Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz

Prostate Cancer
Testing & Surgical Options
Peter J Gilling
Patient Education

PN876703Rev.B7/13
What We Will Talk About Today
 What is the prostate?
 What is prostate cancer?
 How common is it?
 Risks & symptoms
 Who should be screened, and why?
 Questions to ask your doctor
 Understanding your treatment & surgical options

PN876703Rev.B7/13
What Is The Prostate? What Does It Do?
 Male sex gland
 Adds the fluids to
carry sperm
 The urethra (urine
channel/tube) runs
through the middle of
the prostate
Prostate
Rectum
Bladder
Urethra
Source: http://www.cancer.gov/cancertopics/wyntk/prostate/page2

PN876703Rev.B7/13
What Is Prostate Cancer?
 Abnormal cells
growing out of control
 Begins in the prostate
gland
 Can spread and
invade tissues,
organs, and bones
Cancer
Cells
Source: Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; 14.

PN876703Rev.B7/13
How Common Is It?
How many men are affected by prostate cancer in
America?
A) 1 in 3 B) 1 in 6 C) 1 in 12 D) 1 in 24
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
2. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-key-statistics
QUICK FACT:1
Prostate cancer is the 2nd
leading cause of cancer
death in men.
Every 2.4 minutes, a man is newly diagnosed
Every 16 minutes, a man dies of prostate cancer
QUICK FACT:1
Prostate cancer is the 2nd
leading cause of cancer
death in men.
Every 2.4 minutes, a man is newly diagnosed
Every 16 minutes, a man dies of prostate cancer
Answer: B. about 1 in 6 men.1
(Compared to 1 in 8 women for breast cancer2
)

PN876703Rev.B7/13
Risk Factors For Prostate Cancer1,2
 Age
More common in men age
40+
 Family history
If your father, brother or
son have had prostate
cancer
 Race
African-American men are more than twice as likely
to die from prostate cancer than Caucasian men.
MYTH: Prostate cancer is only
an old man’s disease.
NOT true!
FACT: Risk increases with
age, but men of ALL
ages should know
their personal risk
factors.
MYTH: Prostate cancer is only
an old man’s disease.
NOT true!
FACT: Risk increases with
age, but men of ALL
ages should know
their personal risk
factors.
1. http://www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm
2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-risk-factors

PN876703Rev.B7/13
Possible Symptoms Of Prostate Cancer
 Trouble urinating
 Weak urine flow
 Frequent urination, especially
at night
 Painful or burning urination
 Blood in urine or semen
 Pain in the back, hips or pelvis
that won’t go away
 Painful ejaculation
MYTH: If you don’t have
symptoms, you don’t
have prostate
cancer.
Maybe.
FACT: Many men with
prostate cancer have
NO symptoms at all.
Your doctor is often
the first one to
detect signs of
prostate cancer
during a check-up.
MYTH: If you don’t have
symptoms, you don’t
have prostate
cancer.
Maybe.
FACT: Many men with
prostate cancer have
NO symptoms at all.
Your doctor is often
the first one to
detect signs of
prostate cancer
during a check-up.
Source: http://www.cdc.gov/cancer/prostate/basic_info/symptoms.htm

PN876703Rev.B7/13
Prostate Cancer Can Be Treated!
 Early detection and improved treatments have
helped to save lives1,2
 In fact, the chance of dying from prostate
cancer has been lowered by 50% since the 1990s
when the PSA test became widely used in the
U.S.2
 2+ million men are living today in the U.S. after
being diagnosed with prostate cancer3
1. What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf 2. Information Sheet: Prostate-Specific Antigen (PSA) Testing For the Early Detection of
Prostate Cancer. American Urological Association. 2012. http://www.auanet.org/content/media/USPSTF_information_sheet.pdf 3. CDC. Cancer survivors –
United States, 2007. MMWR 2011:60(09):269-272.

PN876703Rev.B7/13
Wondering About
Prostate Cancer Tests?

PN876703Rev.B7/13
If You Don’t Have Symptoms, How Do You
Know If You Have Prostate Cancer?
PSA (Prostate
Specific Antigen)
Blood Test
DRE is a physical
rectal exam to
look for bumps
Prostate Cancer Tests
Source: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
Doctors use prostate cancer tests to determine if you are
likely to have prostate cancer.
The results provide valuable information.

PN876703Rev.B7/13
PSA Test – What Does It Tell?
 PSA = prostate-specific antigen (A protein produced by the
prostate and released into the blood)
 It does not diagnose (confirm) prostate cancer
 Your doctor is usually watching out for either a high PSA
level or a sudden/sharp rise
Source: What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf
High PSA Level
May be
prostate cancer
May be benign
(not cancer)
Sudden/Sharp
Rise in PSA Level
Likely to be
prostate cancer
OR

PN876703Rev.B7/13
Are You Confused About Whether You
Should Have PSA Tests?
 You may have heard confusing talks in the media about the PSA test
 The choice depends on your personal situation (age, risk factors, and
symptoms, etc.) and should be discussed with your doctor
 The American Urological Association (AUA)’s current recommendation
to doctors and patients1
:
“The AUA strongly supports that men be informed of the risks and
benefits of prostate cancer screening before biopsy and the option of
active surveillance in lieu of immediate treatment for certain men
newly diagnosed with prostate cancer.”
1. Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; p6.

PN876703Rev.B7/13
Points to Discuss with Your Doctor As You
Make Your Decision on Testing
Benefits of Current Tests
 Can find prostate cancers
early when they are easier
to cure
 Can track changes in the
prostate over time
 PSA test and DRE are
currently the only widely
available tests to look for
prostate cancer
Risks of Current Tests
 Unclear test results can
cause confusion and
anxiety
 PSA test and DRE are not
100% accurate
Source: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection

PN876703Rev.B7/13
What Happens Next if Your PSA Level Is
Above Normal?
 Your doctor may order a biopsy1
 Based on your PSA test or DRE results
 And consider other factors like your family history,
race, age, overall health and past biopsy results
 A biopsy is the only way to confirm a cancer
diagnosis1
 Doctor uses a thin needle to remove small pieces of
tissue (usually 12 samples) to look for cancer cells
 It has small risks of pain, infection, and bleeding2
1. What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf 2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection

PN876703Rev.B7/13
Biopsy and Grading1
 Biopsy
 To confirm diagnosis
 Thin needle to remove small
pieces (typically 12 samples)
 Gleason score (2-10)
 To grade aggressiveness of
the cancer cells
 Add the scores from 2 areas
with the most cancer cells
 Example: Gleason 7 (3+4)
Least
Aggressive
Most
Aggressive
Grading: Gleason Score
1
2
3
4
5
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis

PN876703Rev.B7/13
Understanding The Biopsy Results
 Your doctor will use the biopsy results to see:
 If you have prostate cancer or not
 If it is slow growing or aggressive (fast growing)
 Depending on the results, your doctor may:
 Tell you that you don’t have prostate cancer
 Repeat the biopsy
 Compare to past biopsy results, if you had them
 Order a bone scan, CT or MRI to see if the prostate
cancer is only in the prostate or has spread
Source: http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis

PN876703Rev.B7/13
Bone Scan, CT and MRI - Staging1
 May use bone scan, CT and MRI
 T1, T2: localized
 T3, T4: spreads outside the prostate
T1 T2
T3 T4
1. http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2

PN876703Rev.B7/13
If you find out that you have prostate
cancer…
Understand ALL
Your Treatment & Surgical Choices
…because you have options

PN876703Rev.B7/13
It Is YOUR Decision, You Are In Control
 It is your personal choice, together with your doctor, to
decide whether to treat & how to treat prostate cancer
 What’s right for one patient may not be right for YOU
 Your doctor will support you seeking a second opinion to
verify and/or gain more information as you need

PN876703Rev.B7/13
Ask Your Doctor Lots Of Questions
1. Is my cancer only in the prostate or also outside of it? Is it slow- or
fast-growing?
2. What are all the ways prostate cancer can be treated?
3. What is the chance of a cure?
4. What are the pros and cons of each treatment?
5. How long will the treatment and recovery take?
6. Will the side effects happen to me soon, or much later? Will they
get better or worse with time?
7. How soon can I control my bladder?
8. How soon will I be able to have sex again?
9. What can doctors do if my prostate cancer returns or spreads?
10. How much experience do you have with these treatments?

PN876703Rev.B7/13
A Few More Important Things To Consider
 Your overall health
 Your age
 Any other serious health conditions?
 Expect to live another 10 years or more?
 Your own feelings about each treatment
 Is a cure more important to you than anything else?
 Want to avoid the chance of getting another cancer?
 What side effects can you live with? For how long?

PN876703Rev.B7/13
Treatment & Surgical Options For Localized
Prostate Cancer
Active
Surveillance
Surgery Radiation
Other
Treatments
What it
means to
you
Live with your
prostate cancer,
and be tested
regularly
The prostate
and cancer cells
will be removed
The cancer cells
may be killed
but not removed
The cancer cells
may be killed
but not
removed
How it’s
done
• PSA and DRE
every 3-6
months
• Biopsy once a
year
• Robotic-
assisted
(minimally
invasive, often
nerve-sparing)
• Traditional
laparoscopic
surgery
(minimally
invasive)
• Traditional
open surgery
• Brachytherapy
(radioactive
seeds inside
the prostate)
• External
Radiation
 IMRT
 IGRT
 Other EBRT
• Hormone
therapy (often
used with
radiation)
• Cryotherapy
(freezes; often
as a secondary
treatment)
• Chemotherapy
(uses drugs)

PN876703Rev.B7/13
Active Surveillance
Pros
 Usually a good choice if
expected to live <10 years
and/or the prostate cancer is
slow growing
 No down-time (besides doctor
visits for tests)
 Avoid possible side effects of
surgery, radiation or other
treatments
 Medical advances may make
future treatment more tolerable
Cons
 More likely to die from prostate
cancer within 10 years vs. surgery1
 May miss the chance to treat the
cancer before it spreads outside
the prostate
 Regular biopsies can increase
the likelihood of erectile
dysfunction2
 May not tolerate treatment if
wait until older
 More than 40% of prostate
cancers are actually faster
growing than graded3
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50 2. Helfand, BT, et al. BJU International. Epub 2012 May 28. 3. Barqawi AB, et al. Int J
Clin Exp Pathol. 2011 Jun 20;4(5):468-75.

PN876703Rev.B7/13
Radiation
External Beam
Uses computer and CT scan to
target radiation at the cancer
cells from outside the body
Daily visits, usually for up to 9
weeks
Some healthy tissue may be
affected
Brachytherapy
Uses small radioactive “seeds”
implanted with a needle
throughout the prostate
1 day outpatient visit, may
require general anesthesia
The seeds stay in the prostate
permanently
1. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-radiation-therapy
Side effects may be slow to appear with radiation therapy, and may
include erectile dysfunction, urinary problems, bowel and bladder
problems, scarring, and fatigue.
Side effects may be slow to appear with radiation therapy, and may
include erectile dysfunction, urinary problems, bowel and bladder
problems, scarring, and fatigue.

PN876703Rev.B7/13
Radiation
Pros
 Good chance for a cure for
appropriate patients
 No hospital stay
 Few restrictions after
treatment, if any
 May be used after surgery if
cancer has spread outside of the
prostate
Cons
 More likely to die from prostate
cancer within 10 years vs. surgery1,2
 Increased fatigue during long
treatment3
 Urinary and bowel problems could
last for years, and sexual potency
tends to get worse over time4-6
 More likely to have another cancer
- your prostate can move during
treatment and radiation can hit
nearby tissues7,8
Very difficult to treat if the prostate
cancer returns after radiation
3. http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page8#SE3 4. Sanda MG, et al. N Engl J Med. 2008 Mar 20;358(12):1250-61. 5. Zelefsky MJ, et al.
J Urol. 2006 Oct;176(4 Pt 1):1415-9. 6. Alicikus ZA, et al. Cancer. 2011 Apr 1;117(7):1429-37. 7. Bhojani N, et al. Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):342-8. 8.
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50.
2. Cooperberg MR, et al. Cancer. 2010 Nov 15;116(22): 5226–5234.

PN876703Rev.B7/13
Surgery (Prostatectomy)
Pros
 Best chance for a cure for
localized prostate cancer1-3
 Short treatment
 Sexual potency is back within 1
year for most patients4,5,
*
 Urinary function is back within
1-3 months for most patients4,5,
*
 If the cancer returns, there are
several back-up treatments
Cons
 Possible short term change in
sexual potency and bladder
control, but normally recover
over time4-6
 A small chance of having major
complications7
 Hospital stay required (length
of stay depends on the type of
surgery chosen)*
 Catheter in place 1-2 weeks
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50. 2. American Urological Association. Guideline for the Management of Clinically Localized
Prostate Cancer: 2007 Update. Reviewed and validity confirmed 2011. 3. Cooperberg MR, et al. Cancer. 2010 Nov 15;116(22): 5226–5234. 4. Rocco B, et al.
BJU Int. 2009 Oct;104(7):991-5. 5. Ficarra V, et al. BJU Int. 2009 Aug;104(4):534-9. 6. Sanda MG, et al. N Engl J Med. 2008 Mar 20;358(12):1250-61. 7.
Carlsson S, et al. Urology. 2010 May;75(5):1092-7.
*Results from robotic-assisted surgery for most patients. Traditional open surgery leads to longer recovery time.

PN876703Rev.B7/13
Other Treatments
Pros
 Could be a choice if you
cannot have surgery or radiation
 May help to manage cancers
that have spread outside the
prostate
Cons
 Much more likely to die from
prostate cancer within 10 years
with hormone therapy vs.
surgery or radiation
 May have weakened bones,
vomiting, diarrhea, hair loss,
impotence, or leaking from the
bladder or rectum
1. Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators,
Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer.
2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456 2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-
hormone-therapy 3. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-cryosurgery 4.
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-chemotherapy

PN876703Rev.B7/13
Another Look At Treatment & Surgical
Options
IndefiniteIndefinite
Tested regularly; if the cancers
gets worse, doctors may repeat
the tests and/or recommend
other treatments.
Patients continue to
have monitoring tests
such as PSA, DRE and
biopsies.
Patients are more likely
to die from prostate
cancer within 10 years
compared to being
treated with surgery.1
1-3 Days1-3 Days
Hospital stay for most patients;
usually return to work or normal
activities in 2-3 weeks.2-6
Most patients recover
their sexual and
urinary functions
within 1 year after
surgery.2,3
The chance of living 10+
years is the highest with
surgery.1,7
2 Months2 Months
Daily visits to a radiation center
for most patients (e.g. IMRT: 5
days a week for a total of 40
visits); usually able to work but
may have increased fatigue.
Many patients begin
to have sexual,
urinary, and/or bowel
problems 1 year after
radiation.8-10
Patients are more likely
to die from prostate
cancer within 10 years
than patients treated
with surgery.1,7
More patients are likely
to get another cancer
within 10 years.11,12
Treatment Period 1 Year Later 10 Years Later
ActiveActive
SurveillanceSurveillance
SurgerySurgery
RadiationRadiation
References: see notes section.

PN876703Rev.B7/13
100-Kattan Score predicting risk of cancer return
(combines PSA, stage and Gleason score)
Surgery
Radiation
Hormone
Predicted10-Year
Cancer-SpecificDeath10-Year Risk of Death: Lowest with Surgery1
1. Cooperberg, M. R., et al. Cancer, 116: 5226–5234. doi: 10.1002/cncr.25456

PN876703Rev.B7/13
If Considering Surgery…
 Talk to your doctor to understand the benefits and risks
and whether you are a candidate
 Talk to patients who had surgery 6-12 months ago
 Why? They can share a lot more about what happened to them
long after the surgery than those who had it more recently
 Find a surgeon experienced in the surgery that you want
to consider
 4 out of 5 patients now choose da Vinci®
Surgery, a minimally
invasive robotic-assisted surgery, when they choose to have
surgery for prostate cancer1
Source: http://www.cancer.gov/ncicancerbulletin/080911/page4

PN876703Rev.B7/13
Open Surgery
 Benefits1
 Open surgery has been performed for prostate
cancer for over 100 years. It has potentially lower
risk of bowel injury and typically a shorter
procedure time than open or lap surgery.
 Risks1
 Hospital re-admission, vessel, nerve ureter or
bladder injury, deep vein thrombosis, and in rare
cases there is the risk of mortality during or shortly
after the procedure.
1
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary
surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol.
2012 Jul;62(1):1-15. Epub 2012 Feb 24

PN876703Rev.B7/13
Laparoscopic Surgery
 Benefits1
 Provides many of the benefits of minimally invasive
surgery vs. open surgery including lower blood loss,
risk of mortality, ureteral injury and deep vein
thrombosis.
 Risks1
 Hospital re-admission, vessel, nerve ureter or
bladder injury, deep vein thrombosis, and in rare
cases there is the risk of mortality during or shortly
after the procedure.
1
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary
surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol.
2012 Jul;62(1):1-15. Epub 2012 Feb 24

PN876703Rev.B7/13
da Vinci®
Surgery
Potential Benefits Compared to Traditional Open Surgery
More precise removal of cancerous tissue1,2,3,4
Ability to perform nerve sparring surgery which enables:
 Faster return of erectile (sexual) function: Studies show
patients who are potent prior to da Vinci Surgery experience a
faster return of erectile function than previously potent
patients who have open surgery5,6
 Better chance for return of urinary continence: Recent studies
show more patients with da Vinci Surgery have full return of
urinary continence within 6 months as compared to patients
having open surgery4,5,6
*See references at end of presentation

PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Potential Benefits Compared to Traditional Open Surgery
(Cont.)
Less blood loss1,4,5,6,7,8,9,10
Less need for a blood transfusion1,4,6,7,8,9,11
Less pain9
Lower risk of complications1,4,7,8,11
Lower risk of wound infection1,7
Shorter hospital stay1,4,5,6,8,12
Less chance of hospital readmission1
Less chance of needing follow-up surgery1
Fewer days with catheter5
Less risk of deep vein thrombosis (life-threatening condition where a
blood clot forms deep in the body)1
Faster recovery10
and return to normal activities12
da Vinci
Surgery
Incisions
Open Surgery
Incision

PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Potential Benefits Compared to Traditional Laparoscopy
More patients return to pre-surgery erectile function at 12-month
checkup,
Faster return of urinary continence14
Lower risk of complications1
Less blood loss and need for a transfusion1,8
Less chance of nerve injury1
Less chance of inuring the rectum1
Shorter operation8
Less risk of deep vein thrombosis (life-threatening condition where a
blood clot forms deep in the body)1
Shorter hospital stay1,8
Less chance of hospital readmission1
Less chance of needing follow-up surgery1

PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Risks & Considerations Related to Prostatectomy & da Vinci
Surgery:
Potential risks of any prostatectomy procedure include:
Urinary and/or sexual dysfunction due to nerve damage
Rectal or bowel injury
Blocked artery in the lung
Blocked bowel
In addition, there are risks related to minimally invasive
surgery, including da Vinci Prostatectomy, such as hernia
(bulging tissue/organ) at incision site.1,11

PN876703Rev.B7/13
How is da Vinci®
Surgery Performed?
 Surgeon controls the highly precise
instruments the entire time to:
 View in 3D-HD with up to 10x
magnification
 Remove the prostate & cancer
cells meticulously
 Work around the important
nerves when indicated
da Vinci Surgery Operating Room

PN876703Rev.B7/13
Precision Matters: Better Cancer Control
with da Vinci Surgery
Cancer Control
T2 Positive Margin
Rate1
Open Surgery da Vinci®
Surgery .
1. Di Pierro GB, et al. Eur Urol. 2011 Jan;59(1):1-6. Epub 2010 Oct 21.
The lower
the positive
margins, the
better

PN876703Rev.B7/13
Precision Matters: Faster Return of Urinary
Continence with da Vinci Surgery
Continence Rates
at 3-Month1
Open
Surgery
da Vinci®
Surgery .
Continence Rates
at 12-Month1
Open
Surgery
da Vinci®
Surgery .
1. Rocco B, et al. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5. 12-month rate difference is statistically significant (P=0.014)
while 3-month rate-difference is not statistically significant (P=0.15)
Higher
is
better

PN876703Rev.B7/13
Precision Matters: Faster Return of
Sexual Function with da Vinci Surgery
Sexual
Function at 1-
Year1
Open
Surgery
da Vinci®
Surgery .
1. Ficarra V, et al. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5.
Higher
is
better

PN876703Rev.B7/13
Take Action
 Know your personal risk factors and talk to your
family
 Talk to your doctor about prostate cancer
screening
 Discuss all treatment options with your doctor
 Get a second opinion
 Choose the option that’s right for YOU

PN876703Rev.B7/13
Surgical Risks

PN876703Rev.B7/13
References – da Vinci Surgery Compared to
Traditional Open and Laparoscopic Surgery
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates
of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic
prostatectomy. Eur Urol. 2012 Jul;62(1):1-15. Epub 2012 Feb 24
2. Weerakoon M, Sengupta S, Sethi K, Ischia J, Webb DR. Predictors of positive surgical margins at open and robot-assisted laparoscopic radical
prostatectomy: a single surgeon series. J Robotic Surg. 2011. http://dx.doi.org/10.1007/s11701-011-0313-4
3. Coronato EE, Harmon JD, Ginsberg PC, Harkaway RC, Singh K, Braitman L, Sloane BB, Jaffe JS. A multiinstitutional comparison of radical
retropubic prostatectomy, radical perineal prostatectomy, and robot-assisted laparoscopic prostatectomy for treatment of localized prostate
cancer. J Robotic Surg (2009) 3:175-178. DOI: 10.1007/s11701-009-0158-2.
4. Health Information and Quality Authority (HIQA), reporting to the Minister of Health-Ireland. Health technology assessment of robot-assisted
surgery in selected surgical procedures, 21 September 2011. http://www.hiqa.ie/system/files/HTA-robot-assisted-surgery.pdf
5. Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy
in a laparoscopically naive centre: a matchedpair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
6. Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-
assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5
7. Carlsson S, Nilsson AE, Schumacher MC, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical
prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7
8. Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, Corcos J, Pautler S. Robot-Assisted Surgery Compared with Open Surgery
and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in
Health (CADTH); 2011 (Technology report no. 137).
9. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted
anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002 Nov;60(5):864-8
10. Miller J, Smith A, Kouba E, Wallen E, Pruthi RS. Prospective evaluation of short-term impact and recovery of health related quality of life in men
undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol. 2007 Sep;178(3 Pt 1):854-8;
discussion 859. Epub 2007 Jul 16
11. Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO,
Montorsi F, Menon M, Karakiewicz PI. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical
prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2012 Apr;61(4):679-85. Epub 2011 Dec 22
12. Hohwu L, Akre O, Pedersen KV, Jonsson M, Nielsen CV, Gustafsson O. Open retropubic prostatectomy versus robot-assisted laparoscopic
prostatectomy: A comparison of length of sick leave. Scand. J. Urol. Nephrol. Apr 7 2009:1-6.
13. Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C. Randomized comparison between laparoscopic and robot-
assisted nerve-sparing radical prostatectomy. J Sex Med. 2011 May;8(5):1503-12. doi: 10.1111/j.1743-6109.2011.02215.x. Epub 2011 Feb 16.
14. Porpiglia F, Morra I, Lucci Chiarissi M, Manfredi M, Mele F, Grande S, Ragni F, Poggio M, Fiori C. Randomised Controlled Trial Comparing
Laparoscopic and Robot-assisted Radical Prostatectomy. Eur Urol. 2012 Jul 20. [Epub ahead of print]
15. National Cancer Institute. NCI Cancer Bulletin. Tracking the Rise of Robotic Surgery for Prostate Cancer. Aug. 9, 2011 Vol. 8/Number 16.
Available from: http://www.cancer.gov/ncicancerbulletin/080911/page4

Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (19)

Semelhante a Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz

Semelhante a Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz (19)

Último

Último (20)

Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz

Notas do Editor