With SMH Urologic Oncologist Robert Carey, MD, PhD
Welcome to “Ask an Expert,” a Q&A series with Sarasota Memorial’s team of doctors, nurses and other health experts, where you can get thorough answers to your health and wellness queries from a local source you can trust. Have a question that you’d like to “Ask an Expert”? Email them to AskAnExpert@smh.com.
Prostate cancer is the second most common cancer among men. We wanted to learn more about minimally invasive surgical treatment for the disease, so we asked Sarasota Memorial’s Dr. Robert Carey, MD, PhD, to weigh in.
A Sarasota urologist for more than a decade, Dr. Carey specializes in Da Vinci Robot-assisted surgeries, including minimally invasive prostatectomy. As one of the founders of robotic surgery at Sarasota Memorial, he is actively involved in research and has been widely published in variety of medical journals and other publications.
Q: What is a minimally invasive prostatectomy?
A prostatectomy is done for someone who has prostate cancer, but not just any prostate cancer. There are many people who have prostate cancer that doesn't need to be treated, and I can work with those patients in other ways. The prostatectomy is for people who have life-threatening prostate cancer that is likely to spread and could cause pain, suffering and death. For these patients, prostatectomy is the ideal way of treating this cancer, and it offers a chance at a complete cure: The prostate and lymph nodes are removed, and the cancer is cured.
Q: What are the benefits of a minimally invasive approach to removing a prostate?
The minimally invasive approach to treating prostate cancer has been around since about 2003. I was fortunate in that I have a PhD that allowed me to work with robotics, in addition to my medical degree. And so, since 2003, we've been doing prostatectomies primarily in a minimally invasive way, meaning that instead of making a large incision and putting our hands in, we're going to use tiny incisions about 8 millimeters each and insert a robotic instrument.
Even though the Da Vinci robot is very large, the actual entry of the instruments into the body are very small. It is a very reliable robot, completely controlled at its console by the surgeon. When we're working inside the body, the camera gives us 10 times magnification, and the fitted instruments are going to give us submillimeter precision. So even though you have this big instrumentation, the actual things that enter the body are very small and allow us to do microscopic and precise dissection of the prostate.
In a prostatectomy, the prostate is completely removed, as are the lymph nodes, and this will afford the patient a cure. The advantages for the patient typically are going to be that there is less pain, but more importantly, you have a better, long-term outcome.
Other benefits include the preservation of continence, so the patient doesn't leak urine, and the preservation of potency. While we emphasize long-term outcome, the patients will have the surgery and go home the next day. About 95 to 97 percent of patients over the last 12 years who have had robotic prostatectomies here at Sarasota Memorial have gone home the next day. The vast majority will have a catheter for about a week. Most of the men do not complain so much about pain. Some of them will have pain pills that they take, but the vast majority, once they go home, will take just Tylenol for pain.
Q: Who is a good candidate for minimally invasive prostatectomy?
For some men who have prostate cancer, it's safe to just keep an eye on its progression. Currently, I have more than 400 patients in what we call "active surveillance." They don't need treatment right now.
It’s the men with high-grade, aggressive prostate cancer who are excellent candidates for minimally invasive prostatectomy. It doesn't matter if you're fat or skinny, tall or short, old or young. It doesn't matter if you're going to have previous surgery or hernias or other things. The ideal candidate for robotic-assisted prostatectomy is someone who has high-grade, high-risk, significant prostate cancer that needs to be treated. And we're able to offer them minimally invasive treatment, where, very quickly, very efficiently, their cancer is cured.
Q: The Da Vinci surgical robot is what we use here at SMH for minimally invasive prostatectomy. Can you tell us about it?
The Da Vinci is four-armed and legged robot that is docked to the patient. The surgeon will “steer” the robot’s small instruments from the console. The Da Vinci works with classic, Newtonian physics, levers and pulleys that are combined with complex, electronic devices, giving us a very reliable robot.
In the more than 3,000 robotic prostatectomies that I've done, we've never had to stop the surgery because the robot didn't work. It is absolutely reliable.