VIP Friends Online Blog

Response to Sun Sentinel Article with MisInformation

2011-09-22T17:10:00.003-04:00

Last week, The Sun Sentinel in South Florida featured an article on alternative method of prostate cancer treatment. The article contained comments of misinformation and so we responded with a Letter to the Editor. The Sentinel did not publish the article, so we thought we'd provide it here for reader review and comments.

Original article link is HERE

Our response is as follow:

Subject: Reader Response to Story, Prostate Cancer Surgery a Big Business, dated 9-11-2011

Dear Editor,

Robotic surgery for prostate cancer changes everything… saving lives, advancing medicine by leaps. I know, I am a PC survivor and a volunteer robotics surgery advocate (www.VIPfriendsonline.com ). Your article, Prostate cancer surgery a big business, but at what cost? that was published September 11, 2011 is irresponsible reporting which cites only one man’s opinion (a physician who studied in the 1970s, wayyyy before technology advanced and the medical procedure for robotic prostate cancer treatment was even invented). Dr. Vorstman’s 30 years of experience staying the course of conservativism and tradition just might be a problem. Your article begs for redress and the other side of the story.

1. The first sentence of your article state, “Amid these numbers, and the fear and uncertainty they spawn, a booming, lucrative business has emerged around what some consider an often overly aggressive treatment, one with unproven results and the possibility of increased risk of lasting effects on sexual and urinary function.” Please cite the sources, for there is a wealth of disputing data amid 2010 and 2011 medical journals.

2. The second sentence of your article states, “And yet robot-assisted "key-hole" surgery to remove cancerous prostates has exploded in popularity as the treatment of choice in America, growing fourfold in the past four years by some estimates and far surpassing traditional laparoscopies.” Why do you think this is happening? Are people just hordes of unwashed dopes being led like sheep blindly to a slaughter house? Dr. Vorstman uses terms like “Russian Roulette” and “a direct assault on manhood” in the white paper touted in the Sun’s article – and he says in your article that the use of “clever” marketing is steering people down a wrong path. Could so many people be so duped as Vorstman alleges? Or could it be a more sophisticated patient does his research and makes competent choices? I challenge you to ask those who chose robotic surgery as to their experience and outcomes. You’ll find that the majority are educated, deliberate decision-makers who favor robotics based on facts and not schemes.

3. Dr. Vorstman’s 32 page white paper is, in and of itself, a marketing tool and persuasive piece of layman scare tactics (a technique to which he accuses his competition of using). The language in the paper uses marketing “jargon” that lacks academic quality or supporting citations. Vorstman is upping his face time by issuing his own press releases as if they were news by the AP, and posting videos on his website (again, the same marketing techniques he criticizes).

4. The referenced “Johns Hopkins Study” in your article regarding outcomes was flawed. Please contact me for clarification – I can put you in touch with data that shows the misinterpretation to clarify the truth.

Two other points in your article are contradictory,

5. You describe Dr. Vorstmans’s hifu treatment, noting that the FDA considers it experimental. You compare this to the robotic surgery approach, which is a fairly recent phenomenon. Hello kettle, you’re black.

6. Within your article, there is a seeming slam against profitability in this business (robotics) and in the same breath you state that Vorstman has investment share in his equipment. Ahem! Say that again? Where I come from, we call that kickbacks.

As a prostate survivor who is cancer-free almost three years, I am completely continent with no erectile dysfunction and that is because of robotic surgery... something that any patient going with the outdated/passé Vorstsman technique cannot say for certain. I implore you with urgency to give equal time to the advocates of Robotic Surgery. I highly recommend you contact the Global Robotics Institute of Florida, Dr. Vipul Patel. His web address is: www.globalroboticsinstitute.com If I can be of assistance in preparing your responsible and clarifying a new article, please feel free to contact me.

Sincerely,

Ralph E. Jordan
Survivor
Advocate for Robotic Prostatectomy
Volunteer President
www.VIPFriendsOnline.com
Email: rjordan@vipfriendsonline.com

VIPFriendsOnline.com & Dr. Patel Mentioned in Orlando Medical News Articles

2010-12-09T23:38:00.007-05:00

Two articles appeared this week in Orlando Medical News, an online professional health care website. Links to the full articles are provided below and comments welcomed!

Paging Dr. Patel
By: LYNNE JETER
Posted: Friday, December 3, 2010 10:30 am
Prostate Cancer Survivor Shares Flip Side of Patient Chart. DUNEDIN—On Jan. 3, 2008, Ralph Jordan, a healthcare professional in his mid-sixties from Dunedin, became the first patient for a robotic-assisted prostatectomy at Florida Hospital’s Global Robotic Institute in Celebration. Six months earlier, a routine test had revealed an elevated PSA of 4.2. A biopsy followed; prostate cancer was detected and confirmed. READ MORE

Raising the Bar
By: LYNNE JETER
Posted: Friday, December 3, 2010 10:30 am
Vipul Patel, MD, Passes 4,000 Mark for Prostate Removal Surgeries via DaVinci Robot. CELEBRATION—Institutions with multiple surgeons have performed more prostate removal surgeries via the daVinci robot, but no single surgeon has come close to the record set recently by Vipul Patel, medical director of Florida Hospital’s Global Robotics Institute in Celebration. In mid-October, the world-renowned surgeon from Central Florida hit the 4,000 mark. READ MORE

September is National Prostate Cancer Awareness Month!

2010-09-13T11:50:00.006-04:00

World Robotic Symposium -- April 11-14, 2010

2010-04-08T14:11:00.000-04:00

The Global Robotics Institute and the Society of Robotic Surgery is being held in Orlando, FL this week.

Website: http://www.globalroboticsinstitute.com/en/symposium-2010

This event highlights the tremendous impact from the introduction of robotic surgical technology, and the challenges we face ahead.

Results Unproven, Robotic Surgery Wins Convert

2010-02-17T09:36:00.000-05:00

“I have not seen anyone who has done a good amount of robotic surgery go back,” said Dr. Vipul Patel, who has done more than 3,500 robot-assisted prostate surgeries.

February 14, 2010
Source: http://www.nytimes.com/2010/02/14/health/14robot.html?sq=robotic%20surgery&st=cse&scp=1&pagewanted=all
By GINA KOLATA
At age 42, Dr. Jeffrey A. Cadeddu felt like a dinosaur in urologic surgery. He was trained to take out cancerous prostates the traditional laparoscopic way: making small incisions in the abdomen and inserting tools with his own hands to slice out the organ.

But now, patient after patient was walking away. They did not want that kind of surgery. They wanted surgery by a robot, controlled by a physician not necessarily even in the operating room, face buried in a console, working the robot’s arms with remote controls.

“Patients interview you,” said Dr. Cadeddu, a urologist at the University of Texas Southwestern Medical Center at Dallas. “They say: ‘Do you use the robot? O.K., well, thank you.’ ” And they leave.

On one level, robot-assisted surgery makes sense. A robot’s slender arms can reach places human hands cannot, and robot-assisted surgery is spreading to other areas of medicine.
But robot-assisted prostate surgery costs more — about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same.

One large national study, which compared outcomes among Medicare patients, indicated that surgery with a robot might lead to fewer in-hospital complications, but that it might also lead to more impotence and incontinence. But the study included conventional laparoscopy patients among the ones who had robot-assisted surgery, making it difficult to assess its conclusions.
It is also not known whether robot-assisted prostate surgery gives better, worse or equivalent long-term cancer control than the traditional methods, either with a four-inch incision or with smaller incisions and a laparoscope. And researchers know of no large studies planned or under way.

Meanwhile, marketing has moved into the breach, with hospitals and surgeons advertising their services with claims that make critics raise their eyebrows. For example, surgeons in private practice at the New Jersey Center for Prostate Cancer and Urology advertise on their Web site that robot-assisted surgery provides “cancer cure equally as well as traditional prostate surgery” and “significantly improved urinary control.”

Robot-assisted prostate surgery has grown at a nearly unprecedented rate.
Last year, 73,000 American men — 86 percent of the 85,000 who had prostate cancer surgery — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical, the only official source of such data. Eight years ago there were fewer than 5,000, Intuitive says.
Dr. Sean R. Tunis, director of the Center for Medical Technology Policy, a nonprofit organization that evaluates medical technology, said few other procedures had made such rapid inroads in medicine.

Medical researchers say the robot situation is emblematic of a more general issue. New technology has sometimes led to big advances, which can justify extra costs. But often, technology spreads long before investigators know whether it is worthwhile.

With drugs, the Food and Drug Administration requires extensive tests to determine safety and efficacy. But surgeons are free to innovate, and few would argue that surgery can or should be held to the same standards as drugs. Still, a situation like robot-assisted surgery illustrates how patients may end up making what can be life-changing decisions based on little more than assertive marketing or the personal prejudices of their surgeon.

“There is no question there is a lot of marketing hype,” said Dr. Gerald L. Andriole Jr., chief of urologic surgery at Washington University. Dr. Andriole does laparoscopic prostate surgery, and although he tried the robot, he went back to the old ways.

“I just think that in this particular instance, with this particular robot,” he said, “there hasn’t been a quantum leap in anything.”

Evaluating technology is complicated. As often happens in surgery, doctors can become enthusiasts without rigorous studies ever being done.

And with prostate cancer, more is at stake than just an academic dispute, said Dr. Jason D. Engel, director of urologic robotic surgery at George Washington University Medical Center in Washington. One in six American men develop prostate cancer in their lifetime. Treatment options include radiation and watchful waiting, but the most popular is surgery.

“With the stream of prostate cancer patients that come through,” Dr. Engel said, “this is a big, big business.”

Dr. Michael J. Barry, a professor of medicine at Massachusetts General Hospital in Boston, said that once a hospital invests in a robot — $1.39 million for the machine and $140,000 a year for the service contract, according to Intuitive — it has an incentive to use it. Doctors and patients become passionate advocates, assuming that newer means better.

“Doctors and medical centers advertise it, and patients demand it,” Dr. Barry said, creating a “folie a deux.”

The robot’s ability to reach into small spaces comes with tradeoffs. Ordinarily, doctors can feel how forcefully they are grabbing tissue, how well they are cutting, how their stitches are holding. With the robot, that is lost. And the robot is slow; it typically takes three and a half hours for a prostate operation, according to Intuitive, twice as long as traditional surgery.

A few highly experienced doctors are much faster. Dr. Vipul Patel, for example, at Florida Hospital in Celebration, Fla., has done more than 3,500 robot-assisted prostate surgeries. He often does six a day, taking about one and a half hours for each.

“From Day 1, when I sat down at that robotic console, I knew we would give patients a better outcome,” Dr. Patel said. “I have not seen anyone who has done a good amount of robotic surgery go back.”

Dr. Patel also started The Journal of Robotic Surgery to provide a forum, he said. Dr. Engel said he and others who use robots welcome it. They had had difficulty getting published in traditional journals, Dr. Engel said.

But papers in the new journal tend to report on one surgeon’s experience. Studies like that, which were also published in the past to promote traditional surgery, have methodological problems — biases in patient selection and evaluation are likely and, because the surgeons tend to be much better than average, it is hard to generalize.

In contrast, the national study of Medicare patients from 2003 to 2007, by Dr. Jim C. Hu of Brigham and Women’s Hospital in Boston, included 6,899 men who had surgery with four-inch incisions and 1,938 who had laparoscopic surgery, many with a robot.

The study was not ideal — patients were not randomly assigned to have one type of surgery or another, and laparoscopic operations done without a robot were included with the robot-assisted ones because Medicare did not distinguish between the two. But it is the only large national study that compares what is thought to be a largely robot-assisted surgery group with a group that did not have a robot.

The paper, published last October in The Journal of the American Medical Association, found that laparoscopic surgery patients had shorter hospital stays, lower transfusion rates and fewer respiratory and surgical complications. But they also had more incontinence and impotence.
It is not known whether the extra costs of robot-assisted surgery are balanced by lower costs for shorter hospital stays and fewer surgical complications.

Experts in robotic surgery say studies like Dr. Hu’s can be misleading. Medicare data, they say, include results from surgeons who may have little experience with robots.

Dr. Barry, an author of Dr. Hu’s paper, said Medicare data reflect the real world. “Everyone tends to cite data from centers of excellence as though they were their own,” he said.
Highly skilled surgeons, like Dr. Ashutosh K. Tewari at Weill Cornell Medical College in New York, say it takes about 200 to 300 robot-assisted operations to become highly proficient. Dr. Tewari has done 3,200.

Surgeons who do nonrobotic prostate surgery agree.

“What happens is that if you take leading experts, whether they do open or robotic, they are going to get good results,” said Dr. Herbert Lepor of New York University, who has done more than 4,000 traditional open prostatectomies.

“I say robotic surgery has to be better to justify its learning curve,” Dr. Lepor said, “to justify its unknown cancer control, to justify its increased cost.”

Both traditional surgeons and those who do robot-assisted surgery point to patients who did extremely well.

Among them is James Lamb, a 40-year-old New York City police officer who had robot-assisted surgery with Dr. Tewari on Jan. 5. Two days later, while he was in the hospital and still had a catheter in his penis, Officer Lamb had an erection.

Two days after that, Officer Lamb said, he was home and had sexual intercourse. (In one study by Dr. Barry, which surveyed patients a year after surgery, only half the men, regardless of surgical method, were back to their presurgery potency a year later, with or without the use of a drug like Viagra.)

But, Dr. Barry and Dr. Tewari note, an extraordinary patient or two can be misleading. “The message for patients is not to assume that newer is better,” Dr. Barry said. Measures like the number of operations a surgeon has done “still matter a lot,” he said.

Dr. Cadeddu, though, said that sort of message is falling on deaf ears. Patients want the robot. So Dr. Cadeddu has now begun offering robot-assisted surgery to those who want it.

“The battle is lost,” Dr. Cadeddu added. “Marketing is driving the case here.”

Great Resource for Tracking Your Cancer Journey, Medical Records, Medication Schedule

2010-01-19T11:26:00.000-05:00

An article in today's news announces the launch of a website called Navigating Cancer which helps patients navigate cancer. A link to the site is being added to our website, vipfriendsonline.com. There is information specific to prostate cancer. Please feel free to post your comments here about this resource.

A copy of the article is reprinted here:

Source: Click for Article

New site helps cancer patients network, improve treatments
January 18, 2010 | Camille Ricketts | Venture Beat

Navigating Cancer, an organization dedicated to helping cancer patients find the best treatment options, has just launched a new, free web site to help its target audience keep track of their medical records, work more closely with their physicians and find other patients going through the same thing. The idea is to give users the information they need to take charge of their health.

The web site, in its beta version, offers all of these resources — including encyclopedic information on cancer and related topics — for free. Often, as part of people’s treatment plans, physicians will provide them with contacts who have battled cancer in the past. Hearing first-hand experiences from someone else has proved very therapeutic in the recovery process. Navigating Cancer aims to make it even easier to forge these connections via forums on its site. Peer organizations like the Caring for Carcinoid Foundation, Cancer Lifeline and Prostate NET will be running group discussions on the site.

Armed with knowledge from reputable sources like the National Cancer Institute — not regular WebMD or other, more casual sites — patients will have the ability to ask their doctors more informed questions, and inquire about a full range of options so they can make sure they are getting the best care for their specific needs, the organization says.

The other major aspect of the web site, the ability to create and save detailed medical records, fits into the trend toward a more digital medical system. Just as President Barack Obama urges the need for electronic medical records, Navigating Cancer and others are allowing patients to easily keep tabs on their own health data and development.

The Navigating Cancer site lets users enter basic health information, prescriptions, doctors appointments and more so that nothing will go forgotten. On top of that, it includes a Daily Health Tracker that patients can use to record their symptoms and any treatment side effects on a day-to-day basis. All of this information could come in handy at their next doctor’s appointment. Navigating Cancer says that all of this information is kept extremely secure.

The next step is to allow patients and physicians to securely share this information on the internet. That way, doctors can keep an eye on patients and any treatment irregularities without constant checkups. Navigating Cancer is working on integrating these features soon.

Dr. Patel has Performed the Most Robotic Prostatectomies in the World

2010-01-14T12:26:00.001-05:00

The article below suggests that if you're thinking about having prostate surgery, you might want to consider a surgeon who has performed at least 80 robotic surgeries to ensure the best outcome. Er.... say again? Was that 80?

How about closer to the 3,000 surgeries range that Dr. Patel has successfully performed?

Here's a recent article

Robot prostate surgery has downsides, needs more data

Mon, Jan 11 2010

NEW YORK (Reuters Health) - Considering having a surgeon remove your cancerous prostate using a robot? You might want to see a surgeon who has done at least 80 operations for the best results, according to the authors of a new research review.

And while the robot-assisted operation is now the "dominant approach" to this surgery in the US and is gaining popularity in other wealthy nations, there's still too little information on how patients fare after the surgery, Dr. Declan G. Murphy of the Peter MacCallum Cancer Center in Melbourne, Australia and his colleagues write.

Laparoscopic surgery, in which a surgeon performs the operation through small incisions, usually with the help of a surgical robot, has been touted as carrying a lower risk of incontinence and impotence than the standard "open" form of the surgery.

But a US study on nearly 9,000 men published in October 2009 found that while open and minimally invasive surgery were equally good for getting rid of prostate cancer, the risk of incontinence and impotence was higher with the minimally invasive approach.

In the current study, Murphy and his team looked at 68 studies of robot-assisted laparoscopic surgery to better understand its downsides. Lack of information on outcomes isn't only a problem for robot-assisted surgery, but "bedevils" the scientific literature on prostate removal overall, the researchers note in the journal European Urology.

In about one in 250 surgeries, the robot failed to work properly. There was also a lack of data on how well patients functioned after surgery, and how patients with high-risk prostate cancer fared long-term.

And while some studies showed low complication rates, the researchers add, those rates went up when doctors used a standardized approach to reporting complications. The authors did not compare robotic surgery complication rates to traditional surgery rates.

The researchers also found that surgeons who have done fewer than 20 of the robot-assisted procedures can achieve "acceptable operating times." Keeping surgeries shorter is a goal because it usually means fewer complications. It may be necessary, however, for surgeons to do 80 or more procedures to ensure that they do not leave cancerous tissue behind.

Also, the researchers add, robot-assisted surgery is no easier to perform and has no better outcomes in patients with conditions that can worsen surgical outcomes, such as being obese, having a large prostate, or having had previous surgery in the area.

Finally, the researchers note, expenses associated with the procedure--the robot costs at least 1.8 million ($2.6 million) to install, 100,000 ($145,000) a year to run, and 1,500 ($2,200) extra for each surgical case-mean the procedure is "prohibitively" expensive "for many hospitals and indeed many countries."

The researchers conclude: "The significant learning curve should not be understated, and the expense of this technology continues to restrict access to many patients."

SOURCE: European Association of Urology, online December 16, 2009

NEW! VIP Friends Online MESSAGE BOARD

2010-01-14T11:47:00.000-05:00

HAPPY NEW YEAR!

We are pleased to tell you what's new at our website. Visit the NEW VIP Friends Online MESSAGE BOARD to interact with others about what matters most to you on the topic of prostate cancer:

CLICK HERE

Tell us what you think!

In the News.... Coffee May Lower Risk of Aggressive Prostate Cancer

2009-12-21T20:59:00.000-05:00

Jody A. Charnow

December 08 2009

HOUSTON—Drinking regular or decaffeinated coffee is associated with a reduced risk of advanced prostate cancer, new research suggests.

“Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer,” said Kathryn M. Wilson, PhD, a postdoctoral fellow at the Channing Laboratory in Boston.

She and her colleagues found that men who drank the most coffee had a 59% decreased risk of either lethal or advanced prostate cancer compared with men who drank no coffee. The magnitude of risk reduction was more pronounced in men who never smoked; in this group, the biggest coffee consumers had an 89% decreased risk compared with men who did not drink coffee.

Dr. Wilson, who presented study findings at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference in Houston, said caffeine is not the key factor in this association.

The researchers analyzed data from men who participated in the Health Professionals' Follow-Up Study. They documented the regular and decaffeinated coffee intake of about 50,000 men every four years from 1986 to 2006. Prostate cancer developed in 4,975 men during this period.

“Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be exciting if this association is confirmed in other studies,” Dr. Wilson said. “While it is too early to recommend increasing coffee intake based on this study alone, our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”

Article Source

In Todays News: Robotic-assisted surgery speeds recovery from prostate removal

2009-09-22T14:03:00.000-04:00

By Body and Mind staff
September 22, 2009, 12:00AM

Submitted photo: The da Vinci Surgical System uses a console with a magnified image of the operative field that allows doctors to see through small incisions in the skin.

Robotic-assisted surgery means fewer complications, a shorter hospital stay and quicker recovery for men with prostate cancer.

Using the da Vinci Surgical System, doctors can do a prostatectomy, or removal of a cancerous prostate gland, with greatly enhanced precision and a 3-D view of the patient's anatomy.

"The da Vinci allows us the ability to use articulation of the wrist, hands and fingers so that we're operating with the same finesse as with live, hands-on surgery but with a lot less blood loss," said Dr. R. Scott Owens, a urologist at Urology of Central Pennsylvania in Camp Hill. "The patient can go home in 24 to 48 hours and get back to normal activities in three to four weeks, rather than six to eight weeks."

A console that displays a magnified 3-D image of the operative field allows doctors to see depth and detail as they manipulate the instruments -- essentially a robotic hand and wrist -- through small incisions in the skin.

With colleague Dr. Christopher Moyer, Owens will be presenting "The Age of Robotic Surgery" on Sept. 28 at a prostate cancer awareness event at Holy Spirit Hospital.

For patients with localized prostate cancer, there are five options for treatment, Owens said. They are: surveillance, using the prostate-specific antigen (PSA) blood test; external radiation; insertion of radioactive seeds, or pellets, into the prostate; cryosurgery, which involves freezing the prostate to minus 40 degrees Celsius to kill normal and cancerous tissue; or radical prostatectomy.

Patients and their doctors decide on the best option depending on the patient's age, overall health status and grade or aggressiveness of the cancer, Owens said.

"Men who are good candidates for the da Vinci surgery are those under age 70 with localized prostate cancer and who have low, medium or high grade cancer," Owens said.

Incontinence and impotence are two complications of conventional open surgery that scare men away from it. With da Vinci, surgeons are beginning to see decreased incidence of those, making the decision to have surgery less intimidating, Owens said.

"If you're 50 and you have a higher grade cancer, you want that prostate out of there for a better chance of cure. With radiation, you never know, did it get all the cancer?" Owens said. "If you're 70, surgery has potentially higher risks and radiation is a safer alternative with less impact on quality of life."

Although both da Vinci and conventional laparoscopic surgery are minimally invasive because they use small incisions, da Vinci instruments allow doctors a much greater range of motion as they manipulate tissue.

Before da Vinci, most doctors were still doing open surgery involving large incisions because conventional laparoscopic surgery was so technically challenging, Owens said. Now, the da Vinci robotic surgery is used in about 70 percent to 80 percent of prostate cancer surgeries, he said.

In 2006, a Patriot-News report indicated da Vinci was used in about 25 percent of prostate removals nationwide.

Gynecologic and heart surgeries are also done using da Vinci, and it is likely to be used for many more types of surgery in the future, Owens said.

Holy Spirit Hospital, which purchased its da Vinci this summer, has the latest model with upgrades in technology and ergonomic improvements, he said.

Versions of the robotic surgical device, made by Intuitive Surgical, have been on the market since 1998. PinnacleHealth System acquired a da Vinci at Harrisburg Hospital in 2006 and has used it in prostate surgeries, according to The Patriot-News archives. Carlisle Regional Medical Center also offers surgery with the da Vinci.

Prostate cancer is the most common non-skin related cancer in American men and the second-leading cause of cancer death in men, according to the American Cancer Society.

Some Recent Prostate Cancer Support Happenings

2009-08-28T19:49:00.001-04:00

Last Night Tennis Great John McEnroe talked with Sean Hannity on Fox TV's, The Hannity Show, about the prostate cancer awareness campaign he launched (Link to News Video).

McEnroe's website is Prostatecancerwatch.com

I had the pleasure of seeing Sean Hannity a week ago in Atlanta at the Freedom Concert and took a moment to drop him a line. I also wrote McEnroe to applaud his efforts (his father had prostate cancer) and in an effort to publicize our website and blog, to share that we maintain personal success stories at the site. I would love to find a way to share links and, of course, get some exposure of our website in an effort to educate. I asked if there is anything we can do together.

As we identify good sources of information regarding prostate cancer information, I want to post links and articles and more personal stories for our readers. Please feel free to reply to this blog entry to comment about any suggestions you may have to help us enhance what we do as a volunteer support group. Or, feel free to email me directly.

Ralph E. Jordan
Founder
Vipfriendsonline.com
Email: Rjordan@vipfriendsonline.com

In Today's News: Dr. Vipul Patel on Robotic Surgery

2009-08-13T14:35:00.000-04:00

Florida Hospital doctor an expert in robotic surgery to treat prostate cancer

Surgeon Vipul Patel's success is model for prostate-cancer surgery -

Fernando Quintero, Sentinel Staff Writer

August 13, 2009 - In the field of robotic prostate- cancer treatment, Florida Hospital surgeon Vipul Patel is a rock star.

Patel, who has performed the most robotic surgeries in the world, is an internationally recognized expert in a type of surgical procedure less invasive than traditional prostatectomies. Men who undergo the surgery are more likely to maintain their bladder control and sexual function.

Patel's patients are a very appreciative bunch.

Dunedin businessman Ralph Jordan is president of Patel's fan club. He was the doctor's first patient at Celebration Health, part of the Florida Hospital system. Jordan was so pleased with Patel's surgical skill and bedside manner that he started a Web site, vipfriendsonline.com. The site is filled with glowing testimonials from Jordan and other patients.

"It seems like when someone literally helps cure you of cancer, you feel this need to give back," said Jordan, 68.

Patel is largely the reason Florida Hospital's Cancer Center is one of five programs recently selected to participate in the Association of Community Cancer Centers' prostate-cancer best-practices project. Florida Hospital, where Patel is medical director of the Global Robotic Institute, will learn and share information about model prostate-cancer programs across the country.

"The need for education and support for prostate care is clearly unmet in many communities," said the association's executive director, Christian Downs.

The best-practices project, funded by Pfizer Inc. pharmaceuticals, is designed to help hospitals and other medical facilities across the country improve prostate-cancer care, Downs said.

More than 185,000 men developed prostate cancer, and nearly 29,000 died from the disease in 2005, according to the most recent data available from the Centers for Disease Control and Prevention. In Florida, there were 13,253 cases and 2,154 deaths.

Dexterous robot

Patel, who has performed more than 3,000 operations on men locally and worldwide, uses a robotic system called da Vinci to remove cancerous tumors. Seated at a console just a few feet from the operating table, Patel pushes a joystick and foot controls to remotely manipulate robotic arms at the bedside. One arm positions a three-dimensional, high-resolution camera, while the other two arms control tiny surgical instruments.

Patel said the robot can remove a cancerous prostate with less anesthesia, less blood loss and need for transfusion. More important, robot-assisted prostatectomies are less likely to cause nerve damage that can lead to permanent incontinence and impotence.

Patient outcomes are the best indicator of a model prostate-cancer care, Patel said.

"Best practices isn't just about the type of surgical option you use, it's about the type of physicians you select, it's the nursing care, it's the support you get from administration," he said, commenting on Florida Hospital's best-practices recognition. "They all combine to provide the best level of care."

Patel supports a multidisciplinary approach to prostate-cancer care in which patients not only visit with their surgeon, but they also are seen by a urologist, radiation specialist and medical oncologist.

"Men should have experts to inform them about their best treatment options, provide second opinions," Patel said. "Thinking that your only option is to have open surgery and lose your sexual function is not acceptable."

As for Jordan and his other devotees, Patel said they represent a growing trend among men diagnosed with prostate cancer.

"Prostate cancer is coming into its own in terms of the level of knowledge and the level of public awareness," Patel said. "Men are doing their homework and asking questions."

Did his research first
When Jordan was diagnosed with cancer in July 2007, a local urologist recommended he undergo a traditional radical prostatectomy right away.

"Thank God I knew enough to do a little research first," Jordan said.

He learned that there was a variety of treatment approaches. In addition to a radical prostatectomy, where the entire prostate gland and nearby lymph nodes are removed, some doctors employ radiation therapy.

A device like an X-ray machine is used, or radioactive pellets called "seeds" are injected into the prostate gland.

For slow-growing cancers, some doctors recommend simply monitoring the tumor.

Jordan learned his tumor was growing slowly, and that he had time to determine what was best for him. In his research, Patel's name kept popping up.

Jordan, whose company specializes in outsourcing specialized surgical personnel, also contacted the manufacturer of the robot Patel uses in his surgeries.

Again, Patel got rave reviews.

"When he actually called me at home one night to talk to me about my surgery, that sort of clinched it," Jordan said.

Willing to open up
Dr. Richard Reiling, an advisory member to the best-practices project and former president of the Association of Community Cancer Centers, applauds men such as Jordan for seeking out information and sharing it with other men.

"It used to be something men didn't talk about because it meant discussing things like incontinence, erectile dysfunction and that uncomfortable exam in your doctor's office," Reiling said. "But society is opening up. Men are more willing to talk about things men of my generation once thought were too personal."

Fernando Quintero can be reached at fquintero@orlandosentinel.com or 407-650-6333.

By the numbers
185,000 men developed prostate cancer.
29,000 died from the disease in 2005, according to the most recent data available from the Centers for Disease Control and Prevention.
13,253 cases in Florida.
2,154 deaths in Florida.

On the Controversy of PSA Testing - Comments Welcomed!

2009-08-13T13:13:00.000-04:00

Recently, FOX News in Orlando, FL Reported on Reports that PSA Test Results (if elevated) may cause men to overreact unnecessarily and that elevated PSA rates may not be reliable. Here is a video interview with Dr. Patel and includes an interview with Ralph Jordan, Founder of VIP Friends Online. Comments Welcomed!

Post-Op Expectations about Sexual Function - Article Reprint

2009-07-29T08:58:00.000-04:00

Post-radical prostatectomy expectations
about sexual function unrealistic

By Mac Overmyer

Patient education about post-surgical outcomes is necessary

Chicago—A significant number of patients undergoing open or robotic radical prostatectomy have unrealistic expectations regarding postoperative sexual function, according to a study from Weill Cornell Medical College, New York.

The study, presented here at the AUA annual meeting, found that many patients were unaware that the prostatectomy would lead to an inability to ejaculate, and "almost none understood that there are documented orgasm changes or that radical prostatectomy may be associated with Peyronie's disease," the authors wrote.

"I think there are many patients who just have false expectations going into their prostate surgery," senior author John Mulhall, MD, who was an associate professor of urology at Weill Cornell at the time of the study, told Urology Times. "They think they are going to get back to the way they were before the operation. For a significant number of men, that is just not true. They are not going to ejaculate. There are patients who are going to have orgasmic dysfunction. There are penile length loss issues, and many appear to just not know that."

The researchers posed 11 questions to 336 patients, 216 of whom had undergone open radical prostatectomy and 120 who had undergone the robotic procedure. The procedures were performed by nine different referring urologists.

Only 10% of the open procedure patients and 12% of the robot-assisted laparoscopic prostatectomy (RALP) patients said they knew that their orgasms would be different after their respective procedures. While 70% of the open surgery patients and 60% of the RALP patients understood that they would not ejaculate (produce semen) following the operation, only 2% of the RALP patients seemed to know that the procedure carried the risk that pain might accompany orgasm or that orgasm might be accompanied by urine leakage.None of the RALP patients seemed to be aware of these possible sequelae, and neither group knew that Peyronie's disease was also a potential risk of the procedure.

"What we need to do is develop a structured discussion for patients prior to treatment. We need to document that the discussion has occurred, and the patients need to be given educational material that comprehensively addresses the different and often transient sexual side effects," said Dr. Mulhall, who is currently director of the male sexual and reproductive medicine program at Memorial Sloan-Kettering Cancer Center in New York.

The study also found curious differences in responses between those undergoing the open and robotic procedures. The average open procedure patient anticipated that he would return to full sexual function in 12 months. The average RALP patient thought he would return to full function in 6 months. Half (50%) of the open patients thought they would have full recovery compared to 75% of the RALP patients. Only 20% of the open patients were aware of the potential need for intercavernosal injections to achieve erections, while only 4% of the RALP patients were aware of it.

The study was designed to establish parameters for patients' understanding of prostatectomy outcomes. It was not designed to determine the origins of their knowledge or their ignorance.

Dr. Mulhall said a number of factors might have contributed to the data. The patients may not have been adequately informed. They may have acquired misinformation about treatment outcomes from Internet sites that promote success and downplay potential adverse outcomes. They may have focused their thinking on the cancer and its treatment, and neglected consideration of treatment outcomes.

"The message, however, is clear. Patients end up after surgery not understanding what might happen to them. We should be making a structured and concerted effort to ensure these patients know what to expect," Dr. Mulhall said.

Reprinted from:
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Post-radical-prostatectomy-expectations-about-sexu/ArticleStandard/Article/detail/614300?contextCategoryId=40184

In the News - Good Survivor Rates for Prostate Cancer

2009-07-29T08:46:00.000-04:00

"A study of almost 13,000 American men who had a radical prostatectomy -- surgical removal of a cancerous prostate gland -- between 1987 and 2005 found that only 12% of them died of the cancer, according to the report in the July 27 issue of the Journal of Clinical Oncology."

Men Who Have Prostate Cancer Surgery Do Well

By Ed Edelson
HealthDay Reporter
Source: http://www.medicinenet.com

MONDAY, July 27 (HealthDay News) -- A major study has good news for men who have prostate cancer surgery but leaves unanswered the complicated question of whether a man should have that operation, another treatment or just watchful waiting.

The study of almost 13,000 American men who had a radical prostatectomy -- surgical removal of a cancerous prostate gland -- between 1987 and 2005 found that only 12% of them died of the cancer, according to the report in the July 27 issue of the Journal of Clinical Oncology.

"Patients with what we thought of as high-risk prostate cancer had a much lower risk of dying of their cancers than we ever thought," said Dr. Peter T. Scardino, chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center, and a member of the research team. "Patients with more favorable prostate cancers did remarkably well, so well that you have to begin to question whether they should have been treated."

The choice of surgery, radiation therapy or watchful waiting must be made each year for more than 190,000 American men, most middle-aged or older, who are diagnosed with prostate cancer. Most choose some kind of treatment, said Dr. Andrew Stephenson, head of urological oncology at the Cleveland Clinic's Glickman Urological and Kidney Institute, and another member of the research team. From 40% to 50% choose surgery, about 10% choose watchful waiting, and the rest choose some form of radiation therapy, Stephenson said.

For men who have surgery, the new research has produced a tool that can allow them to predict their chance of survival for at least 15 years, Scardino said. Survival is measured by essentially three elements: the clinical stage of the cancer when it is detected, determined in great part by how large it is; the Gleason score, a measure of how much of its normal structure the prostate gland has lost; and blood levels of prostate-specific antigen, a protein produced by the gland.

The study found that the score had an accuracy of 82% in predicting 15-year survival, Scardino said. "If you could predict what would happen in the stock market in the next 15 years with 82% accuracy, you would be a genius," he said.

Overall, there was a greater chance that a man in the study would die of a cause other than prostate cancer. The rate of death from other causes was 38%, compared to 12% attributed to prostate cancer.

The new predictive method will be made public soon, after medical review, so that physicians and men can learn about their anticipated survival after surgery, Scardino said.

"Any person can look at it and put in the numbers," he said.

The new predictive tool is an improvement over the existing method, which relies essentially on readings of prostate-specific antigen levels, Stephenson said.

But no such predictive method exists for newly diagnosed men who must chose between treatment and watchful waiting, and so the study presents a predicament for those men and their physicians, he said.

"It questions the lethality of prostate cancer," Stephenson said. "Perhaps a similarly low risk might have been seen if the men did not have prostatectomy. We can't say whether a cancer poses enough of a threat to the patient so that therapy is needed."

Prostate cancer surgery is not free of problems, Stephenson said. Its major side effects are incontinence and loss of sexual function.

Many prostate cancers grow slowly -- so slowly that an old medical byword is that "more men die with their prostate cancer than of it." No existing method can single out the cancers that will be fatal if left untreated.

"We really need better tools for really identifying prostate cancers that pose a threat to longevity," Stephenson said. "Many have been proposed. All are being investigated, and hopefully in the future we will have better tools that accurately predict the risk of dying from prostate cancer."

Until those tools are available, the question is often "a balance between quantity and quality of life," he added. "That is a very complicated decision that must take many factors into consideration."

SOURCES: Peter T. Scardino, M.D., chairman, department of surgery, Memorial Sloan-Kettering Cancer Center, New York City; Andrew Stephenson, M.D., head, urological oncology, Cleveland Clinic Glickman Urological and Kidney Institute, Ohio; July 27, 2009, Journal of Clinical Oncology, online

Copyright © 2009 ScoutNews, LLC. All rights reserved.

What is a Prostate?

2008-12-05T01:13:00.000-05:00

The Canadian Cancer Society asked men this question... Enjoy the video presentation which has a bit of humor to it, along with some excellent facts about the prostate.

Ralph Jordan
Founder
VIP Friends Online

What the VIP FRIENDS ONLINE Blog is All About...

2008-11-23T17:58:00.000-05:00

A Message from the Founder...

I am pleased to announce the launch of our community website, VIP Friends Online and our interactive blog targeted to prostate cancer survivors, those newly diagnosed, researchers, medical professionals, hospital employees and other interested parties. First our community website, VIP Friends Online was created for information and referral for all prostate robotic surgery candidates and prospective patients of The Global Robotics Institute and Dr. Vipul (VIP) Patel. The VIP Friends Online BLOG is an extension of the website and includes articles and commentary on specific topics of interest. Not unlike the message board seen at the main website, here is a place to freely communicate and share stories, but what is different than the message board is that we will be providing intensive coverage on articles and issues published in the industry.

Blogging is one of the hottest trends on the Web. Blog is short for “Web log", which describes a forum in which the blog manager may share news, photos, editorial, industry trends, business advice and more.

VIP Friends Online is utilizing this forum specifically to provide readers news and the latest happenings in the industry specifically related to prostate cancer and robotic surgery with occasional guest spots and ongoing editorial articles. Our intent is to keep readers up to date with events in their areas of expertise or interest--all in one place in an interesting format.

We hope you'll blog along with us. The VIP Friends Online Blog will hopefully provide you good reason to join a conversation on issues about which you care. Participation through commenting makes industry information that much more interesting.

Welcome!

Ralph E. Jordan

Founder

VIP Friends Online

Welcome to Our New Blog

2008-11-21T09:39:00.000-05:00

From time to time we will post items of interest, articles, editorials, issues of interest. Your comments are always welcomed. Our new website VIP FRIENDS ONLINE is currently under construction. Stay tuned for updates!

Doreen
Webmaster
VIP Friends online
www.vipfriendsonline.com