Ralph A. Highshaw, M.D.

The question is: Are positive surgical margins more common after treatment of prostate cancer with Robotic-Assisted Laparoscopic Prostatectomy versus Radical Retropubic Prostatectomy?

Positive surgical margins are the margins of the specimen, in this case the prostate, that are inked by the doctor called a pathologist.

A positive surgical margin or multiple positive margins implies a higher likelihood of spread of the cancer being found outside of the prostate either at the time of removal or in the future. In other words, the cancer was not contained at the time of removal. Hence, answering the question: “Are positive surgical margins more common after treatment of prostate cancer with Robotic-Assisted Laparoscopic Prostatectomy versus Radical Retropubic Prostatectomy?” is valid.

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1) What is urology?

Urology (not neurology) is the study of medicine that deals with handling illnesses related to the kidneys, bladder, prostate (in men), urethra (voiding tube) and ureters (the tubes that drain the kidney into the bladder). Urology deals with male and female issues in these areas mentioned above.

2) What is a bladder spasm?

Bladder spasms are contractions of the bladder that can result in urgency (inability to hold urine), frequency and pain felt after voiding in the bladder or abdomen, or sometimes at the tip of the penis or near the rectum.

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A vasectomy is a ligation (cutting, tying off with suture, disruption) of the flow of sperm through the vas deferens. The vas deferens is a tubular structure which is connected to another tubular structure called the epididymis, which is connected to the testicle, which produces the sperm.

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Kidney stones or nephrolithiasis can be a cause of severe pain. Typical symptoms include back pain on the side of the stone that may be associated with nausea, vomitting, fever, and chills. Stones that are found in the ureter, the tube connecting the kidney to the bladder (which drains the kidney), often get stuck and obstruct the flow of urine. This leads to severe back pain known as flank pain or renal colic. It can lead to an infection of the kidney as well known as pyeloneprhitis.

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In one of earlier blogs, I discussed some of the traditional treatments for prostate cancer. Some of these treatments are radical retropubic prostatectomy, robotic prostatectomy, laparoscopic prostatectomy, cryoablation, radiation treatment (example, IMRT and Brachytherapy), androgen deprivation, and active surveillance. I want to discuss a new modality of treatment for prostate cancer called HIFU or High Intensity focused Ultrasound Therapy.

HIFU was first discovered in the 1950′s and improved as a use for treatment of prostate cancer over the last few decades. HIFU is minimally invasive. It kills prostate cancer cells by thermal ablation. Surgery and radiation is not used to kill the prostate cancer cells. There is no blood loss and no incision! Patients are typically sent home the same day of treatment, and back to regular activity quicker than after surgical management

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Provenge is now approved by the FDA for use in patients with metastatic, hormone refractory prostate cancer. These are patients who do not respond to androgen deprivation therapy. Androgen deprivation therapy involves lowering testosterone levels in the body to below castration levels. This is done because prostate cancer cells feed by testosterone. In a clinical trial of 512 patients across multiple institutions, Provenge was shown to improve the overall survival of prostate cancer patients by 4.1 months.

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Benign Prostatic Hyperplasia othewise known as BPH or an enlarged prostate is common to many men. Fifty-percent of men ages 5o and above may have symptoms. The chance of being symptomatic occurs in a higher percentage each decade after age 50.

The symptoms include frequency, urgency, nocturia ( getting up at night to urinate), incomplete emptying, hesistancy, or at worst urinary retention. treatment is recommended if your life is adversely affected by any one or more of these symptoms.

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There are several methods of treatment for prostate cancer. Choosing the right treatment for you is based on your PSA, gleason score, clinical stage, and volume of disease. Two of the important issues one should think about when choosing a treatment for prostate cancer are cure rate and quality of life.

After a diagnosis of prostate cancer has been made through a transrectal ultrasound biopsy of the prostate, a man has a wide spectrum of treatment options. These options include radical retropubic prostatectomy, robotic radical prostatectomy, laparoscopic radical prostatectomy, radiation treatment (external beam, proton beam, brachytherapy or radioactive seed therapy, and IMRT), cryoablation (freezing the prostate), androgen deprivation therapy, HIFU ( High Intensity Focused Ultrasound, which is non-FDA approved), clinical trials, and active surveillance.

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PSA means Prostate Specific Antigen. It is an enzyme secreted mainly by the prostate and is involved in liquefaction of the semen.  PSA has been used for over two decades to screen and follow PSA post- treatment of prostate cancer. PSA drawn from the bloodstream and the digital rectal exam are the two methods used for screening prostate cancer. The AUA, American Urological Association, recommends a baseline PSA begin at age 40. Screening for prostate cancer should also start at age 40 for men with a positive family history of a first -degree relative or African- American heritage. Both are associated with an increased risk of prostate cancer incidence. An example of a first-degree relative would be a father diagnosed with prostate cancer. In addition, the person being screened should have a life expectancy of 10 years or more.  Other men with an average risk, should start screening at age 50.

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