Early Screening Can Save Your Life
Our goal at Public Employees Health Program (PEHP) is to allow you ownership of your health care. Early screening for prostate cancer can save your life and allow for early diagnosis and treatment. We encourage you to take the time to undergo screening for prostate cancer on a yearly basis, according to your risk group. The risk groups are men aged 50 and older and those over the age of 45 that are considered being at high risk, i.e. African‑American men and men who have a family history of prostate cancer. Those who fall in these groups should have a PSA blood test and digital rectal exam once every year.
As a nation, we’ve faced some tough challenges that have taught us how precious life is. But many of us-myself included – face a more private challenge: prostate cancer. If you’re a man over 40, do yourself and your loved ones a favor: ask your doctor about a simple screening. It might just save your life.” Rudy Giuliani
The last 20 years have improved the diagnoses and survival rate for patients with prostate cancer. The 1980’s brought new treatments and diagnostic tools. The ability to assess prostate cancer has continued to improve and so have the methods to aggressively treat the disease. Currently men have a 97% survival rate when diagnosed with prostate cancer. Prostate cancer awareness and early detection are major factors in the increased survival rate.
Once you have been diagnosed with prostate cancer it is normal to experience a mixture of emotions. These can include fear, depression, not knowing where to turn, frustration, confusion, and sometimes not wanting to do anything. Everyone’s response is somewhat different...that’s OK. You have many people who are willing to support you through this difficult time in your life. One of the most important things you can do is become an active participant in your health care and your treatment decisions. If you feel you are becoming depressed, don’t be afraid to talk with your physician. This can be a very stressful period for you.
"When my doctor said, ‘General, you have prostate cancer,’ I was thrust into an immediate and fearful state of confusion. I can still recall my inability to move a muscle for what seemed like an eternity after hearing my diagnosis. As I look back, I am thankful for the many resources available to me: my doctor’s skill and the unwavering support of my family and loved ones. But another resource I am most thankful for was the availability of an abundance of information that helped me plan my own fight against this dreaded disease."
General H. Norman Schwarzkopf U.S. Army (retired) Commander in Chief, United States Central Command Operation Desert Shield/Desert Storm
We encourage you to seek a second opinion in your diagnoses and treatment. Examine your options and allow others to support you. Your family and friends are usually your first line of support. You have extended community support through your health care team, spiritual leaders, social workers, and other support systems of cancer survivors. Many times if you have questions about what you are experiencing and want to talk with a cancer survivor, there are programs available at no cost, which allow you to talk with someone.
Explore with your physician(s) what your treatment choices are. By understanding the current stage (and likely progression) of your cancer, you will be more conscious of your choices in your treatment decisions. Through comprehensive staging, certain treatment options (or combinations) may be identified for further investigation while others may be ruled out. It is helpful to write down your questions, so when you talk with your physician(s) you will be able to reflect on your written concerns.
Surgical Removal of the Prostate Gland
The surgical removal of the prostate gland is referred to as Radical Prostatectomy. A radical prostatectomy is usually performed when prostate cancer is in the B or T2 stage. It is hoped that through surgical removal of the prostate gland, all of the prostate cancer can be removed before it is allowed to spread to other areas of the body. During the radical prostatectomy, sample cells from the pelvic lymph nodes may also be removed as a precautionary measure, this allows the surgeon to check if the cancer has spread outside of the prostate gland. Most of the time surgery can remove all of the cancer however, if the biopsy of the lymph nodes is positive other treatment options will need to be used along with the surgical procedure.
The majority of urologists believe radical prostatectomy is the most effective means of curing clinically localized prostate cancer. “There’s no better way to eliminate a cancer that’s confined to the prostate than total removal” (Patrick Walsh, urologist, John Hopkins Hospital, 2003). Statistically, surgery has the highest cure rate when the patient is younger than 70 and his cancer is confined to the prostate gland. “The younger the man and the longer you think he has to live, the more we think we ought to take out his prostate” (Gerald Andriole, chief of urology, Washington University Hospital, 2003). With new technology, patients can expect a decrease in surgical morbidity and an improved postoperative quality of life. If you are eligible for surgery there are four types of radical prostatectomies.
Perineal Prostatectomy: Dr. Hugh Young, published the first paper on Perineal Prostatectomy in 1904. This surgical procedure removes the prostate through an incision (cut) made in the perineum (area between the scrotum and the rectum). In this procedure a patient may expect less pain postoperatively and fewer days of operative recovery hospitalization. However, patients may experience some of the following complications: limited hip mobility as the patient is placed in the high lithotomy position, increased hemorrhoidal discomfort for approximately one to three months following surgery and difficulty in healing of the incision due to its location.
Retropubic Prostatectomy:Dr.Terence Millin, first performed the Radical Retropubic Prostatectomy in 1947. This surgical procedure to remove the prostate is completed through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes is usually done for prognosis at the same time. This procedure was once considered to be the “gold standard” by which all other surgeries and treatments were compared. Dr. Patrick Walsh introduced the nerve-sparing Retropubic Prostatectomy in 1982. Long postoperative recovery and hospitalization can be expected with this procedure.
Laparoscopy Prostatectomy : In 1998 two surgeons, Dr.Betrand Guillonneau and Dr. Guy Vallancieu, of the Institute Montrouis first introduced the laparoscopy prostatectomy. This is a surgical procedure to remove the prostate through small incisions through which endoscopes are introduced to perform the prostatectomy and sampling of the nearby lymph nodes. This procedure has the advantage of less post operative pain, less blood loss, better opportunity to preserve the neurovascular bundles, shorter hospital stay, and shorter recovery time than the previous two surgical procedures.
Robotic Surgery: Dr. Mani Menon pioneered the robotic Laparoscopic Prostatectomy surgical procedure. It was accepted in 2001 by the FDA as no longer an experimental procedure and widely accepted in 2003. The robotic surgical system offers several advantages over the traditional Laparoscopic surgery above. The da Vinci ® Surgical System is powered by state-of-the-art robotic technology. This system allows your surgeon’s hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the abdominal cavity. The instruments are designed to provide a wide range of motion, allowing the surgeon to rotate instruments more than 360 degrees. The system is also “intuitive” which means as the surgeon twists the controls clockwise, the robots instruments move clockwise. In standard hand held laparoscopic surgery, the movement of the instruments is “counter-intuitive” which is similar to doing surgery while looking into a mirror. Finally, the robotic system enhances accuracy by correcting and compensating for any tremor in the surgeon’s hand. The magnified three-dimensional view the surgeon experiences enables him or her to perform precise surgery in complex procedures through small surgical incisions. Patients who have laparoscopic surgery, rather than open surgery, often recover more quickly and return to their normal activities sooner” (Michael Blute, urologist, Mayo Clinic, 2003. Early data suggests the cancer removal to be more concise and less nerve damage is associated with this type of surgery than with any of the other surgical procedures. Hospitalization and recovery time are cut by more than half. Patients return to their pre-surgery life style much sooner. For more information please refer to the tables.
Vattikuti Institute Prostatectomy (VIP)
Compared to Open Prostatectomy**
Henry Ford Hospital, Detroit, Michigan
| Measure | Open Surgery | Robotic (VIP) Surgery | |
| Cancer Removal | Negative Margins | 76% | 94% |
| Continence @ 6 months | No Pads | 60% | 96% |
| Potency @ 6 months | Sexual Intercourse | 33% | 66% |
| Safety | No Complications | 85% | 98% |
| Pain | Patient response to Pain Score (1-10) |
7 | 3 |
| Blood Loss | No Transfusion | 89% | 100% |
| NUMERICAL SCORE | 600 | 372(62%) | 524(87%) |
** Information Hot Line 888-881-1117 or http://www.davinciprostatectomy.com/about_davinci.html
Public Employee Health Program and the Center of Excellence
If you are diagnosed with prostate cancer and are advised to have a radical prostatectomy, PEHP’s Center of Excellence will help guide you through this difficult period of personal decisions. It is through this program you will know and understand the various suggested treatment options that are available. PEHP’s Case Management Nurses are available to answer your questions about prostate cancer. If you elect the da Vinci Robotic Prostatectomy our team of medical professionals will assist you through each step of your treatment and follow-up care. PEHP has been actively involved in bringing forth the new frontier of the da Vinci treatment to the state of Utah. We have organized a network of experts and a list of patients who are willing to share their experience of undergoing the da Vinci Robotic Laparoscopic Prostatectomy with you. The following are some of the benefits available to you:
- Educational material to help you understand the disease and to help you make the best treatment choices.
- Web site information
- A seamless process if the da Vinci Robotic Surgery is selected;
- Entry into the system under the direction PEHP’s Case Management Nurses: 800-753-7490
- A referral to the first Utah Urologist trained for Robotic Laparoscopic Prostatectomy
- A surgical team at the Salt Lake Regional Medical Center da Vinci Surgical Suite
- Follow up care from the Da Vince Surgical Team
- If you have PEHP Preferred Care, your co-payment may be waived for the Surgeon’s fee
- PEHP members will be required to pay their hospital copayment prior to surgery
- Patient advocates and a support group who have undergone this surgical procedure.
It is our desire to empower you with the ability to access educational resources, locate and utilize information that is pertinent to your situation and then let you take charge of your treatment decision. Once you have chosen your treatment/care we will assist you in your selection by connecting you to the medical experts in the type of procedure you feel is best for you.
Helpful Definitions of Medical Terms
Adrenal Glands - (n) one of a pair of ductless glands, located above the kidneys, consisting of a cortex, which produces steroidal hormones and medulla, which produces epinephrine and nor epinephrine.
Androgen – (n) A hormone that produces male physical characteristics. The major androgen hormone is testosterone.
Antiandrogen Drug – A drug with the ability to block activity of an androgen hormone.
Anus – (n) the excretory opening at the lower end of the alimentary canal.
Benign Tumor – A tumor that is not malignant and does not spread.
Biopsy – (n) To remove living tissue for diagnostic evaluation.
Brachytherapy – Treatment for prostate cancer with high-energy radiation from tiny radioactive seeds inserted into the prostate tissue.
Chemotherapy – (n) The use of chemical agents in the treatment or control of cancer. Generally not used for prostate cancer.
Cryosurgery – (n) Surgical technique in which freezing is used to destroy diseased tissue.
Digital Rectal Examination (DRE) – A screening procedure for prostate cancer, whereby a doctor inserts a gloved, lubricated finger into the rectum in order to fell the size and shape of the prostate through the rectal wall.
External Beam Radiation Therapy – Radiation therapy using rays from a machine directed toward a specific part of the body.
Extraskeletal Metastasis – A metastasis that is in any tissue other than bone.
Gleason Grade – A system developed using a numerical grade (1-5) which indicate the degree of differentiation or aggressiveness of prostate cancer.
Gleason Score – Two numbers, each from 1 to 5, are assigned to the areas occupying the largest part of the biopsy, and then added together for a final score.
Hemorrhoid – (n) A varicose vein in the region of the anal sphincter, sometimes painful and bleeding.
Hormone Therapy – In prostate cancer, treatment that interferes with the production or activity of male hormones, primarily testosterone, that promote prostate tumor growth.
Impotence – (adj.) (of a male) The inability to attain or sustain a penile erection.
Incontinence – (n) unable to restrain natural discharge or evacuation of urine or feces.
Internal Radiation Therapy – Treatment with rays from radioactive compounds placed inside the tumor or tumors.
Lymph node – (n) any of the gland-like masses of tissue in the lymph vessels containing cells that become lymphocytes. Also called lymph gland(s)
Malignant Tumor – A tumor that is cancerous and has uncontrolled growth. Malignant tumors also have the ability to spread (or metastasize) throughout the body.
Oncologist– (n) A physician who specializes in dealing with tumors, including the origin, development, diagnosis, and treatment of cancer.
Pelvic Lymph Node Dissection – Removal of possible cancer-carrying lymph nodes near the prostate for their evaluation.
Prostate-Specific Antigen (PSA) – A substance produced by the prostate and found in the blood that often increases in cases of prostate cancer and other prostate diseases.
Prostate-Specific Antigen (PSA) Test – First introduced in 1986. PSA is a substance produced by the prostate cells. A PSA test measures the level of PSA in the bloodstream. Very little PSA escapes from a healthy prostate into the bloodstream, but certain prostate conditions can cause larger amounts of PSA to leak into the blood.
Radiation Therapy – Treatment with high–energy rays, such as those from x-rays or other sources of radiation.
Radical Prostatectomy – Surgical removal of the prostate.
Rectum – (n) The terminal section (the last 5 or 6 inches) of the large intestine, ending in the anus.
Stage – To classify the natural progression of a disease especially cancer.
Staging – Process of evaluating the stage of cancer to determine its size and extent.
Testosterone – (n) An androgen, or male hormone; in men it is produced mainly by the testicles. Testosterone stimulates a man’s sexual activity and growth of male sex organs, including the prostate.
Transrectal Ultrasound (TRUS) – The use of an instrument inserted into the rectum to create sound waves that bounce off the prostate. The pattern of sound waves forms a picture that can help locate areas of abnormal tissue.
Tumor – (n) An abnormal, uncontrolled excessive growth of cells.
Tumor-Nodes-Metastases (TNM) – A method of classifying the stage of prostate cancer based on the tumor size (T), the extent of lymph node involvement (N), and whether the cancer has metastasized (M).
Urethra – (n) The canal that carries urine from the bladder and semen from the sex glands to the outside of the body.
Urinary Incontinence – The involuntary loss of urinary control, resulting in leakage of urine.
Urologist – (n) A doctor and a surgeon who is specially trained in the diagnosis and treatment of diseases of the male and female urinary tract and the male genital tract.
Watchful Waiting – The decision to monitor the patient’s condition, but delay treatment until symptoms appear or change.
http://www.davinciprostatectomy.com/ - an information portal on prostate cancer
http://www.saltlakeregional.com/second/urological/about_davinci.htm - The Urological Surgery Health Center
http://www.saltlakeregional.com/second/urological/surgeons.htm - Meet the Surgeon
http://www.ucan.cc - This is the Utah Cancer Action Network (Utah Department of Health), an advocate for cancer education