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Prostate Cancer

More than 230,000 men will be diagnosed with prostate cancer this year, and about one in seven men will be diagnosed with this disease some time in his life. But thanks to improvements with surgery, radiation, chemotherapy and other treatments, many prostate cancer patients can overcome prostate cancer to lead long, productive lives.
 
City of Hope’s multidisciplinary staff can assess and treat prostate cancer in all stages, from localized to recurrent and advanced disease. Our Prostate Cancer Program focuses on providing the most advanced, compassionate care while actively investigating promising new therapies. The goal: to eradicate prostate cancer and help you recover faster, with fewer side effects. 
 
 
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in the research and treatment of prostate cancer. With our decades of experience, specialized therapy protocols and extensive program of clinical trials, newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their needs and gives them the best chance for survival. U.S.News & World Report also named City of Hope as one of the top cancer hospitals in the country for the 11th year.
 
 
City of Hope is a leading center for prostate cancer treatment, offering novel therapies that can improve chances of survival with fewer side effects. Some of our leading edge therapies include:
 
  • High-precision, robotic-assisted prostate surgery, which offers unparalleled surgical accuracy to improve postoperative recovery. Our doctors have performed more advanced procedures for prostate cancer than any other facility on the West Coast.
  • Our team of experts was the first in the western United States to offer Helical TomoTherapy — a targeted radiation therapy that kills cancer cells while minimizing damage to neighboring healthy tissue.
  • For patients with recurrent, advanced or metastasized prostate cancer, our clinical trials offer promising treatments not available elsewhere using either newly-developed agents or novel combinations of existing drugs.
  • Active Surveillance - For those men with low-grade tumors, City of Hope specialists may recommend active surveillance. Our specialists will determine the best course of treatment balanced with each man’s vision of a quality life beyond diagnosis.
 
 
In collaboration with other departments and cancer centers, City of Hope’s prostate cancer program has an active portfolio of prostate cancer clinical trials studying novel treatments, including trials of new surgery, radiation and chemotherapy regimens that are more effective against the disease and/or less harmful to the patient. Many of these promising therapies are only available to patients being treated at the City of Hope.

Current prostate cancer trials at City of Hope include:
 
  • Improving whole body scans to better detect prostate cancer recurrence and metastasis
  • Looking at prostate cancer biomarkers that can be used to personalize therapy regimens, making them more effective against the disease
  • Investigating ways to minimize risk of incontinence or impotence after prostate cancer treatment
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Prostate Cancer Team

About Prostate Cancer

The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that is a part of semen.

Prostate cancer is found mainly in older men and almost all cases are prostate adenocarcinoma (cancer in the gland cells). There are other forms for prostate cancers as well (such as small cell carcinomas, sarcomas and transitional cell carcinomas) but they are extremely rare.

Age also increases the likelihood of benign prostatic hyperplasia, a condition in which the prostate gets bigger and blocks the urethra or bladder. This may cause difficulty in urination, can interfere with sexual function and may require medical intervention. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

Signs and Symptoms of Prostate Cancer
 
Symptoms of prostate cancer include:
 
  • Weak or interrupted flow of urine
  • Frequent urination (especially at night)
  • Trouble urinating
  • Pain or burning during urination
  • Blood in the urine or semen
  • A pain in the back, hips, or pelvis that doesn't go away
  • Painful ejaculation

If your or a loved one are experiencing these symptoms, please contact your doctor for further evaluation, which may include a biopsy to diagnose for prostate cancer or condition.
 
Prostate Cancer Risk Factors
 
Risk factors associated with prostate cancer include the following:
 
  • Age: Age is the main risk factor for prostate cancer. More than 70 percent of all prostate cancers occur in men over 65.
  • Race/Ethnicity: African-American males over 40 have the highest rate of prostate cancer and should consider screenings at age 40. Additionally, African-American men are more likely to die from prostate cancer than Caucasians. Prostate cancer also occurs more often in  Caribbean men of African ancestry.
  • Family History: Those with male relatives diagnosed with prostate cancer are more likely to get the disease themselves. Additionally, men with a first-degree relative (e.g. father, brother) diagnosed with prostate cancer are considered high risk and should consider screening beginning at age 40.
  • Diet: Studies suggest that men who eat a diet high in red meat or high-fat dairy may be at increased risk for prostate cancer.
  • Genetics: Some gene mutations have been linked to a higher prostate cancer risk, such as BRCA1 and BRCA2 mutations (which are also associated with higher breast and ovarian cancer risk in women.)
  • Inflammation: Some studies have shown that prostatitis (inflammation of the prostate gland) is linked to an increased prostate cancer risk.
 
Note that having one or more risk factors does not mean that a person will develop a prostate cancer.

If you suspect that you or a loved one may have prostate cancer, please contact your doctor for a medical examination.

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 
Sources: American Cancer Society and National Cancer Institute
 

Screening and Diagnosing Prostate Cancer

Because prostate cancer often does not cause symptoms, regular screening is important in ensuring that the disease is detected at its earliest, most treatable stage. For men with particularly high risk, this may mean an annual prostate exam starting at age 50.
 
 
Some of the screening tools used at City of Hope to detect and diagnose prostate cancer include:
 
  • Prostate specific antigen (PSA) test: A simple blood test to determine if your PSA level is higher than normal. A high PSA reading can be caused by either a benign or cancerous growth of the prostate, or simply by a prostate infection.
  • Digital rectal exam (DRE): During this procedure, the physician examines the prostate gland by inserting a gloved, lubricated finger into the rectum to check for any evidence of abnormalities in its texture, shape or size. The DRE, along with the PSA test, helps to detect prostate cancer in men who have no symptoms of the disease.
  • Biopsy: A core needle biopsy is the most common method of diagnosing prostate cancer. Usually, six to 18 biopsy samples are taken from different areas of the prostate. Placing the ultrasound probe into the rectum can be temporarily uncomfortable, but is usually easily tolerated by most men. At City of Hope, our urologists have popularized the use of a local anesthetic prior to obtaining the prostate biopsies. This alleviates the pain and discomfort of the individual needle biopsies, making the entire procedure much more tolerable.
  • Transrectal ultrasound of the prostate (TRUSP): TRUSP uses sound waves to create an image of the prostate on a video screen. There is a small probe, which is inserted into the rectum. The prostate is visualized and biopsies can then be taken through the probe while simultaneously imaging the prostate. The procedure takes approximately 10 to 20 minutes.
  • Bone scan: This X-ray procedure can show whether the cancer has spread from the prostate to the bones. This is not routinely ordered unless there are signs of aggressive disease, such as an elevated PSA or localized bone pain.
 
Stages of Prostate Cancer
 
To properly plan for treatment, prostate cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:

  • PSA level in the blood
  • Whether the cancer is detectable by an imaging scan or by touch during a DRE
  • Gleason score (which estimates how aggressive the prostate cancer is)
  • Whether the cancer has spread to lymph nodes or other organs
 
Based on these factors, patients are staged according to their risk level, with higher risk patients requiring more intensive treatments.
 
  • Stage 1: The cancer is found in the prostate only through a biopsy, and cannot be felt by a DRE or seen in imaging tests.
  • Stage 2: The cancer is still contained within the prostate, but is at a more advanced stage than stage 1 based on multiple criteria (such as PSA levels and Gleason scores.)
  • Stage 3: The cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles.
  • Stage 4: The cancer has spread beyond the seminal vesicles to other organs, bones or lymph nodes.
 

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 
 

Prostate Cancer Treatment Approaches

Just as every patient is different, we recognize that every case of prostate cancer is different. What distinguishes City of Hope is the experience and coordination within our care team, which optimize outcomes and ensure continuity of care from diagnosis through treatment to recovery and follow-up.

Additionally, City of Hope offers innovative treatments not available elsewhere, including:

  • Robotic-assisted prostatectomy using the da Vinci S™ Surgical System)
  • Radiation therapy, including TomoTherapy, brachytherapy and intensity-modulated radiation therapy
  • Novel hormone therapy and chemotherapy regimens through our prostate cancer clinical trials

Our patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines. Factors that determine the therapy regimen include:

  • Type and risk level of disease
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the prostate cancer treatment regimen may include one or more of the following:

Surgery

City of Hope was one of the first cancer centers in the country to adopt precise, minimally invasive, robotically-assisted surgical technology using the da Vinci S™ Surgical system. This procedure requires only five tiny incisions, allowing for visualization and use of miniature surgical equipment, which are controlled remotely by a surgeon at a nearby console.
 
Because the robotic arms can rotate 360 degrees, these instruments can move with a full range of motion as they cut and suture with great precision. A highly magnified real-time three-dimensional image helps the surgeon avoid delicate nerves and muscles surrounding the prostate.
 
Because robotic-assisted surgery does not require a large abdominal incision, it lowers risk of side effects to our patients, such as blood loss and pain. Most patients are on their feet within hours of surgery and can get back to a normal life sooner.
 
 

Radiation

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Depending on the type and stage of prostate cancer, our patients may be given one of the following radiation treatments:
 
  • Helical TomoTherapy: City of Hope is the first center in the western United States to offer Helical TomoTherapy, which combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects by minimizing radiation exposure in nearby normal tissues.
  • Brachytherapy: In this procedure, tiny pellets of radioactive material smaller than a grain of rice are inserted directly into the cancerous tissue. The radiation attacks the tumor from the inside out. By directly targeting cancer, brachytherapy minimizes radiation to healthy tissue. In most cases, complications are few, and recovery is relatively rapid.
 

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, may be used in treating prostate cancer, particularly those who have recurrent or advanced disease. Chemotherapy is usually given in cycles, with breaks in between to allow patients to recover from side effects. At City of Hope, our expert team of medical oncologists will assess each patient’s case, evaluate the different drug therapies available and tailor the most appropriate and effective regimen against the disease for optimal outcomes.

In addition to FDA-approved drugs for prostate cancer, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against prostate cancer.

Hormone Therapy

Because male hormones can promote the growth and spread of some prostate cancers, hormone therapy may be used to help shrink or slow the growth of the disease. Though it is not considered a cure, hormone therapy can put the cancer “in hibernation” for many years.
 
Hormone therapy may involve use of drugs that block androgen production, drugs that inhibit the body’s ability to process and use androgen or orchiectomy (surgical removal of testicles — where most of the body’s androgens are produced).
 

Active Surveillance

There has been some debate about the value of regular prostate-cancer screening (prostate-specific antigen, or PSA, test), especially in men who have been diagnosed with prostate cancer. Many prostate cancers do not require immediate treatment because they are small, confined and slow growing.
 
Aggressive treatment may be more disruptive to a man’s quality of life than "active surveillance," which closely monitors patients to detect early signs of disease progression and enables treatment before the cancer has spread beyond the prostate.
 
For those men with low-grade tumors, City of Hope specialists may recommend active surveillance. Our specialists will determine the best course of treatment balanced with each man’s vision of a quality life beyond diagnosis.
 

How to Become a Patient

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Post-treatment Care for Prostate Cancer Patients

Erectile dysfunction and loss of bladder control are potential, but often temporary, side effects of prostate cancer therapy. At City of Hope, 70 percent of patients regain or maintained bladder control following prostate removal surgery, and most men regain sexual potency from a week to 18 months after surgery. For cases of persistent impotence or incontinence, there are many treatments available.
 
Therapies for Urinary Incontinence
 
City of Hope offers the Urinary Incontinence Program through our Rehabilitation Services department. This program includes one-on-one sessions with a team of physical therapists to help prostate cancer patients retrain their pelvic muscles and build bladder control using a combination of biofeedback and pelvic floor exercises.

The return of continence may be immediate and usually occurs within the first few months after surgery but may take as long as one year. If, after one year, a patient is still having issues with urinary incontinence, patients are thoroughly evaluated to determine  the cause. If they are determined to have stress urinary incontinence (leakage of urine with cough and sneeze), they may be a candidate for additional treatments including transurethral collagen injections, a bone-anchored perineal urethral sling or an artificial urinary sphincter to help restore bladder control.
 
Therapies for Erectile Dysfunction
 
Following prostate cancer treatment, the return of erectile function may take anywhere from one day to two years. It is thought that although the neurovascular bundles are spared, the nerves that facilitate erections may be affected during treatment, leading to a temporary loss of nerve function. During this time, oral medications for erectile dysfunction may be unsuccessful because they require intact nerve function. However, there are a number of second-line therapies we offer at City of Hope that act independent of nerve function, that can serve as a temporary or sometimes permanent measure to attain satisfactory erections. These treatments include intraurethral medications, penile injection therapy or a vacuum erection device.

If these treatments prove unsuccessful, we offer patients a penile prosthesis. While this does require a surgical procedure, a penile prosthesis can be an attractive option for treatment. It is associated with over a 90 percent patient and patient/partner satisfaction rate.
 
Prostate Cancer Survivorship Program
 
The Prostate Cancer Survivorship Program provides specialized follow-up care for patients who have completed surgical treatment for localized prostate cancer. Patients who participate in this program are seen every 6 to 12 months in a clinic specially designed to meet the follow-up needs of prostate cancer survivors. Care is provided by a healthcare provider with expertise in prostate cancer care and survivorship issues.  Patients in this program will receive careful monitoring for possible recurrence of their cancer and will have the opportunity to discuss their cancer treatment, its impact on their health and ways to stay as healthy as possible.
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Living with Prostate Cancer

In addition to curative treatments, City of Hope prostate cancer patients have access to the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help patients and loved ones with a variety of care and wellness issues including:
 
 
  • Managing side effects, including incontinence and impotence
  • Pain management
  • Navigation through the health care system
  • Coping and maintaining emotional/social/spiritual well-being
  • Staying healthy and active during/after treatment
  • Guidance on eating and cooking well
  • Healing arts
  • Building caregivers’ skills
 
 
The Sheri & Les Biller Patient and Family Resource Center is the heart of the Department of Supportive Care Medicine, integrating City of Hope's support services under one umbrella. The Biller Resource Center provides a warm and welcoming space where patients, families and caregivers can access the resources, education and support they need to strengthen and empower themselves, before, during and after treatment.

Our team of supportive care experts includes clinical social workers; pain and palliative care physicians and nurses; psychologists, psychiatrists; patient navigators; health educators; spiritual care chaplains; child life specialists and more. The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
 
Why Men Should Pay Attention
 
 
Why should men care about prostate cancer? Get the facts and statistics. When Ralph learned he had prostate cancer and his PSA was a 6, he discussed various options with his urologist. Ralph decided on a treatment plan that was best for his situation, active surveillance.
 
Why Choose City of Hope for Prostate Cancer Treatment and Research?
 
Treatments:  Timothy Wilson, M.D., Chief, Department of Urology and Director, Prostate Cancer Program discusses treatment options. Research: Can white button mushrooms stop prostate cancer recurrence? In a recent clinical trial at City of Hope, two patients experienced tremendous success with tablets made from concentrated white button mushrooms.
 
 

Additional Prostate Cancer Resources
 
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Prostate Cancer Research and Clinical Trials

City of Hope is a recognized leader in prostate cancer research. Our projects have been funded by the National Cancer Institute (NCI) and many other research-based organizations, and our scientists collaborate with other leading research institutions to develop tomorrow’s breakthroughs today.
 
  • New Prostate Cancer Detection Tests: This new noninvasive test detects the presence of telomerase in prostate fluid. Telomerase is an enzyme associated with certain cancers  and this test may prove to be more sensitive than the prostate-specific antigen (PSA) test in the detection of prostate cancer. This research could lead to improvements in early detection of prostate cancer, while reducing the number of unnecessary biopsies. In addition, this test may also help identify high-risk patients who may benefit from additional surveillance and therapy.
  • Erectile Dysfunction Study: A clinical study is currently under way to evaluate whether patients who use regular, low doses of erectile function drugs soon after surgery return to potency faster than those who do not take the doses regularly. This study will help determine if it is beneficial to start rehabilitation as early as possible to increase blood and oxygen flow to the penis. City of Hope researchers are looking to recruit 220 men for the study. Study-related medications will be provided to participants free of charge.
  • Prostate Cancer Outcomes Database: City of Hope has established a prostate cancer database to collect data on all consenting prostate-cancer patients receiving their primary treatment at City of Hope. The data is used to analyze patients’ clinical outcomes and quality of life and correlate them to the treatments and follow-up care they have received.
  • Mapping Interactive Cancer Susceptibility Genes in Prostate Cancer: This study seeks to determine the role of genetic factors in prostate cancer, specifically whether multiple genes with weak impact to prostate cancer risk can interact to become a stronger influence.
  • Quality of Life and Psychological Adjustment in Prostate Cancer Patients and Their Partners: This study examines the psychological adjustment and quality of life issues that may affect prostatectomy patients and their partners before, during and after a prostatectomy. This data will enhance our understanding of the impact of cancer on patients and family members, shed light on patient-partner interactions following diagnosis and help with developing better psychological interventions to improve the patient and their partner’s quality of life.
 
Patients and physicians can access Clinical Trials On-Line to find out about prostate cancer clinical trials that are currently being conducted at City of Hope or visit our clinical trials information page.
 

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 

Robotic Prostatectomy

What is robotic assisted prostatectomy?

Since 2003, City of Hope has been performing prostatectomy using the da Vinci surgical system (DVP), allowing our physicians to take a giant leap forward in the treatment of prostate cancer. The robotic technique provides unparalleled surgical accuracy to significantly reduce blood loss and improve postoperative recovery. City of Hope performs more robotic assisted prostatectomies than any other medical center in the Western U.S and is second in the nation.

How does robotic assisted prostatectomy work?

With the state-of-the-art da Vinci computer-enhanced minimally invasive surgery system, City of Hope surgeons perform the same procedure done in conventional laparoscopic prostatectomy, but are aided by a three-dimensional computer vision system to manipulate four robotic arms. A pencil-size video camera held by one of the arms is inserted through an incision to provide magnified, 3D images of the surgical site. The 3D view helps the surgeon more easily identify the delicate nerves and muscles surrounding the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with greater precision, flexibility and range of motion. To view informational video on robotic assisted prostatectomy click here

What are the benefits of robotic assisted prostatectomy?

Patients experience significantly less pain and less blood loss than those undergoing conventional open incision procedures. In addition, patients tend to enjoy quicker recovery time. A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2-3 months. With robotic assisted surgery the recovery time is as little as two weeks - a greater than 50 percent reduction in recovery time.

How experienced is City of Hope at the robotic assisted prostatectomy procedure?

City of Hope was one of the first cancer centers in the United States to begin performing the robotic assisted laparoscopic radical prostatectomy. Since October 2003, our physicians have performed over 3100 cases, more than any other site in the Western U.S and second in the entire U.S.

What are City of Hope's outcomes?

The department of Urologic Oncology at City of Hope specializes in the diagnosis and treatment of prostate cancer, bladder cancer, kidney cancer, and other urologic malignancies, providing therapies for patients that not only treat the disease but also attempt to achieve the best quality of life. Since 2000, we have been using state-of-the-art minimally invasive techniques for the treatment of urologic malignancies. Both the institution and the department were recently named as America's Best Hospitals in cancer and urology by U.S. News and World Report. We were the first regional cancer center to implement and subsequently advance the use of standard laparoscopic techniques for the treatment of prostate and bladder cancers. In 2003, after an initial experience with over 500 laparoscopic radical prostatectomies we implemented the use of the da Vinci surgical system into our practice. Since then, we have become the busiest minimally invasive and surgical robotics program worldwide and have performed over 3,100 robotic prostatectomies. In 2007, we performed approximately 721 robotic prostatectomies. The robotic program at City of Hope includes robotic and oncology fellowship trained surgeons, fellows, a dedicated operating room team, nurse practitioners, physician assistants, and research coordinators. We currently have four new generation, four-arm robotic systems, including the da Vinici S High Definition platform. All of our procedures are performed in minimally invasive operating theatres, utilizing Karl-Storz OR1 integrated and automated suites. The operation typically takes 2 to 3 hours, and is performed under general anesthesia. Most patients have an estimated blood loss of 300 milliliters, and therefore less than 3% of patients are expected to need a blood transfusion). Most patients typically spend one night in the hospital, and can expect to get discharged the following afternoon if their laboratory tests are acceptable, pain is controlled with oral medications, and they are able to tolerated oral liquids. Patients are discharged with an indwelling foley catheter which will be removed in the clinic 5-7 days after the operation. Patients who do not reside in the local vicinity, can sometimes have their catheters removed by their community urologist. At the first post-operative visit, we review and discuss pathology results, and potential need for any adjuvant therapies if indicated. Most patients have a convalescence period of 2-3 weeks, and can expect to return to their normal activity 4 weeks after surgery. The primary concern for patients with localized prostate cancer who undergo prostatectomy is recurrence, or a return of their cancer. Biochemical recurrence, indicated with elevated levels of prostate-specific antigen, or PSA, affects an estimated 12% of our patients three years following robotic radical prostatectomy, and an estimated 17% of patients at five years. Secondary outcomes of concern to patients include regaining continence and potency. Among our patients who were continent prior to undergoing prostatectomy, 63% regained continence within the first four months following surgery. By 12 months, we found that 87% of patients had regained continence. The average time to return to continence is 1.8 months. Return to potency takes considerably longer for prostatectomy patients. At 12 months following prostatectomy, 46% of our patients had returned to desired potency levels. The number edges higher when we consider a 24 month follow-up period (63%), and the average time to return to potency is 14 months for our patients overall. Age, however, is a notable factor in these estimates. Among younger patients who were under the age of 65 at the time of surgery, the average time to return to potency was under 12 months, and 69% of these patients were said to have regained potency at 2 years. It is important to keep in mind that these results represent outcomes since robotic prostatectomy was started at City of Hope in 2003. Since that time, with growing experience, positive margin rates have declined and individual surgeon results have improved. The operation we do now is considered to be leading edge and state of the art.

Who is a candidate for robotic assisted prostatectomy?

Anyone diagnosed with localized prostate cancer may benefit from robotic-assisted prostatectomy. However, the decision to have prostate cancer treated surgically revolves around numerous considerations. Variables that enter into preoperative evaluation include age, pre-biopsy PSA, biopsy findings, previous prostate cancer treatments and other illnesses. Robotic prostatectomy can be done for men of all sizes and shapes. The surgery can be done in men who have had other operations: appendectomy, laparoscopic hernia repair, repair of abdominal trauma, transurethral prostatectomy (TURP), and in some men who have been treated with previous pelvic radiation.

Does robotic assisted prostatectomy remove the whole prostate?

Yes. This surgery removes the prostate, seminal vesicles, ends of the vas deferens, and, depending on oncological considerations, nerve bundles and/or lymph nodes.

Why is there less blood loss with robotic assisted prostatectomy?

The reduction in blood loss reflects the improved view of the operative field, especially behind the pubic bone, home of the venous plexus of Santorini. The improvement in view comes from using a lens that tracks directly into the operative field where the remote human eye has a hard time going. The robotic surgery also uses magnification and bright illumination. Overall, this improved view permits a more precise and gentle dissection, which means better control of potential sources of bleeding.

Does robotic assisted prostatectomy require general anesthesia?

Yes. Robotic assisted prostatectomy is considered major surgery and thus requires general anesthesia.

Does prostate size matter?

As a practical matter, prostate size is not much of an issue. We routinely remove prostates ranging from 10 to 100 ccs in size.

Can lymph nodes be removed with robotic assisted prostatectomy?

Yes. Lymph nodes, to which prostate cancer may spread, can be removed.

What are the risks of robotic assisted prostatectomy?

This is major surgery, done under general anesthesia and carries the same risks of any major operation, including heart attack, stroke, and death. Robotic-assisted prostatectomy is also associated with the specific risks of impotence and incontinence.

Can the neurovascular bundles be preserved?

Yes. The neurovascular bundles whose preservation is associated with the likelihood of maintaining erections can be preserved. Nerve preservation does not guarantee satisfactory erections after surgery.

Does it make sense to preserve the neurovascular bundles?

Not in all cases. The issue here relates to the physical proximity of the bundles to areas of malignancy, which can microscopically extend beyond the prostate and into the bundles. The decision to preserve one or both neurovascular bundle depends on an individual analysis.

When will the ability to have an erection be regained following surgery?

Return of potency depends on many physical and psychological factors including preoperative erectile function and type of surgery (such as unilateral or bilateral; nerve-sparing or non-nerve sparing). Function may return spontaneously as early as one week after surgery, or with the aid of medications (Viagra, Muse). Potency rehabilitation can be discussed at the one-month visit. Factors that can interfere with erectile function include hypertension, diabetes, obesity, atherosclerosis, history of smoking, and anxiety, among others.

Are venous compression devices used in this surgery?

Yes. As a precaution against developing blood clots each patient has venous compression devices placed prior to surgery. These are removed when the patient becomes ambulatory.

Does robotic assisted prostatectomy require a catheter, drain, dressings, or stitches?

Yes. Like any radical prostatectomy, robotic-assisted prostatectomy requires reconstruction of the bladder-urethra connection. A catheter is left in the urethra, connected to a drainage bag, and used to align the healing suture line and drain the bladder. In the immediate post-op period, the surgery also requires a drain that goes through the abdominal wall and left in the pelvis behind the pubic bone. The drain assures the collection of blood and urine that may accumulate immediately after surgery and is removes when the output drops, usually prior to leaving the hospital. There are stitches, but these dissolve by themselves and require no special care. The surgical dressings are five Band-Aid type dots used to cover the instrument entry sites. These dressings are generally removed 48 hours after surgery.

How long should the catheter stay in?

We routinely remove the catheter in five to seven days at the first follow-up visit.

What can I expect after the catheter comes out?

Almost all patients have some incontinence when the catheter comes out. Incontinence varies from person to person, but usually improves significantly or resolves by the one-month follow-up clinical visit. Continence function returns with time, and patience here is a real virtue.

How can I speed my continence recovery?

You will be given an instruction sheet for Kegel exercises and other suggestions that will help in the recovery of continence. In addition, a Continence Recovery Program is available through our Rehabilitation Services Department beginning 1 month after surgery. Ask your MD for a referral.

Can I bathe after robotic assisted prostatectomy?

Yes. Most patients may shower within 24 hours of surgery.

What can I expect immediately after robotic assisted prostatectomy?

Patients leave the operating room with an intravenous line, a urethral catheter, and a small rubber drain in their lower abdomen. In the first few hours, depending on strength and motivation, most patients get out of bed and stretch their legs, and begin walking by nightfall. Most leave the hospital within 48 hours. Most patients begin drinking fluids on the 1st day after the procedure. Patients are discharged with a catheter connected to a leg bag, which fits under their pants. Loose clothing and shoes that don't require tying seem easier to handle in the first few days.

What can I expect after getting home?

While relative to open surgery robotic assisted prostatectomy is generally less demanding, the experience is still demanding. The single most common complaint after hospital discharge seems to be sleep deprivation and fatigue. Most patients are anxious going into surgery, get little sleep the night before surgery, arrive at the hospital very early on the morning of surgery, and get very little sleep the night after surgery. Accordingly, most patients look forward to a good, long nap and a shower after getting home. The other major complaint seems to be a sense of bloating, with clothes fitting very tight. This bloating seems related to the effects of surgery, anesthesia, and bed rest on intestine function. Often this sensation responds well to walking, which helps the patient expel intestinal gas, which in turn helps the patient regain his overall comfort and appetite.

If I live far away, can I travel after surgery?

Many of our patients come from far away and we can help with numerous logistical issues related to travel, from finding a suitable hotel to arranging medical evaluations pre-operatively. After surgery, we have had patients leaving Duarte within two days, be it by car or plane to various destinations.

What happens to my medical records and who will take care of me when I get home?

We work with our patients to transmit any and all relevant medical data to their home physicians. For those who chose to stay a while, we provide all follow-up medical care.

Must I return for follow-up care?

We support our patients regardless of where their paths take them. In a practical sense, this means that once a patient has had a robotic assisted prostatectomy, we consider him a lifetime patient and are always available. In fact, most of our patients, having come to rely on us during a very trying time in their lives, stay in touch and regularly call and email to update us or ask for our help. While we deliver urological care to all our local patients, there may be no compelling reason for patients to make trips to Duarte for routine follow-up.

What is the long-term follow-up after robotic assisted prostatectomy?

Depending on the pathologist's report of the surgery specimen, a patient may or may not consider additional cancer treatments. In most cases, but not all, the wise course of action is surveillance: periodic measurement of blood PSA, thought to be the most sensitive indicator of cancer recurrence.

What is the Survivorship Clinic?

We are very excited to now offer a unique opportunity for eligible patients. If you are one year post treatment and free of disease, we believe that you would benefit from the Prostate Cancer Survivorship Clinic. Services provided in the Clinic include general health promotion, follow-up assessments, screening for other cancers, education and other support services. For more information, please see the Prostate Cancer Survivorship Program.

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Rick Leonard
Associate Vice President
Direct: 213-241-7218
Email: rleonard@coh.org

 
 

Prostate Cancer

Prostate Cancer

More than 230,000 men will be diagnosed with prostate cancer this year, and about one in seven men will be diagnosed with this disease some time in his life. But thanks to improvements with surgery, radiation, chemotherapy and other treatments, many prostate cancer patients can overcome prostate cancer to lead long, productive lives.
 
City of Hope’s multidisciplinary staff can assess and treat prostate cancer in all stages, from localized to recurrent and advanced disease. Our Prostate Cancer Program focuses on providing the most advanced, compassionate care while actively investigating promising new therapies. The goal: to eradicate prostate cancer and help you recover faster, with fewer side effects. 
 
 
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in the research and treatment of prostate cancer. With our decades of experience, specialized therapy protocols and extensive program of clinical trials, newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their needs and gives them the best chance for survival. U.S.News & World Report also named City of Hope as one of the top cancer hospitals in the country for the 11th year.
 
 
City of Hope is a leading center for prostate cancer treatment, offering novel therapies that can improve chances of survival with fewer side effects. Some of our leading edge therapies include:
 
  • High-precision, robotic-assisted prostate surgery, which offers unparalleled surgical accuracy to improve postoperative recovery. Our doctors have performed more advanced procedures for prostate cancer than any other facility on the West Coast.
  • Our team of experts was the first in the western United States to offer Helical TomoTherapy — a targeted radiation therapy that kills cancer cells while minimizing damage to neighboring healthy tissue.
  • For patients with recurrent, advanced or metastasized prostate cancer, our clinical trials offer promising treatments not available elsewhere using either newly-developed agents or novel combinations of existing drugs.
  • Active Surveillance - For those men with low-grade tumors, City of Hope specialists may recommend active surveillance. Our specialists will determine the best course of treatment balanced with each man’s vision of a quality life beyond diagnosis.
 
 
In collaboration with other departments and cancer centers, City of Hope’s prostate cancer program has an active portfolio of prostate cancer clinical trials studying novel treatments, including trials of new surgery, radiation and chemotherapy regimens that are more effective against the disease and/or less harmful to the patient. Many of these promising therapies are only available to patients being treated at the City of Hope.

Current prostate cancer trials at City of Hope include:
 
  • Improving whole body scans to better detect prostate cancer recurrence and metastasis
  • Looking at prostate cancer biomarkers that can be used to personalize therapy regimens, making them more effective against the disease
  • Investigating ways to minimize risk of incontinence or impotence after prostate cancer treatment
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Prostate Cancer Team

Prostate Cancer Team

About Prostate Cancer

About Prostate Cancer

The prostate is a gland in the male reproductive system located just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that is a part of semen.

Prostate cancer is found mainly in older men and almost all cases are prostate adenocarcinoma (cancer in the gland cells). There are other forms for prostate cancers as well (such as small cell carcinomas, sarcomas and transitional cell carcinomas) but they are extremely rare.

Age also increases the likelihood of benign prostatic hyperplasia, a condition in which the prostate gets bigger and blocks the urethra or bladder. This may cause difficulty in urination, can interfere with sexual function and may require medical intervention. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

Signs and Symptoms of Prostate Cancer
 
Symptoms of prostate cancer include:
 
  • Weak or interrupted flow of urine
  • Frequent urination (especially at night)
  • Trouble urinating
  • Pain or burning during urination
  • Blood in the urine or semen
  • A pain in the back, hips, or pelvis that doesn't go away
  • Painful ejaculation

If your or a loved one are experiencing these symptoms, please contact your doctor for further evaluation, which may include a biopsy to diagnose for prostate cancer or condition.
 
Prostate Cancer Risk Factors
 
Risk factors associated with prostate cancer include the following:
 
  • Age: Age is the main risk factor for prostate cancer. More than 70 percent of all prostate cancers occur in men over 65.
  • Race/Ethnicity: African-American males over 40 have the highest rate of prostate cancer and should consider screenings at age 40. Additionally, African-American men are more likely to die from prostate cancer than Caucasians. Prostate cancer also occurs more often in  Caribbean men of African ancestry.
  • Family History: Those with male relatives diagnosed with prostate cancer are more likely to get the disease themselves. Additionally, men with a first-degree relative (e.g. father, brother) diagnosed with prostate cancer are considered high risk and should consider screening beginning at age 40.
  • Diet: Studies suggest that men who eat a diet high in red meat or high-fat dairy may be at increased risk for prostate cancer.
  • Genetics: Some gene mutations have been linked to a higher prostate cancer risk, such as BRCA1 and BRCA2 mutations (which are also associated with higher breast and ovarian cancer risk in women.)
  • Inflammation: Some studies have shown that prostatitis (inflammation of the prostate gland) is linked to an increased prostate cancer risk.
 
Note that having one or more risk factors does not mean that a person will develop a prostate cancer.

If you suspect that you or a loved one may have prostate cancer, please contact your doctor for a medical examination.

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 
Sources: American Cancer Society and National Cancer Institute
 

Screening and Diagnosing Prostate Cancer

Screening and Diagnosing Prostate Cancer

Because prostate cancer often does not cause symptoms, regular screening is important in ensuring that the disease is detected at its earliest, most treatable stage. For men with particularly high risk, this may mean an annual prostate exam starting at age 50.
 
 
Some of the screening tools used at City of Hope to detect and diagnose prostate cancer include:
 
  • Prostate specific antigen (PSA) test: A simple blood test to determine if your PSA level is higher than normal. A high PSA reading can be caused by either a benign or cancerous growth of the prostate, or simply by a prostate infection.
  • Digital rectal exam (DRE): During this procedure, the physician examines the prostate gland by inserting a gloved, lubricated finger into the rectum to check for any evidence of abnormalities in its texture, shape or size. The DRE, along with the PSA test, helps to detect prostate cancer in men who have no symptoms of the disease.
  • Biopsy: A core needle biopsy is the most common method of diagnosing prostate cancer. Usually, six to 18 biopsy samples are taken from different areas of the prostate. Placing the ultrasound probe into the rectum can be temporarily uncomfortable, but is usually easily tolerated by most men. At City of Hope, our urologists have popularized the use of a local anesthetic prior to obtaining the prostate biopsies. This alleviates the pain and discomfort of the individual needle biopsies, making the entire procedure much more tolerable.
  • Transrectal ultrasound of the prostate (TRUSP): TRUSP uses sound waves to create an image of the prostate on a video screen. There is a small probe, which is inserted into the rectum. The prostate is visualized and biopsies can then be taken through the probe while simultaneously imaging the prostate. The procedure takes approximately 10 to 20 minutes.
  • Bone scan: This X-ray procedure can show whether the cancer has spread from the prostate to the bones. This is not routinely ordered unless there are signs of aggressive disease, such as an elevated PSA or localized bone pain.
 
Stages of Prostate Cancer
 
To properly plan for treatment, prostate cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:

  • PSA level in the blood
  • Whether the cancer is detectable by an imaging scan or by touch during a DRE
  • Gleason score (which estimates how aggressive the prostate cancer is)
  • Whether the cancer has spread to lymph nodes or other organs
 
Based on these factors, patients are staged according to their risk level, with higher risk patients requiring more intensive treatments.
 
  • Stage 1: The cancer is found in the prostate only through a biopsy, and cannot be felt by a DRE or seen in imaging tests.
  • Stage 2: The cancer is still contained within the prostate, but is at a more advanced stage than stage 1 based on multiple criteria (such as PSA levels and Gleason scores.)
  • Stage 3: The cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles.
  • Stage 4: The cancer has spread beyond the seminal vesicles to other organs, bones or lymph nodes.
 

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 
 

Our Treatment Approach

Prostate Cancer Treatment Approaches

Just as every patient is different, we recognize that every case of prostate cancer is different. What distinguishes City of Hope is the experience and coordination within our care team, which optimize outcomes and ensure continuity of care from diagnosis through treatment to recovery and follow-up.

Additionally, City of Hope offers innovative treatments not available elsewhere, including:

  • Robotic-assisted prostatectomy using the da Vinci S™ Surgical System)
  • Radiation therapy, including TomoTherapy, brachytherapy and intensity-modulated radiation therapy
  • Novel hormone therapy and chemotherapy regimens through our prostate cancer clinical trials

Our patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines. Factors that determine the therapy regimen include:

  • Type and risk level of disease
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the prostate cancer treatment regimen may include one or more of the following:

Surgery

City of Hope was one of the first cancer centers in the country to adopt precise, minimally invasive, robotically-assisted surgical technology using the da Vinci S™ Surgical system. This procedure requires only five tiny incisions, allowing for visualization and use of miniature surgical equipment, which are controlled remotely by a surgeon at a nearby console.
 
Because the robotic arms can rotate 360 degrees, these instruments can move with a full range of motion as they cut and suture with great precision. A highly magnified real-time three-dimensional image helps the surgeon avoid delicate nerves and muscles surrounding the prostate.
 
Because robotic-assisted surgery does not require a large abdominal incision, it lowers risk of side effects to our patients, such as blood loss and pain. Most patients are on their feet within hours of surgery and can get back to a normal life sooner.
 
 

Radiation

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Depending on the type and stage of prostate cancer, our patients may be given one of the following radiation treatments:
 
  • Helical TomoTherapy: City of Hope is the first center in the western United States to offer Helical TomoTherapy, which combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects by minimizing radiation exposure in nearby normal tissues.
  • Brachytherapy: In this procedure, tiny pellets of radioactive material smaller than a grain of rice are inserted directly into the cancerous tissue. The radiation attacks the tumor from the inside out. By directly targeting cancer, brachytherapy minimizes radiation to healthy tissue. In most cases, complications are few, and recovery is relatively rapid.
 

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, may be used in treating prostate cancer, particularly those who have recurrent or advanced disease. Chemotherapy is usually given in cycles, with breaks in between to allow patients to recover from side effects. At City of Hope, our expert team of medical oncologists will assess each patient’s case, evaluate the different drug therapies available and tailor the most appropriate and effective regimen against the disease for optimal outcomes.

In addition to FDA-approved drugs for prostate cancer, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against prostate cancer.

Hormone Therapy

Because male hormones can promote the growth and spread of some prostate cancers, hormone therapy may be used to help shrink or slow the growth of the disease. Though it is not considered a cure, hormone therapy can put the cancer “in hibernation” for many years.
 
Hormone therapy may involve use of drugs that block androgen production, drugs that inhibit the body’s ability to process and use androgen or orchiectomy (surgical removal of testicles — where most of the body’s androgens are produced).
 

Active Surveillance

There has been some debate about the value of regular prostate-cancer screening (prostate-specific antigen, or PSA, test), especially in men who have been diagnosed with prostate cancer. Many prostate cancers do not require immediate treatment because they are small, confined and slow growing.
 
Aggressive treatment may be more disruptive to a man’s quality of life than "active surveillance," which closely monitors patients to detect early signs of disease progression and enables treatment before the cancer has spread beyond the prostate.
 
For those men with low-grade tumors, City of Hope specialists may recommend active surveillance. Our specialists will determine the best course of treatment balanced with each man’s vision of a quality life beyond diagnosis.
 

How to Become a Patient

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.

Post Treatment Care

Post-treatment Care for Prostate Cancer Patients

Erectile dysfunction and loss of bladder control are potential, but often temporary, side effects of prostate cancer therapy. At City of Hope, 70 percent of patients regain or maintained bladder control following prostate removal surgery, and most men regain sexual potency from a week to 18 months after surgery. For cases of persistent impotence or incontinence, there are many treatments available.
 
Therapies for Urinary Incontinence
 
City of Hope offers the Urinary Incontinence Program through our Rehabilitation Services department. This program includes one-on-one sessions with a team of physical therapists to help prostate cancer patients retrain their pelvic muscles and build bladder control using a combination of biofeedback and pelvic floor exercises.

The return of continence may be immediate and usually occurs within the first few months after surgery but may take as long as one year. If, after one year, a patient is still having issues with urinary incontinence, patients are thoroughly evaluated to determine  the cause. If they are determined to have stress urinary incontinence (leakage of urine with cough and sneeze), they may be a candidate for additional treatments including transurethral collagen injections, a bone-anchored perineal urethral sling or an artificial urinary sphincter to help restore bladder control.
 
Therapies for Erectile Dysfunction
 
Following prostate cancer treatment, the return of erectile function may take anywhere from one day to two years. It is thought that although the neurovascular bundles are spared, the nerves that facilitate erections may be affected during treatment, leading to a temporary loss of nerve function. During this time, oral medications for erectile dysfunction may be unsuccessful because they require intact nerve function. However, there are a number of second-line therapies we offer at City of Hope that act independent of nerve function, that can serve as a temporary or sometimes permanent measure to attain satisfactory erections. These treatments include intraurethral medications, penile injection therapy or a vacuum erection device.

If these treatments prove unsuccessful, we offer patients a penile prosthesis. While this does require a surgical procedure, a penile prosthesis can be an attractive option for treatment. It is associated with over a 90 percent patient and patient/partner satisfaction rate.
 
Prostate Cancer Survivorship Program
 
The Prostate Cancer Survivorship Program provides specialized follow-up care for patients who have completed surgical treatment for localized prostate cancer. Patients who participate in this program are seen every 6 to 12 months in a clinic specially designed to meet the follow-up needs of prostate cancer survivors. Care is provided by a healthcare provider with expertise in prostate cancer care and survivorship issues.  Patients in this program will receive careful monitoring for possible recurrence of their cancer and will have the opportunity to discuss their cancer treatment, its impact on their health and ways to stay as healthy as possible.
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Living with Prostate Cancer

Living with Prostate Cancer

In addition to curative treatments, City of Hope prostate cancer patients have access to the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can help patients and loved ones with a variety of care and wellness issues including:
 
 
  • Managing side effects, including incontinence and impotence
  • Pain management
  • Navigation through the health care system
  • Coping and maintaining emotional/social/spiritual well-being
  • Staying healthy and active during/after treatment
  • Guidance on eating and cooking well
  • Healing arts
  • Building caregivers’ skills
 
 
The Sheri & Les Biller Patient and Family Resource Center is the heart of the Department of Supportive Care Medicine, integrating City of Hope's support services under one umbrella. The Biller Resource Center provides a warm and welcoming space where patients, families and caregivers can access the resources, education and support they need to strengthen and empower themselves, before, during and after treatment.

Our team of supportive care experts includes clinical social workers; pain and palliative care physicians and nurses; psychologists, psychiatrists; patient navigators; health educators; spiritual care chaplains; child life specialists and more. The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
 
Why Men Should Pay Attention
 
 
Why should men care about prostate cancer? Get the facts and statistics. When Ralph learned he had prostate cancer and his PSA was a 6, he discussed various options with his urologist. Ralph decided on a treatment plan that was best for his situation, active surveillance.
 
Why Choose City of Hope for Prostate Cancer Treatment and Research?
 
Treatments:  Timothy Wilson, M.D., Chief, Department of Urology and Director, Prostate Cancer Program discusses treatment options. Research: Can white button mushrooms stop prostate cancer recurrence? In a recent clinical trial at City of Hope, two patients experienced tremendous success with tablets made from concentrated white button mushrooms.
 
 

Additional Prostate Cancer Resources
 
 

If you have been diagnosed with prostate cancer or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Research and Clinical Trials

Prostate Cancer Research and Clinical Trials

City of Hope is a recognized leader in prostate cancer research. Our projects have been funded by the National Cancer Institute (NCI) and many other research-based organizations, and our scientists collaborate with other leading research institutions to develop tomorrow’s breakthroughs today.
 
  • New Prostate Cancer Detection Tests: This new noninvasive test detects the presence of telomerase in prostate fluid. Telomerase is an enzyme associated with certain cancers  and this test may prove to be more sensitive than the prostate-specific antigen (PSA) test in the detection of prostate cancer. This research could lead to improvements in early detection of prostate cancer, while reducing the number of unnecessary biopsies. In addition, this test may also help identify high-risk patients who may benefit from additional surveillance and therapy.
  • Erectile Dysfunction Study: A clinical study is currently under way to evaluate whether patients who use regular, low doses of erectile function drugs soon after surgery return to potency faster than those who do not take the doses regularly. This study will help determine if it is beneficial to start rehabilitation as early as possible to increase blood and oxygen flow to the penis. City of Hope researchers are looking to recruit 220 men for the study. Study-related medications will be provided to participants free of charge.
  • Prostate Cancer Outcomes Database: City of Hope has established a prostate cancer database to collect data on all consenting prostate-cancer patients receiving their primary treatment at City of Hope. The data is used to analyze patients’ clinical outcomes and quality of life and correlate them to the treatments and follow-up care they have received.
  • Mapping Interactive Cancer Susceptibility Genes in Prostate Cancer: This study seeks to determine the role of genetic factors in prostate cancer, specifically whether multiple genes with weak impact to prostate cancer risk can interact to become a stronger influence.
  • Quality of Life and Psychological Adjustment in Prostate Cancer Patients and Their Partners: This study examines the psychological adjustment and quality of life issues that may affect prostatectomy patients and their partners before, during and after a prostatectomy. This data will enhance our understanding of the impact of cancer on patients and family members, shed light on patient-partner interactions following diagnosis and help with developing better psychological interventions to improve the patient and their partner’s quality of life.
 
Patients and physicians can access Clinical Trials On-Line to find out about prostate cancer clinical trials that are currently being conducted at City of Hope or visit our clinical trials information page.
 

If you have been diagnosed with prostate cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.
 

Robotic Prostatectomy FAQs

Robotic Prostatectomy

What is robotic assisted prostatectomy?

Since 2003, City of Hope has been performing prostatectomy using the da Vinci surgical system (DVP), allowing our physicians to take a giant leap forward in the treatment of prostate cancer. The robotic technique provides unparalleled surgical accuracy to significantly reduce blood loss and improve postoperative recovery. City of Hope performs more robotic assisted prostatectomies than any other medical center in the Western U.S and is second in the nation.

How does robotic assisted prostatectomy work?

With the state-of-the-art da Vinci computer-enhanced minimally invasive surgery system, City of Hope surgeons perform the same procedure done in conventional laparoscopic prostatectomy, but are aided by a three-dimensional computer vision system to manipulate four robotic arms. A pencil-size video camera held by one of the arms is inserted through an incision to provide magnified, 3D images of the surgical site. The 3D view helps the surgeon more easily identify the delicate nerves and muscles surrounding the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with greater precision, flexibility and range of motion. To view informational video on robotic assisted prostatectomy click here

What are the benefits of robotic assisted prostatectomy?

Patients experience significantly less pain and less blood loss than those undergoing conventional open incision procedures. In addition, patients tend to enjoy quicker recovery time. A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2-3 months. With robotic assisted surgery the recovery time is as little as two weeks - a greater than 50 percent reduction in recovery time.

How experienced is City of Hope at the robotic assisted prostatectomy procedure?

City of Hope was one of the first cancer centers in the United States to begin performing the robotic assisted laparoscopic radical prostatectomy. Since October 2003, our physicians have performed over 3100 cases, more than any other site in the Western U.S and second in the entire U.S.

What are City of Hope's outcomes?

The department of Urologic Oncology at City of Hope specializes in the diagnosis and treatment of prostate cancer, bladder cancer, kidney cancer, and other urologic malignancies, providing therapies for patients that not only treat the disease but also attempt to achieve the best quality of life. Since 2000, we have been using state-of-the-art minimally invasive techniques for the treatment of urologic malignancies. Both the institution and the department were recently named as America's Best Hospitals in cancer and urology by U.S. News and World Report. We were the first regional cancer center to implement and subsequently advance the use of standard laparoscopic techniques for the treatment of prostate and bladder cancers. In 2003, after an initial experience with over 500 laparoscopic radical prostatectomies we implemented the use of the da Vinci surgical system into our practice. Since then, we have become the busiest minimally invasive and surgical robotics program worldwide and have performed over 3,100 robotic prostatectomies. In 2007, we performed approximately 721 robotic prostatectomies. The robotic program at City of Hope includes robotic and oncology fellowship trained surgeons, fellows, a dedicated operating room team, nurse practitioners, physician assistants, and research coordinators. We currently have four new generation, four-arm robotic systems, including the da Vinici S High Definition platform. All of our procedures are performed in minimally invasive operating theatres, utilizing Karl-Storz OR1 integrated and automated suites. The operation typically takes 2 to 3 hours, and is performed under general anesthesia. Most patients have an estimated blood loss of 300 milliliters, and therefore less than 3% of patients are expected to need a blood transfusion). Most patients typically spend one night in the hospital, and can expect to get discharged the following afternoon if their laboratory tests are acceptable, pain is controlled with oral medications, and they are able to tolerated oral liquids. Patients are discharged with an indwelling foley catheter which will be removed in the clinic 5-7 days after the operation. Patients who do not reside in the local vicinity, can sometimes have their catheters removed by their community urologist. At the first post-operative visit, we review and discuss pathology results, and potential need for any adjuvant therapies if indicated. Most patients have a convalescence period of 2-3 weeks, and can expect to return to their normal activity 4 weeks after surgery. The primary concern for patients with localized prostate cancer who undergo prostatectomy is recurrence, or a return of their cancer. Biochemical recurrence, indicated with elevated levels of prostate-specific antigen, or PSA, affects an estimated 12% of our patients three years following robotic radical prostatectomy, and an estimated 17% of patients at five years. Secondary outcomes of concern to patients include regaining continence and potency. Among our patients who were continent prior to undergoing prostatectomy, 63% regained continence within the first four months following surgery. By 12 months, we found that 87% of patients had regained continence. The average time to return to continence is 1.8 months. Return to potency takes considerably longer for prostatectomy patients. At 12 months following prostatectomy, 46% of our patients had returned to desired potency levels. The number edges higher when we consider a 24 month follow-up period (63%), and the average time to return to potency is 14 months for our patients overall. Age, however, is a notable factor in these estimates. Among younger patients who were under the age of 65 at the time of surgery, the average time to return to potency was under 12 months, and 69% of these patients were said to have regained potency at 2 years. It is important to keep in mind that these results represent outcomes since robotic prostatectomy was started at City of Hope in 2003. Since that time, with growing experience, positive margin rates have declined and individual surgeon results have improved. The operation we do now is considered to be leading edge and state of the art.

Who is a candidate for robotic assisted prostatectomy?

Anyone diagnosed with localized prostate cancer may benefit from robotic-assisted prostatectomy. However, the decision to have prostate cancer treated surgically revolves around numerous considerations. Variables that enter into preoperative evaluation include age, pre-biopsy PSA, biopsy findings, previous prostate cancer treatments and other illnesses. Robotic prostatectomy can be done for men of all sizes and shapes. The surgery can be done in men who have had other operations: appendectomy, laparoscopic hernia repair, repair of abdominal trauma, transurethral prostatectomy (TURP), and in some men who have been treated with previous pelvic radiation.

Does robotic assisted prostatectomy remove the whole prostate?

Yes. This surgery removes the prostate, seminal vesicles, ends of the vas deferens, and, depending on oncological considerations, nerve bundles and/or lymph nodes.

Why is there less blood loss with robotic assisted prostatectomy?

The reduction in blood loss reflects the improved view of the operative field, especially behind the pubic bone, home of the venous plexus of Santorini. The improvement in view comes from using a lens that tracks directly into the operative field where the remote human eye has a hard time going. The robotic surgery also uses magnification and bright illumination. Overall, this improved view permits a more precise and gentle dissection, which means better control of potential sources of bleeding.

Does robotic assisted prostatectomy require general anesthesia?

Yes. Robotic assisted prostatectomy is considered major surgery and thus requires general anesthesia.

Does prostate size matter?

As a practical matter, prostate size is not much of an issue. We routinely remove prostates ranging from 10 to 100 ccs in size.

Can lymph nodes be removed with robotic assisted prostatectomy?

Yes. Lymph nodes, to which prostate cancer may spread, can be removed.

What are the risks of robotic assisted prostatectomy?

This is major surgery, done under general anesthesia and carries the same risks of any major operation, including heart attack, stroke, and death. Robotic-assisted prostatectomy is also associated with the specific risks of impotence and incontinence.

Can the neurovascular bundles be preserved?

Yes. The neurovascular bundles whose preservation is associated with the likelihood of maintaining erections can be preserved. Nerve preservation does not guarantee satisfactory erections after surgery.

Does it make sense to preserve the neurovascular bundles?

Not in all cases. The issue here relates to the physical proximity of the bundles to areas of malignancy, which can microscopically extend beyond the prostate and into the bundles. The decision to preserve one or both neurovascular bundle depends on an individual analysis.

When will the ability to have an erection be regained following surgery?

Return of potency depends on many physical and psychological factors including preoperative erectile function and type of surgery (such as unilateral or bilateral; nerve-sparing or non-nerve sparing). Function may return spontaneously as early as one week after surgery, or with the aid of medications (Viagra, Muse). Potency rehabilitation can be discussed at the one-month visit. Factors that can interfere with erectile function include hypertension, diabetes, obesity, atherosclerosis, history of smoking, and anxiety, among others.

Are venous compression devices used in this surgery?

Yes. As a precaution against developing blood clots each patient has venous compression devices placed prior to surgery. These are removed when the patient becomes ambulatory.

Does robotic assisted prostatectomy require a catheter, drain, dressings, or stitches?

Yes. Like any radical prostatectomy, robotic-assisted prostatectomy requires reconstruction of the bladder-urethra connection. A catheter is left in the urethra, connected to a drainage bag, and used to align the healing suture line and drain the bladder. In the immediate post-op period, the surgery also requires a drain that goes through the abdominal wall and left in the pelvis behind the pubic bone. The drain assures the collection of blood and urine that may accumulate immediately after surgery and is removes when the output drops, usually prior to leaving the hospital. There are stitches, but these dissolve by themselves and require no special care. The surgical dressings are five Band-Aid type dots used to cover the instrument entry sites. These dressings are generally removed 48 hours after surgery.

How long should the catheter stay in?

We routinely remove the catheter in five to seven days at the first follow-up visit.

What can I expect after the catheter comes out?

Almost all patients have some incontinence when the catheter comes out. Incontinence varies from person to person, but usually improves significantly or resolves by the one-month follow-up clinical visit. Continence function returns with time, and patience here is a real virtue.

How can I speed my continence recovery?

You will be given an instruction sheet for Kegel exercises and other suggestions that will help in the recovery of continence. In addition, a Continence Recovery Program is available through our Rehabilitation Services Department beginning 1 month after surgery. Ask your MD for a referral.

Can I bathe after robotic assisted prostatectomy?

Yes. Most patients may shower within 24 hours of surgery.

What can I expect immediately after robotic assisted prostatectomy?

Patients leave the operating room with an intravenous line, a urethral catheter, and a small rubber drain in their lower abdomen. In the first few hours, depending on strength and motivation, most patients get out of bed and stretch their legs, and begin walking by nightfall. Most leave the hospital within 48 hours. Most patients begin drinking fluids on the 1st day after the procedure. Patients are discharged with a catheter connected to a leg bag, which fits under their pants. Loose clothing and shoes that don't require tying seem easier to handle in the first few days.

What can I expect after getting home?

While relative to open surgery robotic assisted prostatectomy is generally less demanding, the experience is still demanding. The single most common complaint after hospital discharge seems to be sleep deprivation and fatigue. Most patients are anxious going into surgery, get little sleep the night before surgery, arrive at the hospital very early on the morning of surgery, and get very little sleep the night after surgery. Accordingly, most patients look forward to a good, long nap and a shower after getting home. The other major complaint seems to be a sense of bloating, with clothes fitting very tight. This bloating seems related to the effects of surgery, anesthesia, and bed rest on intestine function. Often this sensation responds well to walking, which helps the patient expel intestinal gas, which in turn helps the patient regain his overall comfort and appetite.

If I live far away, can I travel after surgery?

Many of our patients come from far away and we can help with numerous logistical issues related to travel, from finding a suitable hotel to arranging medical evaluations pre-operatively. After surgery, we have had patients leaving Duarte within two days, be it by car or plane to various destinations.

What happens to my medical records and who will take care of me when I get home?

We work with our patients to transmit any and all relevant medical data to their home physicians. For those who chose to stay a while, we provide all follow-up medical care.

Must I return for follow-up care?

We support our patients regardless of where their paths take them. In a practical sense, this means that once a patient has had a robotic assisted prostatectomy, we consider him a lifetime patient and are always available. In fact, most of our patients, having come to rely on us during a very trying time in their lives, stay in touch and regularly call and email to update us or ask for our help. While we deliver urological care to all our local patients, there may be no compelling reason for patients to make trips to Duarte for routine follow-up.

What is the long-term follow-up after robotic assisted prostatectomy?

Depending on the pathologist's report of the surgery specimen, a patient may or may not consider additional cancer treatments. In most cases, but not all, the wise course of action is surveillance: periodic measurement of blood PSA, thought to be the most sensitive indicator of cancer recurrence.

What is the Survivorship Clinic?

We are very excited to now offer a unique opportunity for eligible patients. If you are one year post treatment and free of disease, we believe that you would benefit from the Prostate Cancer Survivorship Clinic. Services provided in the Clinic include general health promotion, follow-up assessments, screening for other cancers, education and other support services. For more information, please see the Prostate Cancer Survivorship Program.

Support This Program

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Rick Leonard
Associate Vice President
Direct: 213-241-7218
Email: rleonard@coh.org

 
 
Quick Links
Research, plus newest techniques, improves treatment ofprostate cancer

Research, plus newest techniques, improves treatment of prostate cancer

Counter-intuitive though it might seem, a prostate cancer diagnosis shouldn’t always lead to immediate prostate cancer treatment. Although prostate cancer is the second-leading cancer killer...

July 28, 2014

 
AACR 2014: Where ‘meaningful advances’ against cancerbegin

AACR 2014: Where ‘meaningful advances’ against cancer begin

More than 18,000 researchers, clinicians, advocates and other professionals will convene at the 105th American Association for Cancer Research (AACR) annual meeting taking place in San Diego from Apri...

April 5, 2014

 
Meet our doctors: Philip Pearson and David Rhodes on activesurveillance

Meet our doctors: Philip Pearson and David Rhodes on active surveillance

Cancer of the prostate is the No. 2 cancer killer of men, behind lung cancer, accounting for more than 29,000 deaths annually in this country. But because prostate cancer advances slowly, good pr...

April 5, 2014

 
New prostate cancer treatment uses MRI to guide ultrasoundablation

New prostate cancer treatment uses MRI to guide ultrasound ablation

Men with prostate cancer face tough choices: when, or even if, to treat their cancer; what procedure to use; and how to balance their chosen treatment with their quality of life. Now, a new multicente...

April 1, 2014

 
Urologic cancers: Dispatches from research’s frontlines

Urologic cancers: Dispatches from research’s front lines

Urologic cancers, including prostate cancer, kidney cancer and bladder cancer, are diagnosed in more than 381,000 Americans each year, and almost 60,000 people die from the diseases. City of Hope’s ph...

March 28, 2014

 
Prostate Cancer Videos
Mushrooms to treat prostate cancer?
Urology and Urologic Oncology Research

City of Hopes's Division of Urology strives to improve quality of care through innovative research that helps expand our understanding of urologic cancers. This brochure provides the key areas of research and studies our division is focusing on.
 
 
Robotic-assisted Radical Prostatectomy
Read more about having your robotic-assisted radical prostatectomy at City of Hope.
 
PSA Screening Overview
The Division of Urology continually assesses practices related to urologic cancer care and prevention. So, when the United State Prevention and Safety Task Force (USPSTF) released a report on PSA screenings in 2013, the division presented an overview that summarizes the USPSTF findings.
 
To view this presentation, click the link below.
 
NEWS & UPDATES
  • Advanced age tops the list among breast cancer risk factor for women. Not far behind is family history and genetics. Two City of Hope researchers delving deep into these issues recently received important grants to advance their studies. Arti Hurria, M.D., director of the Cancer and Aging Research Program, and ...
  • City of Hope is extending the reach of its lifesaving mission well beyond U.S. borders. To that end, three distinguished City of Hope leaders visited China earlier this year to lay the foundation for the institution’s new International Medicine Program. The program is part of City of Hope’s strategi...
  • A hallmark of cancer is that it doesn’t always limit itself to a primary location. It spreads. Breast cancer and lung cancer in particular are prone to spread, or metastasize, to the brain. Often the brain metastasis isn’t discovered until years after the initial diagnosis, just when patients were beginning to ...
  • Blueberries, cinnamon, baikal scullcap, grape seed extract (and grape skin extract), mushrooms, barberry, pomegranates … all contain compounds with the potential to treat, or prevent, cancer. Scientists at City of Hope have found tantalizing evidence of this potential and are determined to explore it to t...
  • Most women who are treated for breast cancer with a mastectomy do not choose to undergo reconstructive surgery. The reasons for this, according to a recent JAMA Surgery study, vary. Nearly half say they do not want any additional surgery, while nearly 34 percent say breast cancer reconstruction simply isn’t imp...
  • The leading risk factor for breast cancer is simply being a woman. The second top risk factor is getting older. Obviously, these two factors cannot be controlled, which is why all women should be aware of their risk and how to minimize those risks. Many risk factors can be mitigated, and simple changes can lead...
  • All women are at some risk of developing the disease in their lifetimes, but breast cancer, like other cancers, has a disproportionate effect on minorities. Although white women have the highest incidence of breast cancer, African-American women have the highest breast cancer death rates of all racial and ethni...
  • First, the good news: HIV infections have dropped dramatically over the past 30 years. Doctors, researchers and health officials have made great strides in preventing and treating the disease, turning what was once a death sentence into, for some, a chronic condition. Now, the reality check: HIV is still a worl...
  • Screening for breast cancer has dramatically increased the number of cancers found before they cause symptoms – catching the disease when it is most treatable and curable. Mammograms, however, are not infallible. It’s important to conduct self-exams, and know the signs and symptoms that should be checked by a h...
  • Rob Darakjian was diagnosed with acute lymphoblastic leukemia at just 19 years old. He began chemotherapy and was in and out of the hospital for four months. After his fourth round of treatment, he received a bone marrow transplantation from an anonymous donor. Today, he’s cancer free.   In his previ...
  • In a single day, former professional triathlete Lisa Birk learned she couldn’t have children and that she had breast cancer. “Where do you go from there?” she asks. For Birk, who swims three miles, runs 10 miles and cycles every day, the answer  ultimately was a decision to take control of her cancer care. Afte...
  • More and more people are surviving cancer, thanks to advanced cancer treatments and screening tools. Today there are nearly 14.5 million cancer survivors in the United States. But in up to 20 percent of cancer patients, the disease ultimately spreads to their brain. Each year, nearly 170,000 new cases of brain ...
  • Cancer cells are masters of survival. Despite excessive damage to their most basic workings and the constant vigilance of the body’s immune system, they manage to persevere. Much of this extraordinary ability to survive falls under the control of proteins bearing the name STAT, short for signal transducer and a...
  • One person receives the breast cancer diagnosis, but the cancer affects the entire family. Couples, in particular, can find the diagnosis and treatment challenging, especially if they have traditional male/female communication styles. “Though every individual is unique, men and women often respond differently d...
  • Here’s a statistic you’ll hear and read frequently over the next month: One in eight women born in the United States will develop breast cancer at some point in her lifetime. Although this statement is accurate, based on breast cancer incidence rates in 2013, it’s often misunderstood. Leslie Bernstein, Ph.D., d...