In that sense, this is a very important topic to be talking about and to understand the do's and don’ts.
Melanie: Let’s talk about diagnosis then because men have to go see their urologist, they don’t want to go, it’s not easy to get them to go because they're afraid of that digital, but speak about the PSA and what you guys are looking for when you're doing both the digital and the PSA.
Dr. Parihar: It is not the most comfortable thing for a man to undergo a rectal exam. What we’re feeling for is the prostate and it’s, in fact, one of the internal organs that we can feel and get an idea and detect simply with a rectal exam. The second part of the screening entails a blood test of PSA. This is a prostate cancer tumor marker and if there are any abnormalities of the PSA, this can be easily detected in a simple blood test. Normally, the PSA is recommended along with the rectal exam, starting at age 55 up to age 69. Of course, there are caveats to that if a patient has a family history or based on certain ethnicities, these guidelines can certainly be tailored according to the patient's needs.
Melanie: If you’ve done these tests and you determine that a man does have prostate cancer and you have to stage this and discuss treatments, how do that work?
Dr. Parihar: Staging again comes back to the clinical examination, which is based upon your rectal exam findings, the blood tests, the PSA levels. In addition, if warranted, we test any spread of the disease using CT scan of the abdomen/pelvis, sometimes MRI, in conjunction with a bone scan which is looking for any spread of the tumor to the bones.
Melanie: Then the treatment options, you have so many tools as I said in the introduction. There's watchful waiting, there's radiation hormone, targeted therapies, there's also surgery. Tell us a little bit about the surgical interventional for prostate cancer and the robotic surgery at Henry Mayo Newhall Hospital.
Dr. Parihar: I'm very excited that Henry Mayo Hospital has acquired the robotic systems. This really revolutionizes the pelvic operations. Robotic surgery, in general, started in the field of urology in about 2001 and before then, the majority of the prostatectomies were being done in an open fashion with longer recovery time, more incisional pain, as well as longer hospitalizations, usually three to four days for patients to be in the hospital from the surgery. After robotics was started, these days, up to 85% to 90% of cases are being done robotic fashion, usually, the patient can be discharged the following day with minimal incisional pain and a much faster recovery.
Melanie: Tell us a little bit about the robotic surgery itself. Is it difficult to learn as Henry Mayo has acquired this Da Vinci? Tell us what's involved for you surgeons in learning to use it.
Dr. Parihar: Surgery and human anatomy is anatomy. Obviously, the surgeons need to have basic surgical skills and knowledge of the region that they're working in, but performing robotic surgery certainly takes a special skill set. A lot of us have fellowship training in this field specifically in where we trained over hundreds and thousands of cases in complex cases. I think if you're looking for robotic surgery, it’s probably in your best interest to seek out of the special fellowship trained doctors who perform this on a daily basis and are much more familiar with the technology. There is certainly a learning curve to this and as with anything, the more of those procedures you do, the better the outcomes will be.
Melanie: You mentioned that it would be shorter recovery time and smaller incisions. What does this mean for the man as far as afterward and possible side effects because again men are very concerned when they hear the words prostate cancer about those side effects that could be incontinence or erectile dysfunction? Does that help with any of these make it just a little bit easier on the man?
Dr. Parihar: The prostate is situated deep into the pelvis where it is difficult to see behind the pubic bone and to delineate some of these nerve structures as you're referring to for erectile function, it is the use of robotics in this type of surgery that has really revolutionized prostate surgery. We have less blood loss, improved visualization, magnified view, and wristed endoscopic surgical tools that can allow us to dissect more finely, and also to separate and preserve some of these nerve structures so that men can have a chance for erections following surgery. Same thing goes with continence. The osmosis that is done between the bladder and the urethra, in my opinion, can certainly much better visualized and much better performed when doing this with a robot.
Melanie: How do they know if the treatment is working after surgery? Side effects may or may not happen and you'll deal with them as that occurs, but how do they know this prostate cancer is either limited to the organ itself or hasn’t metastasized or hasn’t come back? How do they know afterward?
Dr. Parihar: That's a good question and a very commonly asked question. What happens after the prostate is removed, the entire gland is looked at under a microscope by a pathologist and they really search for all these tumor cells within the prostate and try to detect whether these tumor cells have escaped the prostate or not. The second portion of the prostatectomy is usually a lymph node dissection. These lymph nodes are almost like filters in your body which help catch infections or cancers, and as part of the surgery, they're commonly sampled as well. With the sampling of the lymph nodes and the prostate, the entire tissue is looked at under a microscope and if there's any evidence of spread, then further treatments may be recommended.
Melanie: What else would you like to add, and your best advice, information that you would like people to know about the new robotic system at Henry Mayo Newhall Hospital for prostate cancer and for other types of cancers and procedures what you really want them to know and possible prevention, and/or screening?
Dr. Parihar: As I mentioned, screening is of the utmost importance. Prostate cancer is one of those things that patients may have and not have any symptoms from, or they may have a lot of urinary symptoms and may not have any problems with their prostate. It really has to be delineated with a variety of testing, cystoscopy and also the blood tests. Following this, the proper diagnosis and treatment recommendations can be made. It's really exciting that Henry Mayo Hospital and community hospitals have acquired these robotic systems so that patients can see the specialists in the area as well as get the surgery done in the area where the friends and family and be part of their ongoing care. I think it speaks volume of the investments that the hospitals are making to improve patient's access to care and the quality of care being delivered.
Melanie: That certainly is wonderful that they have such experienced surgeons such as yourself and thank you so much for being with us today. You're listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole. Thanks for tuning in.