COLORS FOR A CURE: Robotic surgery yields better outcomes for prostate cancer patients

Robotic technology has come to the forefront of modern medical techniques to fight cancer.

Up until about three years ago, operations involving prostate cancer at Columbus Regional Hospital were done with traditional open surgery techniques. Because the surgeon was often forced to have both hands inside the body, as well as work with limited visibility, precise dissections were difficult and the patient was often left with a big incision from the naval to the pelvic bone.

However, CRH was able to address a number of those problems by hiring urologist Dr. John Francis, a Chicago native who was trained to be a physician at Rush Medical College in his hometown.

Francis said it was during his residency training at Case Western Reserve University in Cleveland that he received specialized training in robotic surgery.

After observing and later performing several robotic surgeries, the surgeon said he found the high-tech procedures challenging but fascinating because “you could really make an improvement on someone’s quality of life.”

“I brought the training I received in Cleveland to Columbus, where the urology group before us wasn’t really doing many of those types of operations,” Francis said.

When some folks hear about robotic surgery, they assume the patient is hooked up to a machine and the robot does all the work with minimal physician assistance, the surgeon said.

“That’s a bit of a misnomer,” Francis said. “It’s a laparoscopic machine that I control from a console across the room. I have direct visualization into somebody’s abdomen.”

A laparoscopic machine means it is designed to perform minimally invasive surgery carried out through a very small incision, with special instruments and techniques including fiber optics, according to the Mayo Clinic website.

For men with prostate cancer, robotic surgery provides more precise dissection that will result in less pain, smaller incisions and less blood loss, the physician said. In addition, men who receive robotic surgery tend to have shorter hospital stays, better levels of urinary competence and increased sexual function compared with those who undergo a conventional operation, Francis said.

If someone is a skeptic regarding prostate cancer screening, there was once a now-outdated factual basis for the skepticism.

In 2004, conclusions from a large randomized controlled trial concluded that there was no benefit for screening for prostate cancer, Francis said. That conclusion resulted in a national recommendation that nobody should get a prostate screening with blood tests, the physician said.

But 10 years later, a flaw in the controlled trial was discovered. This was found while urologists began to see more prostate cancer cases at an advanced stage, Francis said. So widespread physician recommendations for PSA (prostate specific antigen) blood screenings are normal today.

The general guideline recommends that males start PSA blood screenings at age 55, but there are individuals who are at higher risk of developing prostate cancer than others, the urologist said.

“I’ve always said to guys in their late 40s to early 50s to consider a PSA blood test now,” Francis said. “If it’s normal, we can sit on it for two to three years until it’s time to take it again. But if it’s high, that might indicate an early case of prostate cancer. The earlier we detect it, the better the chances for long-term survival and better treatment options.”

With the exception of melanoma (skin) lung cancer, prostate is the most common form of cancer, according to the World Cancer Research Fund. And when a medical professional tells someone they have cancer, Francis says it will likely cause fear, depression, stress, anxiety and worry.

For that reason, the physician attempts to frame discussions with a person newly diagnosed with prostate cancer in a positive way. Before the first discussion begins, he suggests that the patient bring a family member into the room.

“I first tell them that this is not a ‘get your affairs in order’ discussion,” Francis said. “I assure them that prostate cancer is the type that is very, very manageable with good long-term outcomes. I assure them we’re going to take care of them and be with them throughout the entire process. I make sure they know they are not alone in this.”

The best way to encourage a positive mindset is a careful discussion of all treatment options, what the patient can expect, and — most importantly — letting the patient know that their doctor and his team are always there to support them and address any questions or concern that may arise.

While Francis does not work with colorectal diseases, he does understand why the American Cancer Society has recently started to recommend colon cancer screenings at age 45, rather than the traditional 50.

“Although it is very rare, it’s my understanding that it is a disease that people can get in their 30s,” Francis said.

An example cited by the physician was actor Chadwick Boseman, who died two years ago at the age of 43. The “Black Panther” star was diagnosed with stage 3 colon cancer in 2016, and battled with it for the final four years of his life.

“I think his death prompted a lot of people to say that if someone as healthy and fit as Chadwick was can die of this disease, we should also take notice,” Francis said.

Regular screenings every five years can find colorectal cancer when it is small, hasn’t spread, and might be easier to treat, the surgeon said. Some screenings can also help find and remove pre-cancerous growths called polyps before they have a chance to turn into cancer, he added.

While the general guidelines recommend that men start PSA (prostate specific antigen) blood tests at age 55, some men should start the tests earlier.

The U.S. Preventative Services Task Force and the American Urological Association have agreed that you may need PSA blood screening between the ages of 40 and 54 if you:

  • Have at least one first-degree relative (such as your father or brother) who has had prostate cancer.
  • Have at least two extended family members who have had prostate cancer.
  • Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers.

Source: The Mayo Clinic