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Clinically localized prostate cancer: Prostatectomy David D. Thiel, MD Mayo Clinic Florida Department of Urology.

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Presentation on theme: "Clinically localized prostate cancer: Prostatectomy David D. Thiel, MD Mayo Clinic Florida Department of Urology."— Presentation transcript:

1 Clinically localized prostate cancer: Prostatectomy David D. Thiel, MD Mayo Clinic Florida Department of Urology

2 Prostate Cancer in Perspective Estimated risk per 1,000 men

3 Cancer Deaths, U.S. Breast ,40046, ,05040,460 % Decrease 33% 12% Prostate

4 Prostate Cancer Therapy Goals Eradicate Cancer Eradicate Cancer Preserve Continence Preserve Continence Prevent Regret Prevent Regret Preserve Erections Preserve Erections Quality of Life

5 Prostate Cancer Options Watchful waiting Watchful waiting Active surveillance Active surveillance Surgery Surgery Retropubic Retropubic Perineal Perineal Robotic Robotic Radiation Therapy Radiation Therapy External beam External beam Brachytherapy Brachytherapy Proton Beam Proton Beam Cryotherapy HIFU Cyber knife Androgen deprivation (ADT)

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11 Da Vinci Fred Moll (surgeon) approached by SRI international Fred Moll (surgeon) approached by SRI international Develop Field Robot for wounded soldiers Develop Field Robot for wounded soldiers Too expensive and not practical Too expensive and not practical Together with engingeers and Venture Cap money – Started Intuitive Corp. Together with engingeers and Venture Cap money – Started Intuitive Corp.

12 $127 Million in Venture cap money $127 Million in Venture cap money 1999 posted $18.4 million loss 1999 posted $18.4 million loss Marketed for Gall Bladders Marketed for Gall Bladders 2000 prospectus made no mention of prostate surgery 2000 prospectus made no mention of prostate surgery

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14 General Numbers 8000 RALP in RALP in % of prostates in 2006 RALP 10-17% of prostates in 2006 RALP 80% in % in Contemp Urology (2). - J Endourology (11).

15 da Vinci ® Surgical System

16 da Vinci ® System Console

17 Hand controls

18 Five degrees of Freedom

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27 Patient Positioning

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32 Operative Data Blood Transfusion < 1% Blood Transfusion < 1% Conversion to open < 1% Conversion to open < 1% Rectal injury < 0.1% Rectal injury < 0.1% Deaths – 0% Deaths – 0%

33 QOL data Incontinence < 1% Incontinence < 1% Erections – long talk Erections – long talk Best treatment to preserve long term erections Best treatment to preserve long term erections

34 Reasons for young men to have prosatectomy (What is young?) 1. Potential voiding dysfunction 1. Potential voiding dysfunction 2. Adjuvant therapy if failure 2. Adjuvant therapy if failure 3. Secondary malignancy 3. Secondary malignancy

35 Prostatectomy Non-debatable disadvantages 100% ejaculatory failure 100% ejaculatory failure Possible blood transfusion Possible blood transfusion 0.03% surgical mortality 0.03% surgical mortality Surgical risk Surgical risk Infx Infx PE PE MI MI Etc. Etc.

36 Prostatectomy Non-debatable advantages Definitive staging Definitive staging Pt cured if tumor pathologically confined Pt cured if tumor pathologically confined Tx simultaneous LUTS/BPH Tx simultaneous LUTS/BPH Easy monitoring Easy monitoring Decrease PSA anxiety over follow-up Decrease PSA anxiety over follow-up


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