Dr. Randy Fagin on Prostate Cancer
Hi, I'm Dr. Randy Fagin with the Urology Team. Today we're going to be talking about one of the ways that we can find prostate cancer and one of the ways that we can treat it.
Prostate cancer is one of the most common cancers in the United States today. Over 250,000 cases are diagnosed annually. Over 12,000 in the state of Texas alone. It is the second leading cause of cancer related death in men. 1 in 6 men over the course of their lifetime will get it.
So what are the risk factors? Two most common risk factors are family history. If you have a blood relative who had prostate cancer, your risk can be increased up to 7 fold. The second is being African American. African Americans have a higher risk of prostate cancer than white Americans.
So how do you know if you have prostate cancer? Well, unfortunately there are no symptoms. Prostate cancer is a completely silent disease. That means that screening for it and catching it early is critical to being able to cure it.
So how do we diagnose it early? Two simple tests. An annual rectal exam and an annual PSA blood test. One of the most common questions I get asked is, do I really need to get this test done every year, and the answer is yes, you really do need to have a rectal exam and a PSA done every year. For most men it starts at age 50. If you have a positive family history or if you're African American, that starts at age 40.
It's also important to know that what we consider an acceptable PSA changes from decade to decade. If you're less than 50, your PSA should be less than 2-1/2. If you're less than 60, it should be less than 3-1/2. If you're more than 60, it should be less than 4. More importantly, the change of PSA over time is critically important. That's why this test has to be done every single year. A rise in your PSA of more than .75 could mean that you have prostate cancer regardless of what your PSA is.
So, you've been diagnosed with prostate cancer. Now what? The good news is, you have many treatment options to choose from and you have some time to make an informed decision.
Many patients choose surgery and for those patients who do choose surgery, over 80% of them choose surgery with the da Vinci robotic system. In fact, da Vinci robotic surgery is the most common treatment for prostate cancer in the world today.
So what is the da Vinci robot? It's made by Intuitive Surgical. It was FDA approved in 2000. Over 1,400 da Vinci robots exist around the world today on 5 out of the 7 continents.
So what makes this robotic system so special? 2 things in particular. 1 is the vision system. If you look at the picture here, you can see the camera actually has a right eye, a left eye and a headlight. The headlight lets us see inside the abdominal cavity. The right and left eye actually magnify the surgical field 10 times and transfer that image into the surgeon console as a separate right and left eye view. That means the surgeon sees what's in the surgical field not only 10 times magnified, not only in HD vision but in a true stereoscopic 3-D view. The second thing that makes this system so special are the instruments. The instruments are actually wristed. That means that when my hands go onto the instruments in the surgeon console and I move my hands, those hand movements are duplicated as robotic movements. And not just right, left, up and down, but also flexing and extending my wrist and opening and closing my fingers.
So when a patient enters the operating room, they're placed on the operating room table, laproscopic ports are placed under the belly and the patient's side robotic system is locked or docked onto the patient. The surgeon then sits down at the surgeon console and places their hands on the hand controls. With the surgeon's hands on the hand controls, his movements are then duplicated as robotic movements. Right is right, left is left, up is up, down is down, flexing and extending his wrist flexes and extends the instruments and opening and closing his fingers open and closes the jaws of the instruments.
Here we are inside the abdominal cavity sewing the urethra down to the bladder. These instruments are 2 millimeters at the tip and 8 millimeters in diameter. You can see how large they look and the precision with which we're able to operate inside the small contained space.
Remember, the da Vinci robot is just a tool. It's not a replacement for surgical skill. If you choose da Vinci robotic surgery, it's important that you also choose a surgeon with a high level of experience. I've been fortunate enough to perform this operation over 2,000 times on patients from over half the United States and over 10 countries. But, da Vinci surgery is not the right choice for everybody.
Prostate cancer - know your facts. Get your PSA and your rectal exam done every single year. You want to start this at age 50 for most men and age 40 for men who have a family history or who are African American.
We want to look for a PSA that's too high or a PSA that rises by more than .75 in a one year period of time. If this happens, then further measures need to be taken to make sure that you don't have prostate cancer.
If you are diagnosed with prostate cancer, take the time, learn the facts. If you decide that robotic surgery is right for you, there are some advantages to the patient but you have to make sure that you choose a surgeon with a high level of experience.