High-tech Treatment

Not so long ago, routine surgery to remove the prostate gland required four to six weeks of recovery time.

Now it isn’t uncommon for a man who has had a prostatectomy at the University of Minnesota's Institute for Prostate and Urologic Cancers (IPUC) to be doing yard work and his other usual activities just three weeks later.

Such are the benefits of using new technology to improve care for men with prostate cancer. Minimally invasive surgery, more precisely targeted radiation treatments, and advanced training techniques are all contributing to better results for patients.

The benefits of discovery

New technologies at the IPUC offer many benefits. Robot-assisted laparoscopic surgery to remove the prostate gland, for instance, requires as few as six 1-centimeter incisions, compared with a 15- to 23- centimeter incision through the muscle extending from the belly button to pubic bone with traditional “open” surgery. As a result, this minimally invasive procedure is generally followed by a much shorter recovery period, often with less blood lost, less pain, and less scarring.

This technique, performed with a robot such as the da Vinci® Surgical System, has a number of distinct advantages over traditional surgery, according to Kenneth Koeneman, M.D., a urologic surgeon and director of the Institute for Prostate and Urologic Cancers. Koeneman says robot-assisted surgery can improve the surgeon’s ability to see the prostate gland. A console gives the surgeon a three-dimensional view of the surgical field, with magnification that is especially helpful for seeing small nerves. Avoiding damage to these nerves improves the chances of maintaining sexual function

“The beauty of the robot is its ability to focus on a small area,” Koeneman says. “It allows you to perform fine movements in reconstructive surgery, such as tying and sewing in a tiny space in the pelvis.”

And because it can bend in ways a human arm cannot, the robot improves the surgeon’s dexterity.

Not all patients are good candidates for this minimally invasive surgery, however. It is generally most successful in patients who have early-stage cancer and small tumors. Patients who have larger tumors, have more advanced cancer, or require extensive lymph node dissection are still candidates for traditional surgery.

Results with radiation therapy

Another advanced treatment for prostate cancer is TomoTherapy, also offered at the IPUC, where it is performed by L. Chinsoo Cho, M.D., M.S., radiation oncologist and associate professor in the Department of Therapeutic Radiology–Radiation Oncology.

TomoTherapy uses a sophisticated radiation technique to destroy tumors. The technology delivers radiation—guided by computed tomography imaging—in thousands of small, targeted beams from 360 degrees around the tumor.

Cho works with other IPUC physicians on innovative research and clinical studies that may one day improve prostate cancer treatment worldwide.

For example, Cho and Koeneman are co-investigators for a study evaluating stereotactic body radiotherapy (SBRT), which uses more focused, higher dosage radiation therapy for treating prostate cancer. The treatment method could reduce the number of radiation sessions a prostate cancer patient typically undergoes from forty-two sessions with TomoTherapy to just five sessions with SBRT.

SBRT has contributed to good short-term results in people with lung cancer and liver cancer. But because it’s relatively new, long-term outcomes are still being assessed.

Looking to the future

The Institute for Prostate and Urologic Cancers is also using advances in technology to train the next generation of surgeons. Virtual reality and simulation are especially helpful tools in training urology residents and fellows in urologic surgery.

In this area, the IPUC draws on the experience and expertise of Robert Sweet, M.D., a urologic surgeon and clinical director of simulation programs at the University’s Academic Health Center. Sweet is developing simulation and virtual-reality tools to provide training in robotic techniques and in more conventional laparoscopic and endoscopic techniques.

Sweet says he has been interested in virtual reality and simulation training since he performed his first transurethral resection of the prostate (TURP) as a resident several years ago. A member of the video-game generation, Sweet was convinced that there must be a better way to master the skills necessary to perform the challenging procedure. He realized that simulation and virtual reality might be the answer.

“It’s hard to rely on what you read in textbooks when you’re first expected to do a procedure,” Sweet explains.“With these simulators, urology residents can practice on a machine instead of practicing on live patients in the operating room.”

One simulator Sweet developed allows trainees to practice a surgical procedure like TURP, a treatment for benign prostatic hyperplasia, or enlarged prostate, until they are proficient, at which point they are ready to perform the procedure on a patient. This simulator was recently licensed from Sweet’s lab, commercialized, and formally released this year.

Sweet is currently expanding these virtual-reality modules to cover training for laparoscopic treatment of kidney and prostate cancers as well.

What else does the future hold? Five years from now, Sweet imagines that surgeons will be able to rehearse a patient-specific procedure by uploading that patient’s scan onto a virtual model and practicing until they perfect it.

In the meantime, urologic surgery residents and fellows at the University are receiving better training than ever, gaining new skills and knowledge by using the latest available technology, which in turn benefits prostate cancer patients today and in the future.

- Story courtesy University of Minnesota Foundation

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