The National Cancer Institute estimates there are almost 200,000 newly diagnosed cases of prostate cancer in the United States annually. Prostate cancer is the second leading cause of cancer death in men in the United States with approximately 28,000 men dying of it each year.
Listen as Dr. Jaspreet Parihar, urological oncologist and a member of the Medical Staff at Palmdale Regional Medical Center, discusses Prostate Cancer and the use of robotic surgery as an option for treatment that can lead to better outcomes.
Robotic Surgery for Prostate Cancer
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.
Dr. Parihar has done extensive research and clinical work in the fields of urology and robotic surgery. He is certified on the Da Vinci surgical systems and has published numerous book chapter and research articles on the topic. He believes in utilizing the latest technology and minimally-invasive techniques to achieve the best results for his patients.
Learn more about Dr. Jaspreet Parihar
Jaspreet S. Parihar, MD
Dr. Jaspreet Parihar is a Urologist, a Urological Oncologist, and a member of the Medical Staff at Palmdale Regional Medical Center.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.
Dr. Parihar has done extensive research and clinical work in the fields of urology and robotic surgery. He is certified on the Da Vinci surgical systems and has published numerous book chapter and research articles on the topic. He believes in utilizing the latest technology and minimally-invasive techniques to achieve the best results for his patients.
Learn more about Dr. Jaspreet Parihar
Transcription:
Robotic Surgery for Prostate Cancer
Melanie Cole (Host): The National Cancer Institute estimates that there are almost 200,000 newly diagnosed cases of prostate cancer in the US annually. My guest today is Dr. Jaspreet Parihar. He’s a urologist and a urological oncologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Parihar. Tell us about prostate cancer. Who is at risk for prostate cancer?
Dr. Jaspreet Parihar (Guest): Well, first of all, thank you very much for giving me this opportunity. So, let me just talk about basics about prostate and what prostate cancer is. So, a prostate gland is a walnut sized reproductive gland found in men. As you mentioned, over 200,000 men annually are diagnosed with prostate cancer and over 26,000 men die from the disease. About one in seven men will have a lifetime risk of getting diagnosed with prostate cancer. Now, some of the risk factors for getting prostate cancer include family history of cancer, for example in father, uncle, or other first or second degree relatives. Also, race plays an important role in prostate cancer development. So, African American men have higher incidents as well as higher mortality as compared to some of the other races.
Melanie: Is there screening available for prostate cancer? And, if so, who should be screened and when?
Dr. Parihar: Absolutely. So, the screening entails a blood test called a “prostate specific antigen”, or a PSA, and an anorectal examination of the prostate performed by a urologist. Now, as you know, prostate cancer is the most common cancer diagnosed in men and second only to lung cancer in cancer-related deaths. So, a lot of times patients may have prostate cancer and have no symptoms and the only way to detect this problem is by routine screening. There have been a lot of controversies over the last several years of who to screen, when to screen, how often to screen; my best recommendations for my patients is that it should be decided between a doctor and the patient and between them a shared decision making process has to occur and based on patient’s own risk factors, family history, and age a recommendation can be given at what age to start prostate cancer screening and how often to obtain it. Generally, patients older than 55 are recommended to have DRE examination, which is rectal examination, and PSA testing on an annual basis. Sometimes we start screening early at age 40 if there are higher risk factors but, again, the important point for everybody to understand is that this is a shared decision making process. There’s no single age where you should or should not have a screening.
Melanie: If a man is diagnosed with prostate cancer, what are some of the treatment options available to them?
Dr. Parihar: When prostate cancer was treated 15 to 30 years back, almost all men with prostate cancer were recommended to seek treatment. As we realize and the nature of the disease process and its biology of cancer, we are better able to stratify those patients who need treatment and those patients who can be observed. Now, prostate cancer is a very common disease. A lot of men may have it and not get detected or treated and eventually end up passing away from other diseases such as heart problems, lung problems, et cetera. But patients who are detected to have prostate cancer, we sit down and have a total discussion of their age, their comorbidities, and their overall life expectancy, and then come up with a treatment option which is best suited for that individual patient. There are many excellent treatment options including surgery. These days we utilize robotics to perform this. There’s radiation which can be given externally to the prostate or sometimes we implant radioactive seeds in the prostate to give internal radiation. There is also, as I was mentioning earlier, active surveillance in which we determine the progressiveness of the prostate cancer and come up with an algorithm for individual patients to monitor the PSAs and repeat biopsy on a surveillance schedule. If it looks like the prostate cancer is becoming more aggressive or more in volume, then we would recommend obtaining treatment. So again, this is an individualized approach. One treatment option for one patient may not be the perfect option for another patient and it really has to be a discussion held between the doctor and the patient as to what are the goals of care and how best to approach a treatment for prostate cancer.
Melanie: Dr. Parihar, aside from the types of treatments that you mentioned - external beam radiation or brachytherapy, hormone therapy, any of these others - if surgery is what’s designed and what you’ve decided with a patient, tell us about what’s going on with robotic prostate surgery today. Are you still removing prostates on a regular basis or is that declining a bit?
Dr. Parihar: You know, Melanie, that’s a great question. So, just in general, the prostatectomy has been around for many, many years and more recently, since about the year 2001, robotics was introduced in surgery and specifically starting in urology fields. At this point over 85% of prostatectomies are performed in robotic approach. Just a bit about the robotic instrumentation: when you have robotic prostatectomy it’s not like the robot is performing the operation. The robot is just a tool for the surgeon to use and to control and to perform a very precise operation in a small, limited pelvic area. With robotics, we have seen patients have less pain post-operatively, we have shorter time for recovery; we have shorter hospitalization. Usually, patients after having a major operation like this for cancer can go home the next day and this has really revolutionized the field.
Melanie: Do patients sometimes need adjunct treatments along with the prostatectomy?
Dr. Parihar: Yes, sometimes the disease is very aggressive and, in fact, has microscopically spread outside of the prostate. It may go to the prostate capsule, it may go to the lymph nodes in the pelvis, or sometimes even other organs. In those situations patients may need multi-model approach. In that case, the patient may need surgery with radiation plus/minus hormone deprivation therapy, which, again, controls the prostate cancer.
Melanie: So, then, wrap it up for us. What do you tell men and the women that love them or the partners that love them about prostate cancer and if they’ve been recently diagnosed, what would you like them to know?
Dr. Parihar: What I would like patients to understand that this is a common process; this is a common cancer. It effects a lot of men, and a lot of families because at the end of the day, it’s just not the patient who’s undergoing this--it’s the wife, it’s the family, it’s the children. There are many treatment options available which is good but also causes a lot of confusion in patients because they may read the internet or talk to some friends, but I think I cannot overemphasize the discussion that has to be held between a urologist who does this routinely and the patient and the family and come up with a game plan of how to approach a new diagnosis of prostate cancer. With the advent of robotics surgery this is a minimally invasive operation that can be easily performed with reduced adverse effects. So, at Palmdale Regional Medical Center we can offer patients a multidisciplinary treatment option. We have many colleagues. We work with a surgery department, with medical oncology radiation, if needed, as well as all the medical physicians. Palmdale Regional Medical Center offers a comprehensive and compassionate care to the patients and it is top notch quality care in the Antelope Valley area.
Melanie: Thank you so much, Dr. Parihar, for being with us today. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to www.PalmdaleRegional.com. That's www.PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Robotic Surgery for Prostate Cancer
Melanie Cole (Host): The National Cancer Institute estimates that there are almost 200,000 newly diagnosed cases of prostate cancer in the US annually. My guest today is Dr. Jaspreet Parihar. He’s a urologist and a urological oncologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Parihar. Tell us about prostate cancer. Who is at risk for prostate cancer?
Dr. Jaspreet Parihar (Guest): Well, first of all, thank you very much for giving me this opportunity. So, let me just talk about basics about prostate and what prostate cancer is. So, a prostate gland is a walnut sized reproductive gland found in men. As you mentioned, over 200,000 men annually are diagnosed with prostate cancer and over 26,000 men die from the disease. About one in seven men will have a lifetime risk of getting diagnosed with prostate cancer. Now, some of the risk factors for getting prostate cancer include family history of cancer, for example in father, uncle, or other first or second degree relatives. Also, race plays an important role in prostate cancer development. So, African American men have higher incidents as well as higher mortality as compared to some of the other races.
Melanie: Is there screening available for prostate cancer? And, if so, who should be screened and when?
Dr. Parihar: Absolutely. So, the screening entails a blood test called a “prostate specific antigen”, or a PSA, and an anorectal examination of the prostate performed by a urologist. Now, as you know, prostate cancer is the most common cancer diagnosed in men and second only to lung cancer in cancer-related deaths. So, a lot of times patients may have prostate cancer and have no symptoms and the only way to detect this problem is by routine screening. There have been a lot of controversies over the last several years of who to screen, when to screen, how often to screen; my best recommendations for my patients is that it should be decided between a doctor and the patient and between them a shared decision making process has to occur and based on patient’s own risk factors, family history, and age a recommendation can be given at what age to start prostate cancer screening and how often to obtain it. Generally, patients older than 55 are recommended to have DRE examination, which is rectal examination, and PSA testing on an annual basis. Sometimes we start screening early at age 40 if there are higher risk factors but, again, the important point for everybody to understand is that this is a shared decision making process. There’s no single age where you should or should not have a screening.
Melanie: If a man is diagnosed with prostate cancer, what are some of the treatment options available to them?
Dr. Parihar: When prostate cancer was treated 15 to 30 years back, almost all men with prostate cancer were recommended to seek treatment. As we realize and the nature of the disease process and its biology of cancer, we are better able to stratify those patients who need treatment and those patients who can be observed. Now, prostate cancer is a very common disease. A lot of men may have it and not get detected or treated and eventually end up passing away from other diseases such as heart problems, lung problems, et cetera. But patients who are detected to have prostate cancer, we sit down and have a total discussion of their age, their comorbidities, and their overall life expectancy, and then come up with a treatment option which is best suited for that individual patient. There are many excellent treatment options including surgery. These days we utilize robotics to perform this. There’s radiation which can be given externally to the prostate or sometimes we implant radioactive seeds in the prostate to give internal radiation. There is also, as I was mentioning earlier, active surveillance in which we determine the progressiveness of the prostate cancer and come up with an algorithm for individual patients to monitor the PSAs and repeat biopsy on a surveillance schedule. If it looks like the prostate cancer is becoming more aggressive or more in volume, then we would recommend obtaining treatment. So again, this is an individualized approach. One treatment option for one patient may not be the perfect option for another patient and it really has to be a discussion held between the doctor and the patient as to what are the goals of care and how best to approach a treatment for prostate cancer.
Melanie: Dr. Parihar, aside from the types of treatments that you mentioned - external beam radiation or brachytherapy, hormone therapy, any of these others - if surgery is what’s designed and what you’ve decided with a patient, tell us about what’s going on with robotic prostate surgery today. Are you still removing prostates on a regular basis or is that declining a bit?
Dr. Parihar: You know, Melanie, that’s a great question. So, just in general, the prostatectomy has been around for many, many years and more recently, since about the year 2001, robotics was introduced in surgery and specifically starting in urology fields. At this point over 85% of prostatectomies are performed in robotic approach. Just a bit about the robotic instrumentation: when you have robotic prostatectomy it’s not like the robot is performing the operation. The robot is just a tool for the surgeon to use and to control and to perform a very precise operation in a small, limited pelvic area. With robotics, we have seen patients have less pain post-operatively, we have shorter time for recovery; we have shorter hospitalization. Usually, patients after having a major operation like this for cancer can go home the next day and this has really revolutionized the field.
Melanie: Do patients sometimes need adjunct treatments along with the prostatectomy?
Dr. Parihar: Yes, sometimes the disease is very aggressive and, in fact, has microscopically spread outside of the prostate. It may go to the prostate capsule, it may go to the lymph nodes in the pelvis, or sometimes even other organs. In those situations patients may need multi-model approach. In that case, the patient may need surgery with radiation plus/minus hormone deprivation therapy, which, again, controls the prostate cancer.
Melanie: So, then, wrap it up for us. What do you tell men and the women that love them or the partners that love them about prostate cancer and if they’ve been recently diagnosed, what would you like them to know?
Dr. Parihar: What I would like patients to understand that this is a common process; this is a common cancer. It effects a lot of men, and a lot of families because at the end of the day, it’s just not the patient who’s undergoing this--it’s the wife, it’s the family, it’s the children. There are many treatment options available which is good but also causes a lot of confusion in patients because they may read the internet or talk to some friends, but I think I cannot overemphasize the discussion that has to be held between a urologist who does this routinely and the patient and the family and come up with a game plan of how to approach a new diagnosis of prostate cancer. With the advent of robotics surgery this is a minimally invasive operation that can be easily performed with reduced adverse effects. So, at Palmdale Regional Medical Center we can offer patients a multidisciplinary treatment option. We have many colleagues. We work with a surgery department, with medical oncology radiation, if needed, as well as all the medical physicians. Palmdale Regional Medical Center offers a comprehensive and compassionate care to the patients and it is top notch quality care in the Antelope Valley area.
Melanie: Thank you so much, Dr. Parihar, for being with us today. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, you can go to www.PalmdaleRegional.com. That's www.PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.