If you knew you might have only one chance to defeat prostate cancer what would you do? This is a decision that many American men face annually. Advances in technology and robotics have opened the door to alternative laparoscopic procedure.

A laparoscopic procedure used to treat prostate cancer is known as the da Vinci Radical Prostatectomy. This surgery was initially hailed as a dramatic advancement in prostate cancer surgery because of its quick recovery time and decreased blood loss (relative to traditional open radical prostatectomy). However, the robotic radical procedure has recently come under scrutiny for having an increased chance of long term complications. Given this new information, each man considering prostate cancer treatment options should question what the trade off he is is willing to take for comfort over potential effectiveness.

Short Term Comfort versus Potential Effectiveness:

How much are you willing to sacrifice for effectiveness? It is not an easy question to answer, especially with the ease some patients have reported in recovering from a robotic radical prostatectomy procedure. In many instances men experience a hospital stay of less than two days, with less pain and less blood loss. From a first impression standpoint the surgery seems like a natural choice and maintains this impression until you start to review long term data.

The Most Effective Prostate Cancer Cure Rates:

Prostate cancer patients look to an open prostatectomy when they need assurance of effectiveness and cure rates. The open prostatectomy, as performed by Dr. Patrick Walsh at Johns Hopkins University, has the second-highest documented cure rates in the world at 80%.

The physicians that maintain the highest documented cure rates in the world are located in Georgia at Radiotherapy Clinics of Georgia (RCOG), home of the oldest and largest seed implant program for prostate cancer in the country. The overall cure rate for prostate cancer at RCOG is 84%.

Being effective means using the same standards for cure rates. Prostate cancer cure rates should be calculated using a PSA cutpoint of 0.2 ng/ml, which provides an "apples to apples" comparison of treatment options. Any man facing a decision about prostate cancer treatment options has to consider two things – what treatment gives the best opportunity to be cured of this disease, and what are the complication rates for each treatment option.

ProstRcision Prostate Cancer Treatment:

The ProstRcision prostate cancer treatment relies on two forms of radiation therapy, brachytherapy and external beam treatment, to destroy the cancer cells. The first patient was treated with this procedure in 1979 and annually about 1,000 men elect for this operation. Currently Radiotherapy Clinics of Georgia is the only location where this prostate cancer treatment is available. Over 12,000 men for all 50 states and over 40 countries have journeyed to RCOG to seek cure of their prostate cancer.

Consider the Long Term Risk:

So much is known and has been discussed about the robotic radical prostatectomy procedure. The da Vinci Radical Prostatectomy might provide the benefit of short term comfort relative to the traditional radical, but compared to the ProstRcision procedure performed at RCOG, it’s actually more arduous. ProstRcision is an outpatient procedure – men go home the same day.

Also, it is critical to consider the long term risk. In a May, 2008 published study Dr. Jim C. Hu examined the outcome of minimally invasive radical prostatectomy procedures. Notably patients of the robotic radical procedure had a 40 percent increased risk of scarring that interfered with organ function when compared to patients that elected for an open prostatectomy. To correct this additional corrective surgery could be required.

There was also a noticeable difference in need for hormonal or drug therapy six months after surgery. Patients of a laparoscopy procedure typically needed this additional treatment almost a quarter of the time, compared to about ten percent of open prostatectomy patients.

Selecting the Right Treatment:

Finding the right treatment begins with doing your research. The opening sentence discussed the concept of having only one opportunity to defeat prostate cancer. It is a tough subject to deal with. Ask questions. Ask about the short term and the long term impact of different treatment options. Work with your doctor to tailor treatment to your condition. Your decision around your treatment could be the biggest decision you make in your life.

About the Author

John Critz helps inform men about prostate cancer treatment options . His company, RCOG offers the ProstRcision prostate cancer surgery , a leading prostate seed implant treatment .

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If you knew you might have only one chance to defeat prostate cancer what would you do? This is a decision that many American men face annually. Advances in technology and robotics have opened the door to alternative laparoscopic procedure.

A laparoscopic procedure used to treat prostate cancer is known as the da Vinci Radical Prostatectomy. This surgery was initially hailed as a dramatic advancement in prostate cancer surgery because of its quick recovery time and decreased blood loss (relative to traditional open radical prostatectomy). However, the robotic radical procedure has recently come under scrutiny for having an increased chance of long term complications. Given this new information, each man considering prostate cancer treatment options should question what the trade off he is is willing to take for comfort over potential effectiveness.

Short Term Comfort versus Potential Effectiveness:

How much are you willing to sacrifice for effectiveness? It is not an easy question to answer, especially with the ease some patients have reported in recovering from a robotic radical prostatectomy procedure. In many instances men experience a hospital stay of less than two days, with less pain and less blood loss. From a first impression standpoint the surgery seems like a natural choice and maintains this impression until you start to review long term data.

The Most Effective Prostate Cancer Cure Rates:

Prostate cancer patients look to an open prostatectomy when they need assurance of effectiveness and cure rates. The open prostatectomy, as performed by Dr. Patrick Walsh at Johns Hopkins University, has the second-highest documented cure rates in the world at 80%.

The physicians that maintain the highest documented cure rates in the world are located in Georgia at Radiotherapy Clinics of Georgia (RCOG), home of the oldest and largest seed implant program for prostate cancer in the country. The overall cure rate for prostate cancer at RCOG is 84%.

Being effective means using the same standards for cure rates. Prostate cancer cure rates should be calculated using a PSA cutpoint of 0.2 ng/ml, which provides an "apples to apples" comparison of treatment options. Any man facing a decision about prostate cancer treatment options has to consider two things – what treatment gives the best opportunity to be cured of this disease, and what are the complication rates for each treatment option.

ProstRcision Prostate Cancer Treatment:

The ProstRcision prostate cancer treatment relies on two forms of radiation therapy, brachytherapy and external beam treatment, to destroy the cancer cells. The first patient was treated with this procedure in 1979 and annually about 1,000 men elect for this operation. Currently Radiotherapy Clinics of Georgia is the only location where this prostate cancer treatment is available. Over 12,000 men for all 50 states and over 40 countries have journeyed to RCOG to seek cure of their prostate cancer.

Consider the Long Term Risk:

So much is known and has been discussed about the robotic radical prostatectomy procedure. The da Vinci Radical Prostatectomy might provide the benefit of short term comfort relative to the traditional radical, but compared to the ProstRcision procedure performed at RCOG, it’s actually more arduous. ProstRcision is an outpatient procedure – men go home the same day.

Also, it is critical to consider the long term risk. In a May, 2008 published study Dr. Jim C. Hu examined the outcome of minimally invasive radical prostatectomy procedures. Notably patients of the robotic radical procedure had a 40 percent increased risk of scarring that interfered with organ function when compared to patients that elected for an open prostatectomy. To correct this additional corrective surgery could be required.

There was also a noticeable difference in need for hormonal or drug therapy six months after surgery. Patients of a laparoscopy procedure typically needed this additional treatment almost a quarter of the time, compared to about ten percent of open prostatectomy patients.

Selecting the Right Treatment:

Finding the right treatment begins with doing your research. The opening sentence discussed the concept of having only one opportunity to defeat prostate cancer. It is a tough subject to deal with. Ask questions. Ask about the short term and the long term impact of different treatment options. Work with your doctor to tailor treatment to your condition. Your decision around your treatment could be the biggest decision you make in your life.

About the Author
John Critz helps inform men about prostate cancer treatment options . His company, RCOG offers the ProstRcision prostate cancer surgery , a leading prostate seed implant treatment .

Read More......

The learning curve in a production setting is a concept which was first introduced in the aeronautical industry during the 1920s.

It was developed to analyze the time taken to move from the initial phase of production, where work is slower and less efficient, to a more effective phase, once production is well established.

Clearly, the notion of a learning curve is relevant in surgery. When developing a new service, or introducing a new technique, there will be a phase when the surgeon only has a small amount of experience in that procedure.

Understanding this learning curve is very important in order to minimize risks to patients, but at the same time, allow for the development of new services. The learning curve enables us to divide the introduction of a new procedure into the early ‘ramping up’ stage and the later ‘production’ phase.

In the early ‘ramping up’ phase, measures such as mentoring and low risk case mix should be introduced to minimize adverse outcomes for patients. Once the surgeon completes their learning curve and are in the ‘production phase’ the risk to patients will be minimal.

However, the learning curve has not been applied as effectively to surgery as it potentially could be.

The learning curve is generally measured in terms of operating time. While this is a simple variable, which is valuable in terms of planning theater time, it is of little significance for patients in terms of clinical outcomes. Equally, it is highly subjective and can be manipulated.

I set out to explore the use of additional variables in a study of the data of Mr Alan Doherty, of Birmingham Prostate Clinic and the Queen Elizabeth Hospital in Birmingham.

Mr Doherty is one of a small number of surgeons in the UK undertaking laparoscopic prostatectomies. I approached Mr Doherty because he has carried out a large number of these complex, specialised procedures and he has an extensive, audited database of all patients’ results.

My analysis was of the first 300 laparoscopic prostatectomies performed by Mr Doherty between June 2003 and June 2006.

I introduced two new variables in addition to operating time. A very precise measurement of post-operative PSA was used, along with positive margins.
Positive margins is the term used to describe any evidence of malignant cells at the edge of the removed prostate. This would present a risk of some tumour cells remaining in the surgical field.

Both of these variables are clinically relevant and cannot be adjusted or manipulated.

I used what is known as Statistical Process Control charts (SPC) to assess these variables. SPC charts are not league tables – they do not rank one surgeon against another.

Instead, they set out the limits of expected standards, allowing for risk adjustment and single case variation.

The analysis demonstrated that in terms of operating times, Mr Doherty moved from the ramping up stage to production stage after the 28th patient.

The transition was at the 30th patient in terms of uPSA (Ultra-sensitive PSA) and 32nd for positive margins.

The analysis also shows that the learning curve is not a simple two phase process, but that learning continues throughout practice.

There is not one learning curve, but several, depending on which variable is being measured.

Mr Doherty’s data shows he was within acceptable standards during his learning curve of the first 30 cases. During the subsequent 270 cases, Mr Doherty exceeded acceptable standards.

To place this study into a wider text, it demonstrates how SPC charts can be used to chart a variety of measurements of the learning curve.

It offers a more rigorous model for governance, with the potential for issuing an early warning if standards fall below acceptable limits, and provides a far more meaningful assessment of clinical outcomes to inform both the patient and the surgeon. In this regard, they are useful for monitoring both the learning curve and the ongoing performance of the surgeon.

About the Author

Dr Richard Viney has conducted this study on behalf of the Birmingham Prostate Clinic, UK who have a range of pioneering prostate cancer treatments, including Radical Laparoscopic Prostatectomy.

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Chuck Gallagher

Unlike normal blog postings dealing with Choices, Ethics, and Consequences - my topics as a professional motivational speaker - it seemed appropriate today to speak of my complete recovery from prostate cancer hoping that it might help others who are faced with decisions on prostate cancer treatment.


Discovering I had prostate cancer at the age of 47 was almost an accident and certainly not something that in any way I expected. I had no symptoms - none whatsoever. In layman's terms, everything seemed to work fine. So the discovery of prostate cancer was quite accidental. It seems I had gone to my doctor simply requesting a pill (propecia - a drug to reduce hair loss). She required I have a blood test, as this drug would have an effect on my PSA. Frankly, all that was greek to me...as I didn't know what PSA was and had never had it checked. I hated needles - had always said I was allergic to them - hence I avoided being stuck as much as I could. But on this day in November 2004 I decided to take the plunge - have my blood checked - and get the prescription.


Two days later I got a call while out of town saying that all the lab work was fine except that my PSA was a bit elevated - it was 4.58 and for someone my age that was high. My doctor referred me to a Urologist. The appointment was set.


Of course I had some concern, but after all, all the plumbing seem to work fine and I had no symptoms, so surely there was no problem. The Urologist's exam was routine - in fact he said he thought I had nothing to worry about as he felt nothing abnormal. But, to be on the safe side he schedule a biopsy. Being fearful of needles (and a biopsy is the ultimate needle) I asked if it would hurt. His response, "Most men don't really feel a thing." That was a lie! Looking back, I would have asked for good drugs as that was the most painful experience I can recall.


Several days following the biopsy I received the results. Prostate Cancer! I had a Gleason score of 6 and 30% of one side of my prostate was cancerous. My heart sank as I received the news. How could I, a 47 year old healthy male, with no other medical issues have prostate cancer? And, how amazing that it was caught by a simple test that my well versed female doctor required. Looking back, her diligence saved my life.


What next?


My local doctor wanted to schedule surgery immediately. He said I had four options:
(1) Radical prostotectemy (traditional surgery);
(2) Radiation;
(3) Hormone therapy and/or
(4) Watch and wait. Again,
he recommended surgery. My immediate question was how many of the surgeries that he was suggesting did he do weekly or monthly. The number was low. In the back of my mind I thought, "Hum, maybe I need someone who isn't so surgery happy and who does this delicate removal frequently." I was like learning to play golf - I would prefer to learn from someone who plays daily than learn from a weekend hacker. Maybe that analogy seems harsh, but after all the decision made would have lasting and profound effects.


Following the meeting with the Urologist, and after telling my family (who thought I was joking), I spent some time in research. First thing I found - based on my diagnosis - I had time to consider carefully my options. Not that nothing should be done, but I didn't have to rush into any hasty decisions. Prostate cancer generally is slow in it's progression. CAUTION - do not use my experience as a crutch to avoid treatment (I witnessed my father-in-law die from complications from prostate cancer), rather, seek competent medical help in making your treatment decisions.


Options Considered:


Watch and wait. Well for several months I did just that. I researched - changed my diet - considered the possibility that I could reverse what existed and even reduce the cancer. I began a regiment of daily intake of cottage cheese and flax seed oil. For a short time I actually saw a decrease in my PSA; however, that was short lived. What I did learn was that diet was important - not only for general well being - but an effective tool in promoting a cancer free body. This was valuable time in that it gave me the opportunity to consider all my options.

Radiation Therapy. Not really an option for me. While I talked with a man in his late 60's to early 70's who had outstanding results using focused radiation (proton therapy I think it was called), the reality is - once you opt for radiation and the tissue is destroyed, if prostate cancer returns, it cannot be surgically removed. Hence the best advice I received was, in my case, this would not be a practical option. By the way information on proton treatment can be found at http://www.protons.com/ or at http://www.llu.edu/. The people I talked with who had used this treatment were extremely pleased with the level of care they received and the overall outcome.

High Intensity Focused Ultrasound (HIFU). In my search for the right treatment, I spent much time in considering this alternative. There were three practical objectives I wished to accomplish with whatever treatment I selected: (1) Cancer elimination, (2) Minimal issues with incontinence (preferably none) and (3) minimal issues with erectile function (again, preferably none). Based on my Gleason score and prostate cancer diagnosis, it seemed that this treatment would be viable. For research information visit http://www.ushifu.com/. As part of my consideration I met with Dr. George Suarez, Medical Director for USHifu. He reviewed my medical background and was kind in taking the time to discuss with me my options using this new prostate cancer treatment. Dr. Suarez took the time to explain all my options and how, if I elected, HIFU could be effective while meeting my three objectives. My only resistance was, at the time, it was not an option yet approved by the FDA in the United States, hence I would have to seek the treatment outside the scope of my medical insurance outside of the country. While I gave this serious consideration, I ultimately decided to go another route.

Radical Prostatectomy. All of the possibilities above, brought me back to the original suggestion - SURGERY. The issue I had was what kind and who would perform it. Since I had the time to research I discovered (through the wonder of the Internet) this, then, new procedure called a robotic-assisted radical prostatectomy. Hum...seemed that needed more study. Of course, at the time, Johns Hopkins Brady Urological Institute was recognized as one of the best in the world for prostate cancer research and study. After careful consideration I contacted Johns Hopkins inquiring about this seemingly new procedure - using the daVinci Surgical System. www.urology.jhu.edu/MIS/daVinci/

The folks at Johns Hopkins could not have been more caring and helpful as I sought all my treatment options. Of course, they reviewed my file carefully and spent all the time I wanted and needed to evaluate my options. Dr. Li-Ming Su was my surgeon and my hat is off to him and his skill and patience. In the end, one thing was clear - all other options being equal - surgical removal was still the "gold standard" in the fight against prostate cancer. Likewise, it appeared that this robotic assisted laparoscopic radical prostatectomy would meet my three objectives.

The surgery went fine - of course I don't remember a thing - so all I can base it on what the Doctor's report. Initially the report indicated that the cancer was contained in the prostate and the removal should yield me "cancer free." Of course this was to be confirmed later from lab reports. The first several days following surgery were not pleasant, but tolerable. Within three days, I boarded a plane and flew home to North Carolina - travel was not a big issue. The most discomforting thing following surgery was the catheter - which remained in for three weeks.

Outcome. Within four weeks following surgery I boarded a plane to Dallas, TX to begin a new job. My energy level was back and I had minimal incontinence isses with subsided within another three weeks. Within seven weeks of surgery incontinence was not an issue. Erecticle function returned within three months (with the aid of medication) and returned to full function (without medication) within twelve months.

Now it's been two years since surgery and all three objective have been achieved. Life is normal. I am cancer free. My sincere thanks to all who were there for me as I sought out the treatment that was right for me. I would not have the opportunity to function as a motivational speaker today if it were not for the skill and help of the fine folks at Johns Hopkins. While printing such personal items for all to read may seem (to some) out there! I feel that, perhaps, others who find themselves diagnosed with prostate cancer may learn from my experience. If you find this helpful, but still need to talk - please visit my web site: http://www.chuckgallagher.com/ and contact me through that portal. I'll be happy to talk with you via e-mail or phone.

Source: http://www.articlealley.com/article_180625_17.html

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