Gala Event - International Prostate Cancer Foundation

Link to Gala Information

Article in Orlando Sentinel This Weekend

New prostate cancer foundation pushes awareness, research

March 03, 2012|By Kate Santich, Orlando Sentinel

A renowned prostate-cancer surgeon is working to make Central Florida the global epicenter of the battle against the disease — the No. 2 cancer killer of men — by launching a charitable foundation to promote education and research on genetic testing and more sophisticated treatment options.

Dr. Vipul Patel, the 42-year-old medical director of the Florida Hospital Global Robotics Institute in Celebration, has operated on more than 5,000 men from around the world, including NBA Hall of Fame basketball player Oscar Robertson — who is now on Patel's board of directors and joining his public-awareness campaign.

"There's still a stigma about prostate cancer," Patel said. "Until five or 10 years ago, when someone got diagnosed with prostate cancer, it was a life-altering thing. Many died, and others had treatment that either left them impotent or incontinent."

Through his International Prostate Cancer Foundation, Patel hopes to raise an initial $5 million to start early-screening programs and online education. He also has recruited board members from the University of Central Florida College of Medicine, the Sanford-Burnham Medical Research Institute and an A-list of Central Florida business leaders, including defense attorney Mark NeJame.

The legwork on the foundation already was underway last October when a government task force advised against routine prostate screening, saying the current tests do not save men's lives and often lead to unnecessary and potentially harmful treatment. The position outraged many urologists, including Patel.

"Screening saves lives — that's the message we want out," said Patel, who wrote a position paper against the task force's advisory.

'Major problem'

In 2012, nearly 250,000 American men will be diagnosed with prostate cancer, said Ranjan Perera, scientific director of genomics and bioinformatics at Sanford-Burnham, and a founding member of Patel's charity. And more than 28,000 will die from the disease.

"Prostate cancer is a major problem," said Perera. "So what is extremely important at this moment is prostate-cancer awareness."

Patel, Perera and Dr. Kristiina Vuori, president of Sanford-Burnham, already are writing grant proposals for prostate-cancer research. Their hope is to use such advanced technologies as next-generation DNA sequencing to pinpoint which tumors are likely to be aggressive and to decide the best and most targeted way to treat them.

"Ever since PSA screening was implemented a decade ago, the death rate from prostate cancer has gone down. Every year it has gone down," Patel said. "But even with that, prostate cancer is the No. 1 [non-skin] cancer diagnosed in men, and it's the second-leading cause of death. So if we get rid of screening, it will become the No. 1 cause of death — by far."

PSA, or prostate-specific antigen, is a protein often found in elevated amounts in the blood of patients with prostate cancer. In 1994, U.S. health officials approved the PSA as a screening method; since then, there has been both a dramatic increase in the diagnosis of prostate cancer and a significant drop in the death rate. Typically, doctors use both the PSA blood test and a digital exam of the rectum to screen for the disease.

The problem is that neither elevated PSA levels nor an enlarged prostate detected during the digital exam definitively indicate cancer. And even if there is cancer, the task force said, many times it grows so slowly that men will die of other causes long before their prostate disease becomes a problem.

Still, Patel, his foundation and many fellow urologists say the tests can provide essential information, at least as a point of comparison for monitoring men over time. And they insist that advances in surgery, radiation and chemotherapy have both improved chances for survival and lowered the risk for devastating side effects.

'Being foolish'

"Men should have this checked out so they can find out what's in their body," said Robertson, who is convinced that routine screening — and the subsequent surgery by Patel — saved his life. "If they don't, I think they're being foolish."

Robertson, 73, knows many men are reluctant, both because of the invasive nature of the digital exam and because of what may happen if cancer is detected. But he hopes to be a catalyst to change that mentality.

For one thing, African-American men are more than twice as likely to die of prostate cancer than white man. Partly, Patel said, that's because they're less likely to be screened, but also because they're genetically predisposed to more aggressive tumors.

NeJame applauds Robertson's decision to discuss his experience publicly.

"This is the male equivalent of breast cancer," NeJame said. "You know, it took countless brave women to come out and talk about breast cancer, and now men need to come out and talk about and help educate the public about prostate cancer."

The American Urology Association, which "strongly opposes" the task-force opinion, continues to recommend that men over 40 have the option of PSA screening but that they be informed of both the benefits and the potential risk of "over-detection and overtreatment." Patel agrees.

"Our perspective is: The decision to treat or not to treat should be made after diagnosis. And it should be made by the patient in consultation with his physician." Patel said. "But just denying men screening and denying them the right to know doesn't really make sense."

ksantich@tribune.com or 407-420-5503

Foundation gala

The International Prostate Cancer Foundation will host its inaugural Celebration of Life Gala on March 10 at the Waldorf Astoria-Orlando. For more information, go to fightingprostatecancer.com.

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Response to Sun Sentinel Article with MisInformation

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

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!

World Robotic Symposium -- April 11-14, 2010

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

“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.”