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The Arkansas Prostate Cancer Foundation’s mobile screening unit facilitates early detection of prostate cancer by providing a convenient and private location for screenings in communities and at events around the state.

Men are notoriously reluctant to have their prostates checked, but awareness of prostate cancer is growing and new advances in robotics are revolutionizing treatment plans. To many, using robots in surgery still seems like a scene from a science fiction movie, but today, hospitals around the state are beginning to invest in da Vinci Robot Systems. The robotic systems offer minimally invasive surgery that dramatically influences the treatment of prostate cancer.

There will soon be nine da Vinci Robotic systems in use in Arkansas.

“The addition of robotic surgery has made surgery more palatable for many patients and is now widely available, including Batesville (White River Medical Center),” said Dr. Rob Emery of Batesville Surgery Clinic.

Dr. Graham Greene, associate professor of urology and head of genitourologic oncology at UAMS, agreed.

“Evidence consistently shows that robotic surgery can be done efficiently, with less blood loss, less postoperative analgesic requirements, shorter recovery time and equal oncologic outcomes to conventional open prostatectomy,” said Greene.

Studies show this type of surgery may also improve the control of the patient’s cancer and lower the risk of impotence and urinary incontinence. Although robotic surgery is less invasive with overall better outcomes, the cost remains high.

Radical prostatectomy is just one use of the da Vinci Robot. Surgeons can use it for complex procedures, such as urologic, gynecologic, thoracoscopic and thoracoscopically-assisted cardiotomy procedures. Dr. Rabii Madi, assistant professor of urology at UAMS, recently performed the first partial nephrectomy on a large renal cell cancer, Greene said.

Greene said the focus at UAMS is to develop a vibrant robotics program that stretches across many disciplines, concentrating on a strong curriculum for teaching resident and medical students how to perform robotic surgery.

As clinical and scientific research of prostate cancer continues to develop, patients have opportunities to participate in a variety of clinical research trials ranging from prostate cancer awareness to metastatic disease.

Emery said that the profession has hopes of immunotherapy or even vaccines for prostate cancer in the next couple of decades.

“The most recent trial opened was for hormone refractory prostate cancer patients without demonstrable metastatic disease (serological failure only),” Greene said. “Our ultimate goal is to create an environment supportive of investigator-initiated Phase 1 (bench to bedside) trials.”

He said he hopes eventually to use various techniques in genomics and proteomics to individualize patients’ care and define their cancer’s unique phenotype, in order to tailor their therapy and modify treatment regimens based on tumor response at the molecular level.

Increasing prostate cancer awareness may help with early diagnoses.

“Men, in general, are poor advocates for their own health,” said Greene.
“Increased prostate cancer awareness and engaging leadership amongst survivors will help us bridge the gap and catch up with women’s health advocates.”

“Unfortunately, many men only go to the doctor when they are in pain, which is generally not the best time for health discussions or preventive screenings,” said Helen Baldwin, executive director Arkansas Prostate Cancer Foundation.

Since prostate cancer has no early-stage symptoms, the Medical Advisory Committee of the Arkansas Prostate Cancer Foundation advises doctors work with male patients to establish a baseline prostate specific antigen (PSA) around the age of 40.

The Arkansas Prostate Cancer Foundation provides information and free screenings to fulfill its mission of promoting awareness, encouraging timely detection, and supporting improved treatment of prostate cancer in Arkansas.

According to Baldwin, male patients should know their PSA score to know if it is increasing. The rate of increase in the PSA, also known as PSA velocity (PSAV), is even more indicative of aggressive prostate cancer than the score itself.

“The National Comprehensive Cancer Network tells us that for men with a PSA less than four ng/ml, a velocity of 0.35 ng/ml per year is suspicious for the presence of cancer,” said Baldwin. “For men whose PSA is between four and ten ng/ml, a PSA velocity of 0.75 ng/ml per year is suspicious. PSAs should be drawn on at least three consecutive specimens over at least an 18 to 24-month interval.”

Even though the media is doing a good job with prostate cancer awareness, Greene believes the media will soon “catch the wave” as more men become comfortable about sharing their stories and speaking out.

Baldwin added that age and ethnicity play a part in a man’s PSA and are important to consider when evaluating his cancer risk. The American Urological Association (AUA) Best Practice Policy on PSA Testing recommends the doctor refer him to a urologist if his PSA is greater than the target levels for his age and ethnicity.



July 2008

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