Robotic Prostate Surgery for the Treatment of Prostate Cancer

What is da Vinci Prostate Cancer Surgery?

Prostate cancer surgery has been revolutionized with the use of the da Vinci robotic surgical system. Da Vinci Robotic Prostatectomy is a minimally invasive option for prostate cancer treatment available thanks to cutting edge breakthroughs in surgical technology. Da Vinci robotic prostate cancer surgery maintains all of the benefits of definitive surgical treatment for prostate cancer while adding the benefits decreased blood loss, less pain and more rapid return to regular activities and a shorter hospital stay.  For these reasons it is clear why da Vinci robotic prostate cancer surgery has become the preferred method for removal of the prostate after early diagnosis of prostate cancer.

About Dr. David Robbins

Miami urologist David Robbins, MD is a board certified urologist and is the director of the robotic surgical program at Urological Consultants of Florida. He has a special focus in prostate cancer having trained under the guidance of world renowned prostatectomy surgeon and pioneer in the field of nerve-sparing prostate cancer surgery Dr. Herbert Lepor. He refined his techniques of nerve-sparing prostatectomy for prostate cancer during his time at NYU and is now recognized by his colleagues and patients as one of the best prostate cancer surgeons performing da Vinci robotic prostatectomy surgery in greater Miami region. Dr. Robbins is currently performing da Vinci robotic prostate cancer surgery on a weekly basis with excellent results with respect to maintenance of erectile function, urinary continence and most importantly cancer cure. Dr. Robbins is currently perfoming da Vinci robotic prostatectomy procedures for prostate cancer at Mount Sinai Medcial Center in Miami Beach and Aventura Hospital and Medical Center in Aventura.

Why Choose Dr. David Robbins?

Miami urologist Dr. David Robbins trained at New York University and learned how to perform robotic surgery from world leaders in the field of prostate cancer surgery and da Vinci robotic surgery. This specialized training in robotic prostate cancer surgery along with Dr. Robbins’ intense drive toward improvement has helped him to develop the skills necessary to provide patients with the highest quality robotic surgery outcomes espcecially with regard to prostate cancer cure, urinary continence and maintenance of erectile function. In addition to patient satisfaction with the functional aspects of robotic prostate cancer surgery, Dr. Robbins is highly appreciated by his patients for the personal care that he delivers and his genuine compasion. For these reasons, Dr. David Robbins is considered by many to be the best urologist specializing in robotic prostatectomy surgery and prostate cancer treatment in Miami, Florida.

Why Robotic Surgery?

During open “radical” prostatectomy (removal of the prostate) for prosate cancer, the prostate is removed using a large midline incision from the umbilicus to the pubic bone. The major drawback of this approach is not only the size of the incision but also the stretching of the abdominal muscles and skin that is necessary to place a retractor to gain the appropriate visualization in order to perform an open prostatectomy. This large incision can take longer to heal and results in increased post operative pain and impaired mobility. One of the many advantages to da Vinci robotic prostatectomy for prostate cancer is that is can be performed through five tiny incisions and the prostate removed through the umbilicus at the end of the procedure. This leads to less post operative pain and scarring and a quicker return to regular activities. Additionally, the view of the surgical field afforded by the 3D stereoscopic display means that the surgeon has a much clearer view of the nerves and blood vessels surrounding the prostate which helps to minimize blood loss and reduces the risk of damaging the nerves responsible for continence and erectile function. During da Vinci robotic prostatectomy for prostate cancer, the prostate gland and seminal vesicles are separated from the bladder and urethra and then these two structures are reconnected over a foley catheter to maintain a contained urinary channel. For advanced disease the pelvic lymph nodes can be sampled to verify that the disease has not spread beyond the prostate.

What is the “robot”?

The robot itself consists of two units. The Patient-side cart has four robotic arms for carrying out the surgery; one arm holds a camera and the other three hold instruments. The surgeon sits at a console with a stereoscopic 3D view of the operating field. Unlike a conventional (2D) screen, this allows the perception of depth which makes accurate surgery much easier. Beneath the display are the master controls which translate the surgeon’s hand movements in real-time to the movement of the robotic arms and instruments. The system is designed to remove tremor and allow very precise movement.

Patient Testimonials

“I was diagnosed with prostate cancer in November 2010. On February 15, 2011, I registered at Mt. Sinai Hospital for robotic surgery to be performed by Dr. David Robbins and his team. Deep inside, I was expecting the worst. These were the results: 1) Pain – No pain (Percocet was prescribed. Didn’t have to use any). 2) Overall Discomfort – The same night of the surgery I walked the hallway on my hospital floor. 3) Incontinence – After the catheter was removed I used pads for a few days. Not saying that every once in a while I got a little wet, but three weeks after the surgery it was 95% under control. Today, fine and dandy. I thank the Good Lord for delivering me into the gifted hands of Dr. Robbins. An event that causes so much distress because of the obscure, turned out to be a positive, very bearable life changing experience.” DR. ROBBINS’ EXPERT ROBOTIC TEAM Please click here to download and print a copy of Dr. Robbins preoperative and postoperative instructions for da Vinci robotic prostatectomy. Please click here to link to additional information from Intuitive Surgical regarding da Vinci robotic prostatectomy.

Prostate Cancer Surgery Miami

“This is another article which highlights the debate over PSA screening for prostate cancer.  It seems that although the US Preventative Task Force has decided unilaterally to recommend against PSA screening, government officials including President Obama and Senator Wyden have chosen to ignore the recommendations and have their PSA screened.  Senator Wyden additionally underwent surgery after being diagnosed with prostate cancer.”  David Robbins

The politics of prostate cancer

  • Sen. Ron Wyden walks to the Senate floor on Capitol Hill. | AP Photo
Sen. Ron Wyden chose surgery for prostate cancer over ‘active surveillance.’ | AP PhotoClose
By DIANE WEBBER | 12/21/10 4:40 AM EST

Sen. Ron Wyden had surgery for prostate cancer Monday, putting himself — through no fault of his own — in the middle of a debate about diagnosis, treatment and bending the cost curve.

The longtime health care advocate and Oregon Democrat was operated on by Alan Partin at Johns Hopkins Hospital in Baltimore. The cancer was caught early, and Wyden, 61, has an excellent prognosis, according to his office.

The option known as “active surveillance” (formerly “watchful waiting”) allows patients to avoid or delay surgery, radiation and chemotherapy — and the side effects that come with those treatments. Active surveillance means coming back to the doctor on a regular schedule for a blood test and examination to see if the cancer is growing. But few men choose it.

Wargo discusses active surveillance with her patients, and she considers it a good option for those who fear surgery or have other serious health problems. She is on board with the new nomenclature. “Watchful waiting sounds like you can just go disappear and not come back to see me,” she said. But she understands why many men choose surgery. “There is a personality of men who can’t live with the idea that there is something inside them that could kill them.”

Bruce Quinn, M.D., health specialist with Foley Hoag and a former official in California’s Medicare program, pointed out that, over a five-year period, active surveillance doesn’t save significant funds, because the slow-growing cancers often become aggressive and require more expensive, invasive treatment.

“It’s not the difference of $100 versus $30,000 if you look at the cost comparisons over five years. Active surveillance is more costly than people think,” said Quinn. “It’s not popular, I think, because patients must find it pretty uncomfortable to be told they have a 2-to-3-centimeter tumor that could eventually blow up and kill them, and we’re just going to watch it. Men say, ‘Just get the damn thing out!’”

Wargo and Quinn both noted problems with the prostate-specific antigen test that is the screening tool used for diagnosis. A normal level in one individual might be abnormal in another, and doctors need to track changes in the level over time to approach any kind of accuracy.

“You really have to look at each patient individually,” said Wargo. “A PSA level of 4 is normal in an older patient, but it is completely unacceptable in a 47-year-old. You can have a low level and still have aggressive prostate cancer.”

Complicating matters is the fact that no test accurately predicts who will get the aggressive, deadly form of the disease and who will get a slow-growing, non-life-threatening form. Quinn points to Medicare reimbursements as part of the problem.

In choosing surgery over what used to be called “watchful waiting,” Wyden took a path that many men take when faced with a prostate cancer diagnosis. But increasingly, that path is questioned in the era of health care reform, as cost-cutting is pitted against personal choice.

Doctors acknowledge that the cost-cutters have a point but bristle at the intrusion into the physician-patient relationship.

“It is well and good for statisticians to say, ‘This is the patient who doesn’t need to be treated,’” said Heather C. Wargo, a urologist practicing in Mount Laurel, N.J. “But when I am sitting with a patient, looking him and his spouse in the eye, it is very difficult to say, ‘I’ve been accused of overtreating, so I’m not going to treat you.’”

The U.S. Preventive Services Task Force, the body that sparked a firestorm when it said that most women do not need an annual mammogram until age 50, was set to vote on new prostate-cancer-screening recommendations last month. Instead, the panel canceled its November meeting, citing “scheduling conflicts.”

Kenneth Lin, professor and family physician, quit the task force in protest. “Politics trumped science this time, as it has in the past, and may at times in the future,” Lin wrote in his blog, where he linked to a news account of the mammogram controversy.

Rep. Debbie Wasserman Schultz (D-Fla.), who had breast cancer, told POLITICO that the task force “seems out of touch with reality.”

“I think that organization really undermines its credibility, not necessarily among the scientific community but for the general public,” Wasserman Schultz said, noting that there were no cancer experts on the panel when the breast-cancer-screening recommendations were made.

Yet statistical analysis like the task force’s research has some of the greatest potential to save money on health care spending.

Prostate cancer is ripe for study. Researchers question whether it is being overdiagnosed and whether too many surgeries are being performed on tumors that would never become dangerous.

“The Medicare fee schedule is around $20 for the PSA test, and it is just frozen there,” said Quinn. “It’s really hard for companies to do the trials that they need to do to come up with a more effective, more precise prostate cancer test with this artificially very low fee.”

Mara Aspinall is CEO of On-Q-ity, a company working on new diagnostic tests that have the potential to identify rare cancer cells circulating in the bloodstream, long before they are prevalent enough to be picked up as tumors on MRI and CT scans.

Aspinall said the Medicare fee schedule is a problem for her new technology. “In the laboratory, the more steps your process has, the more you’re paid,” she said. “This was a useful construct some time ago, but it has not kept pace with technology. We now can have one really big step to replace 10 small ones. It’s an incredible disincentive.”

While Aspinall argued that better diagnostic tests could bring more clarity and potential cost savings to prostate cancer treatment, she emphasized that tests can’t replace the doctor-patient dialogue.

“It is essential that the decision on how to proceed — even in the era of diagnostics — needs to continue to be an educated discussion between the physician and the patient,” said Aspinall. “We want to bring more information to the equation.”

Wyden will no doubt be helpful in bringing more information to the equation as he recovers from his disease. He started working on public health issues as a young lawyer when he founded a legal aid society for the elderly and Oregon’s first chapter of the Gray Panthers. During health care reform, he was the architect of the Healthy Americans Act, which would have radically changed health care from the employer-based system, and now he is co-sponsoring a bill that encourages states to innovate on reform implementation.

“If anything is taken away from my experience, I hope it is the importance of getting routine physicals,” Wyden said as he was disclosing his disease last week. “One in six men will be diagnosed with prostate cancer during their lifetimes. Early detection is critical to catching this disease when treatment is most effective.”

PSA Screening

Change Screening Attitudes, Cancer Researcher Says

By Nancy Walsh, Staff Writer, MedPage Today
Published: November 25, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
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Action Points

    • A researcher believes that the time has come for a fundamental shift in attitude toward cancer screening, with greater emphasis on providing the public with information about absolute risks and the potential for harm associated with screening.
  • It was recommended that patients and the public should be given clear information — based on science rather than opinion or advocacy — that explains cancer incidence and mortality, and provides transparent information about the risks and benefits of screening.

The time has come for a fundamental shift in attitude toward cancer screening, with greater emphasis on providing the public with information about absolute risks and the potential for harm associated with screening, according to a behavioral oncology researcher.

The firestorm that erupted after the U.S. Preventive Services Task Force recommended against mammograms for women ages 40 to 49 was emblematic of the controversies generated among healthcare providers, the public, and advocacy groups every time new guidelines are announced, according to Michael Edward Stefanek, PhD, of Indiana University in Bloomington.

A perspective that is unappreciated is that at least 1,900 women in their 40s would need to undergo mammography to avoid one death over 11 years. During that follow-up time, there would be 2,000 false-positive tests, “along with the resulting unnecessary biopsies, overdiagnosis, and overtreatment,” Stefanek explained in a commentary in the December 20 issue of the Journal of the National Cancer Institute.

Even routine mammography for women ages 50 to 70 — a recommendation that has not been seen as controversial — has considerable opportunity for harm, with 838 women having to be screened during six years to prevent a single death from breast cancer.

And among women in their 50s, five in 1,000 can be expected to succumb to breast cancer during a ten-year period, but annual screening during that time would only prevent one of those five deaths. Nearly 1,000 women “screened for ten years will have gained nothing, and may have been subject to as many as 50% false-positive tests, unnecessary biopsies, overdiagnosis, and overtreatment for breast cancer,” he argued.

The public has not been well served by policy makers and institutions that have taken the approach of emphasizing the benefits of cancer screening, particularly in reducing mortality, and downplaying the consequences, particularly of unnecessary treatments, he stated.

“There will come a time when all the patients have been followed, all the analyses done, all the groups assembled, and all the editorials written, and we still will not be secure in our knowledge of the individual harms and benefits of cancer screening. It appears that this time has come,” wrote Stefanek, who has previously held positions at the National Cancer Institute and the American Cancer Society.

The evidence for prostate cancer screening also is ambiguous. For instance, one study that included 20,000 men who had prostate-specific antigen (PSA) testing every two years or no screening found a decrease in deaths from prostate cancer of nearly 50% with the test over 14 years.

Yet a meta-analysis that included almost 400,000 men found no improvement in either overall mortality or prostate cancer-specific deaths.

Moreover, a randomized trial determined that 1,410 men would have to undergo screening and 48 cancers treated to prevent a single prostate cancer-related death, according to Stefanek.

And for the more recent notion of screening smokers for lung cancer using CT scans, the potential harms associated with screening have been clearly demonstrated by the finding that about 95% of positive screens were, in fact, false positives.

To address these concerns, Stefanek offered a number of possible strategies.

An important shift must emphasize the education of healthcare providers and the public, rather than encouraging a specific approach or behavior.

Patients and the public should be given clear information — based on science rather than opinion or advocacy — that explains cancer incidence and mortality, and provides transparent information about the risks and benefits of screening.

Furthermore, risks should be presented as absolute rates and in ways that can be easily understood, the researcher advised.

Another component of the new strategy would be the creation of a partnership among scientific and advocacy groups, but not to further develop and disseminate guidelines.

Rather, the task should be to develop the clearest educational materials so patients and caregivers can together make the most appropriate individual decisions on screening.

This informed decision-making approach should be accompanied by the implementation of measures that evaluate the number of patients who have been educated, rather than how many are screened.

In addition to these strategies, “and critically important, we need to energize work to identify markers that discriminate minimal-risk disease likely to have little impact on mortality versus high-risk disease,” he wrote.

Shifting screening decisions away from a public health perspective to an informed individual approach will allow consideration of factors typically overlooked, such as anxiety about illness, acceptable degrees of risk, and the negative consequences of unnecessary treatment.

Such an approach, clearly informing patients about both benefits and harms of screening “involves a fundamental respect for individuals and a tolerance for truly informed decisions even if, as individuals ourselves, we would not make the same choice,” Stefanek concluded.

Debate about prostate tests rages

“This article from North Caroloina highlights the issues involoved in the PSA debate that continues to affect the lives of patients in Miami and around the country.” David Robbins

Debate about prostate tests rages

By: RICHARD CRAVER | Winston-Salem Journal
Published: November 19, 2011

Turning 50 proved to be a milestone for Mike Tyson not just in terms of age.

Tyson, of Winston-Salem, credits the symbolic birthday for saving his life because he chose to undergo a routine prostate-specific antigen test at that time. The test measures a specific protein released by prostate cells.

Because his PSA level was elevated for his age, Tyson underwent a biopsy that revealed prostate cancer. He had surgery in February.

He said his recovery was slow but that in August, he began feeling more like himself, particularly after participating in the Livestrong program for cancer patients and survivors at local YMCAs.

The necessity of the PSA test — and the consequences of what it might reveal — has become a significant topic at local urologist offices since October, when the U.S. Preventive Services Task Force recommended against it.

For men, prostate cancer is second only to skin cancer in frequency of cancer cases. It also is the second leading cause of death, behind lung cancer.

In 2009, health-care lobbying groups criticized the task force for recommending that most women wait until age 50 to get mammograms and then have one every two years. The American Cancer Society’s longstanding recommendation is annual screening starting at 40.

Opponents of the PSA test say it tends to lead to potential misdiagnosis and unnecessary biopsies and treatment for men, particularly for those 50 and older. They say urologists support PSA testing because it can be a significant revenue source.

After conducting five clinical PSA trials, the task force said, “There is moderate or high certainty that the service has no net benefit and that the harms outweigh the benefits.” According to a New York Times report, the task force said the test “cannot tell the difference between cancers that will and will not affect a man during his natural lifetime.”

Proponents point to examples, such as Tyson, as to why the test is pertinent.

Tyson said he’s convinced PSA testing is not only necessary but should be done sooner.

“I had no symptoms of prostate cancer,” Tyson said. “Having my wife die of bone cancer in February 2008 after fighting it valiantly for seven years, and with an 11-year-old daughter to care for, I didn’t consider anything other than surgery.

“If I had gone with the watch-and-wait approach, I might not have been checked for months, if not years, because of being 50. Who knows how much the prostate cancer could have spread in that time?”

Urologists affiliated with Forsyth and Wake Forest Baptist medical centers support the stance of the American Urological Association.

“Until there is a better widespread test for this potentially devastating disease, the task force — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test,” said Dr. Sushil Lacy, president of the association.

“It is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, or risk assessment and monitoring of prostate cancer patients.”

This issue isn’t one that affects just urologists, said Karen Richardson, a spokeswoman for Wake Forest Baptist. “Many men get their prostate cancer screenings from their primary-care physicians,” she said.

Dr. Jeremy Hubbard, a urologist at Carolina Urological Associates, said he disagrees with the task force’s recommendation because it is a sweeping declaration for a decision that is individual in nature.

“We’re concerned that some patients — and some primary physicians — may only consider the task force’s recommendations and not access all the pertinent information they may need,” Hubbard said.

In 2008, the task force recommended against PSA testing in men ages 75 or older, relying instead on the watch-and-wait approach because treating the prostate cancer for men of that age could cause more harm than the disease itself.

Hubbard said that because some prostate cancer is slow to grow, “it requires reasonable active surveillance by physician and patient.”

“Treatment recommendations for someone with prostate cancer are different for someone in their 40s and 50s compared with 60s and 70s,” he said.

The American Council on Science and Health supported the task force’s recommendations because it said tens of thousands of men have had serious complications from unnecessary prostate surgery, ranging from blood in the urine to incontinence and impotence, and even death.

Dr. Gilbert Ross of the council said a more specific test for prostate cancer is needed — one that will identify only cancer cells that are likely to develop into dangerous tumors and metastases.

“The PSA test should not continue to wreak so much havoc on people’s lives,” Ross said.

Prostate Cancer Awareness Month

September is National Prostate Cancer Awareness Month

September 14, 2011

 – This week Rep. Debbie Wasserman Schultz (FL-20) met with medical professionals and a prostate cancer survivor at Mount Sinai Comprehensive Cancer Center in Miami Beach to raise awareness of prostate cancer and raise awareness of the free screenings that are available to South Floridians.

Prostate Cancer Awareness 012.jpg

Prostate cancer is becoming the most commonly diagnosed cancer in American males today – and it’s the second leading cause of cancer deaths overall in the United States. Even former Florida State football coach Bobby Bowden recently revealed that he battled prostate cancer while he was coaching in 2007.

Here are the facts:

• Every 5 minutes in this country, two men are diagnosed with prostate cancer.

• One in every six men is at risk of getting prostate cancer in their lifetime.

• And men who have a close relative with the disease have double the chance of getting it themselves.  With two close relatives, that risk becomes five-fold. With three, the chance is 97 percent.

So no matter a man’s age now, it’s important to educate men of all ages about knowing the signs to look for and taking the time to get one of the free screenings available in their community.

We know that prostate cancer is mainly found in men over age 55, with an average age of 70 at the time of diagnosis.   And thanks to the passage of the Affordable Care Act – the health care reform law, there are many free preventative services available so that prostate cancer and other diseases can be detected early.

In fact, the 3.3 million Floridians who are on Medicare can now obtain annual recommended preventive services for free – that includes important screenings like the Prostate Specific Antigen (PSA) Test, mammograms, colonoscopies, and even a free annual wellness visit, all of which will keep you healthier longer.

Please share this with a family member or friend, and make sure someone you love gets screened today.