Cancer of the prostate gland is a serious health risk for men. In fact, nearly 240,000 American men yearly will be diagnosed with it. The good news is that prostate cancer is survivable, especially if it is detected early, before it can spread.
City of Hope is a leader in the use of robotic-assisted prostatectomy to treat prostate cancer; our experienced team have performed thousands of robotic prostatectomies since the program's start in 2003, more than any other medical center in the Western U.S. and second in the nation.
In this segment, Dr. Bertram Yuh, associate clinical professor in Division of Urology and Urologic Oncology, at City of Hope, discusses the latest advances in Robotic Surgery for Complex Prostate Cancer.
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Robotic Surgery for Complex Prostate Cancer
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Learn more about Dr. Yuh
Bertram Yuh, MD
Dr. Bertram Yuh is an associate clinical professor in Division of Urology and Urologic Oncology, Department of Surgery at City of Hope.Learn more about Dr. Yuh
Transcription:
Robotic Surgery for Complex Prostate Cancer
Melanie Cole (Host): Cancer of the prostate gland is a serious health risk for men. In fact, nearly 240,000 American men yearly will be diagnosed with it. The good news is that prostate cancer is survivable, especially if it's detected early before it can spread. My guest today is Dr. Bertram Yuh. He's an Associate Clinical Professor in the Division of Urology and Urologic Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Yuh. So, if a man is diagnosed with prostate cancer, I'd like to start with the aspect of staging and how do you tell the man or figure out whether this is a complex prostate cancer or one that was caught in an early detection?
Dr. Bertram Yuh (Guest): Oftentimes, we want to look at the big picture as it relates to a prostate cancer disease in a specific patient. There are a lot of factors that go into play in understanding the aggressiveness of a prostate cancer. We also want to assess if they've had previous treatment for prostate cancer, as well. We oftentimes will combine information looking at the biopsy results, blood test results, certain genetic profiling results, as well as imaging results to try to determine whether cancers are more aggressive or less aggressive. These are all tools that we use to assist us in making this decision. This is very important because we understand that the disease of the prostate can assume a lot of different presentations, especially in this day and age with the landscape of prostate cancer presentations evolving, we are treating more aggressive prostate cancers and the treatments thereof of these cancers certainly can be different than with less aggressive prostate cancers.
Melanie: So, once you've determined that someone does have a more aggressive form, then what sort of treatment options are available to those men?
Dr. Yuh: So, City of Hope has a long experience with treatment of prostate cancer both with surgical treatments as well as radiation therapy treatments, and more novel treatments, as well. Our significant experience with robotic surgery and proven long-term effective results has really been shown through our data and patient experiences. We feel that having performed these operations for more than a decade and pioneering a lot of these technologies and techniques, that we can offer patients a better outcome. We believe that surgical treatment, oftentimes, in the setting of more aggressive prostate cancer, can be an excellent first step to take not only for its effective cancer control, but as a means of understanding more about a specific cancer, in particular of the staging. During an operation, we are much better able to assess the local extent of cancer as well as whether cancer has gone to lymph nodes, as well. As for this reason, we also understand that prostate cancer treatment with surgery is an excellent first step for men to take who may require a multi-modal, or multiple treatment approach to addressing their cancer.
Melanie: So, then, let's start with the surgical procedure? What's involved? Is this minimally-invasive, robotically-assisted prostatectomies? What are you doing surgically?
Dr. Yuh: At City of Hope, essentially all of our surgeries for the prostate are performed robotically. We have traditionally treated all men with prostate cancer with surgical treatment; however, in this day and age, as we're seeing more aggressive needs, we continue to evolve our techniques. We do believe that an operation for a more aggressive prostate cancer does have some specific components that differentiate it from treatment from less aggressive cancers. We know that these cancers can be more bulky, they can invade into surrounding structures and, therefore, have more overall complexity for the surgeon. As related to this, City of Hope is well-equipped to address these specific cancers due to our significant experience treating things of this type.
Melanie: So, when you're doing this surgery, if you decide you're going to do the surgery with a patient, Dr. Yuh, when do you notice if it has spread and do you still do the surgery if it has? Are there any parameters by which you would change this course of treatment?
Dr. Yuh: That's a great question. We know that imaging tests such as CT scans, bone scans, PET scans, MRI's can be used to get an assessment before surgery of whether there has been cancer that left the prostate. However, having said that, we do know that many patients can have microscopic disease that spreads to lymph nodes or other parts of the body that may not be detected through tradition imaging modalities. For this reason, during operations of the prostate to perform robotically, we have one of the largest experiences of the world from removing a larger number of lymph nodes. What this provides is a better detailed information about whether there is actually cancer in these lymph nodes or not which really helps to guide patients in terms of understanding their disease, understanding the prognosis, and understanding whether additional treatments are necessary.
Melanie: If additional treatments are necessary, what are some of these adjuvant treatments that you might do? If you've done surgery, maybe you have detected that some of those microscopic cells have spread a little bit. Then, what are some of the other treatments that might go along?
Dr. Yuh: So, we have a number of clinical trials that are available for patients. The traditional treatments are in the areas of radiation therapy as well as hormone treatments, but we are continuing to explore various chemotherapy agents, and other oral medications as well as immunotherapies and vaccine treatments for our patients. We also believe that there are patients with even cancer outside the prostate that may be curable with an operation alone and, therefore, even in patients who have some evidence of cancer outside the prostate, we don't want to tell them that surgery is not an option for them. We want to consider how surgery can still potentially play a role from a cancer control standpoint as well as a quality of life urination standpoint.
Melanie: So, that's a good point, Dr. Yuh. What about some of those side effects if men say to you, "Well, I'm willing to do immunotherapy or radiation, whatever it is," but they get worried about surgery, especially complex surgery for a more complex prostate cancer and the side effects that might go along with it such as incontinence or erectile dysfunction?
Dr. Yuh: So, there are a lot of components to making a decision about how to address prostate cancer, and, certainly, quality of life and expectations are part of the decision-making process. We do know that oftentimes, treatments for the prostate, whether they be surgery or radiation or focused ultrasound or cryotherapy may all lead to potential side effects as the ones that you mentioned. For patients, it's very important to set expectations, to understand oftentimes these quality of life factors may change. We know that these changes can sometimes be temporary and sometimes they may be long-term. We oftentimes have ways to support them in ways that can assist with improving urinary control or erectile function, for instance, if these become issues for patients after various forms of treatment. One way that we're trying to reduce the side effects profile associated with surgical treatment is by better understanding the anatomy of nerves in the pelvis as they run alongside the prostate. While traditionally, we are able to see these nerve bundles better using a robotic procedure, there are still improvements that we'd like to see made. We do have some intra-operative techniques using fluorescent imaging and antibodies that are helping us to better identify where these nerve tissues that are so important to functional outcomes may be and, therefore, do a more precise operation in terms of removing cancer and sparing those areas which are important for functional control.
Melanie: So, Dr. Yuh, kind of give us a wrap up about prostate cancer and complex ones specifically--what you really want men to know and tell us also what you're doing that's really exciting in this world at City of Hope.
Dr. Yuh: I think it's very important for men to understand that, while some traditional thinking may have made surgical treatments less desirable with aggressive prostate cancers, that improvements in surgical technique and technology, especially with the experience of the doctors at City of Hope that surgical treatment is certainly an option and, in many instances, may be the optimal option to consider. We do know that surgical treatment combined with other therapies can provide significant benefits to cancer control with more aggressive cancer treatments. Though there can be side effects that we try to address and maintain as well as possible, that often, if multiple treatments are required, we have the experience to be able to deliver those.
Melanie: Thank you so much for being with us today, Dr. Yuh. It's great information. You're listening to City of Hope Radio and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Robotic Surgery for Complex Prostate Cancer
Melanie Cole (Host): Cancer of the prostate gland is a serious health risk for men. In fact, nearly 240,000 American men yearly will be diagnosed with it. The good news is that prostate cancer is survivable, especially if it's detected early before it can spread. My guest today is Dr. Bertram Yuh. He's an Associate Clinical Professor in the Division of Urology and Urologic Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Yuh. So, if a man is diagnosed with prostate cancer, I'd like to start with the aspect of staging and how do you tell the man or figure out whether this is a complex prostate cancer or one that was caught in an early detection?
Dr. Bertram Yuh (Guest): Oftentimes, we want to look at the big picture as it relates to a prostate cancer disease in a specific patient. There are a lot of factors that go into play in understanding the aggressiveness of a prostate cancer. We also want to assess if they've had previous treatment for prostate cancer, as well. We oftentimes will combine information looking at the biopsy results, blood test results, certain genetic profiling results, as well as imaging results to try to determine whether cancers are more aggressive or less aggressive. These are all tools that we use to assist us in making this decision. This is very important because we understand that the disease of the prostate can assume a lot of different presentations, especially in this day and age with the landscape of prostate cancer presentations evolving, we are treating more aggressive prostate cancers and the treatments thereof of these cancers certainly can be different than with less aggressive prostate cancers.
Melanie: So, once you've determined that someone does have a more aggressive form, then what sort of treatment options are available to those men?
Dr. Yuh: So, City of Hope has a long experience with treatment of prostate cancer both with surgical treatments as well as radiation therapy treatments, and more novel treatments, as well. Our significant experience with robotic surgery and proven long-term effective results has really been shown through our data and patient experiences. We feel that having performed these operations for more than a decade and pioneering a lot of these technologies and techniques, that we can offer patients a better outcome. We believe that surgical treatment, oftentimes, in the setting of more aggressive prostate cancer, can be an excellent first step to take not only for its effective cancer control, but as a means of understanding more about a specific cancer, in particular of the staging. During an operation, we are much better able to assess the local extent of cancer as well as whether cancer has gone to lymph nodes, as well. As for this reason, we also understand that prostate cancer treatment with surgery is an excellent first step for men to take who may require a multi-modal, or multiple treatment approach to addressing their cancer.
Melanie: So, then, let's start with the surgical procedure? What's involved? Is this minimally-invasive, robotically-assisted prostatectomies? What are you doing surgically?
Dr. Yuh: At City of Hope, essentially all of our surgeries for the prostate are performed robotically. We have traditionally treated all men with prostate cancer with surgical treatment; however, in this day and age, as we're seeing more aggressive needs, we continue to evolve our techniques. We do believe that an operation for a more aggressive prostate cancer does have some specific components that differentiate it from treatment from less aggressive cancers. We know that these cancers can be more bulky, they can invade into surrounding structures and, therefore, have more overall complexity for the surgeon. As related to this, City of Hope is well-equipped to address these specific cancers due to our significant experience treating things of this type.
Melanie: So, when you're doing this surgery, if you decide you're going to do the surgery with a patient, Dr. Yuh, when do you notice if it has spread and do you still do the surgery if it has? Are there any parameters by which you would change this course of treatment?
Dr. Yuh: That's a great question. We know that imaging tests such as CT scans, bone scans, PET scans, MRI's can be used to get an assessment before surgery of whether there has been cancer that left the prostate. However, having said that, we do know that many patients can have microscopic disease that spreads to lymph nodes or other parts of the body that may not be detected through tradition imaging modalities. For this reason, during operations of the prostate to perform robotically, we have one of the largest experiences of the world from removing a larger number of lymph nodes. What this provides is a better detailed information about whether there is actually cancer in these lymph nodes or not which really helps to guide patients in terms of understanding their disease, understanding the prognosis, and understanding whether additional treatments are necessary.
Melanie: If additional treatments are necessary, what are some of these adjuvant treatments that you might do? If you've done surgery, maybe you have detected that some of those microscopic cells have spread a little bit. Then, what are some of the other treatments that might go along?
Dr. Yuh: So, we have a number of clinical trials that are available for patients. The traditional treatments are in the areas of radiation therapy as well as hormone treatments, but we are continuing to explore various chemotherapy agents, and other oral medications as well as immunotherapies and vaccine treatments for our patients. We also believe that there are patients with even cancer outside the prostate that may be curable with an operation alone and, therefore, even in patients who have some evidence of cancer outside the prostate, we don't want to tell them that surgery is not an option for them. We want to consider how surgery can still potentially play a role from a cancer control standpoint as well as a quality of life urination standpoint.
Melanie: So, that's a good point, Dr. Yuh. What about some of those side effects if men say to you, "Well, I'm willing to do immunotherapy or radiation, whatever it is," but they get worried about surgery, especially complex surgery for a more complex prostate cancer and the side effects that might go along with it such as incontinence or erectile dysfunction?
Dr. Yuh: So, there are a lot of components to making a decision about how to address prostate cancer, and, certainly, quality of life and expectations are part of the decision-making process. We do know that oftentimes, treatments for the prostate, whether they be surgery or radiation or focused ultrasound or cryotherapy may all lead to potential side effects as the ones that you mentioned. For patients, it's very important to set expectations, to understand oftentimes these quality of life factors may change. We know that these changes can sometimes be temporary and sometimes they may be long-term. We oftentimes have ways to support them in ways that can assist with improving urinary control or erectile function, for instance, if these become issues for patients after various forms of treatment. One way that we're trying to reduce the side effects profile associated with surgical treatment is by better understanding the anatomy of nerves in the pelvis as they run alongside the prostate. While traditionally, we are able to see these nerve bundles better using a robotic procedure, there are still improvements that we'd like to see made. We do have some intra-operative techniques using fluorescent imaging and antibodies that are helping us to better identify where these nerve tissues that are so important to functional outcomes may be and, therefore, do a more precise operation in terms of removing cancer and sparing those areas which are important for functional control.
Melanie: So, Dr. Yuh, kind of give us a wrap up about prostate cancer and complex ones specifically--what you really want men to know and tell us also what you're doing that's really exciting in this world at City of Hope.
Dr. Yuh: I think it's very important for men to understand that, while some traditional thinking may have made surgical treatments less desirable with aggressive prostate cancers, that improvements in surgical technique and technology, especially with the experience of the doctors at City of Hope that surgical treatment is certainly an option and, in many instances, may be the optimal option to consider. We do know that surgical treatment combined with other therapies can provide significant benefits to cancer control with more aggressive cancer treatments. Though there can be side effects that we try to address and maintain as well as possible, that often, if multiple treatments are required, we have the experience to be able to deliver those.
Melanie: Thank you so much for being with us today, Dr. Yuh. It's great information. You're listening to City of Hope Radio and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.