Randall Minion, M.D., was helping out a newly hired lab technician when he had his prostate specific antigen (PSA) tested. When he volunteered his blood sample for training purposes at his private practice, he never dreamed it would lead to the serendipitous early detection and treatment of prostate cancer.
"I was 49, so I was half-joking, but it was an appropriate test to run because I would be turning 50 in a few months," says Dr. Minion, a family medicine physician in Fort Dodge, Iowa. "When my PSA was elevated, I visited my local urologist, who did a biopsy." It came back positive for cancer and Minion's doctor discussed treatment options, which included a new robotic surgery procedure.
A physician himself, Dr. Minion already knew the possible side effects of radical prostatectomy, which include urinary incontinence and impotence. He did extensive research on treatment options. "I chose surgery to avoid the many trips required for radiation therapy," he says. "It also offered me the best chance for a cure."
After learning more about robotic surgery and its benefits, Dr. Minion scheduled an appointment at Mayo Clinic, whose urology practice is ranked among the top centers for Urology by U.S. News and World Report. It also has one of the longest and most extensive track records in surgical therapy for prostate cancer in the nation.
Today prostate cancer is the second-leading cause of cancer deaths in American men. Mayo Clinic is working to change that statistic by using different methods of evaluating and treating prostate cancer patients.
"Dr. Minion was younger than most patients we treat with prostate cancer," says Igor Frank, a urologist at Mayo Clinic in Rochester, Minn. "And, he was in excellent health in every other way."
When exploring treatment options, urologists at Mayo Clinic consider a number of criteria and map them to the patient. "One of those criteria is age," explains Dr. Frank. "Dr. Minion was young, with significant life expectancy."
Mayo Clinic also evaluates if the cancer is confined; once it spreads outside the prostate, it becomes more difficult to treat or cure. "This patient's cancer was totally confined to the prostate because it was detected so early through PSA testing," says Dr. Frank. "And he was in otherwise excellent health, so the decision to treat him in the most effective, yet least invasive way was preferred."
Together, the doctors decided to treat the cancer with a minimally invasive surgery technique, which would remove the cancer from the prostate, while sparing the surrounding structures responsible for sexual function and urinary control. "This would give Dr. Minion the treatment he needed without compromising his quality of life," explains Dr. Frank.
Surgeons at Mayo Clinic have been using a robotic assist device — called the da Vinci® Surgical System — for urologic procedures since 2003. The system was approved by the U.S. Food and Drug Administration in 2001 for prostate surgery. "Urology leads the way in robot-assisted surgery because the prevalence of prostate cancer is so high and the robot is so ideally suited for pelvic surgery," says Dr. Frank, who performed Dr. Minion's surgery.
With the robotic-assisted procedure, surgical instruments and a miniature camera are inserted through small "key-hole" incisions. This approach compares to an incision of at least five to six inches when treatment involves a standard open radical prostatectomy. Minimally invasive surgery is performed by surgeons directing robotic "hands" to perform the delicate, complex surgery. Robotic technology is available at all three Mayo Clinic locations.
The surgeon's finger motions, conveyed through sophisticated joy sticks, direct the minute maneuvers carried out by three robotic arms holding surgical instruments.
The surgeon views the surgery on a special monitor, which shows a greatly enlarged three-dimensional view of the surgical area. The images are transmitted by two separate small cameras within a single instrument mounted to a fourth robotic arm.
"With smaller incisions, men undergoing prostate surgery can expect to have less pain, fewer blood transfusions, less blood loss during surgery and a faster recovery," says Dr. Frank. "Using robotic precision translates into excellent preservation of the nerves and blood vessels that are responsible for erections, which improves one's chances of retaining sexual function."
"This procedure is really the cat's pajamas," laughs Dr. Minion, who left the hospital the day after his surgery. Besides shorter hospital stays, other benefits of robot-assisted surgery are decreased blood loss, shorter recovery times and less scarring due to smaller incision sites.
"The da Vinci® robotic system elevates surgery to a new level," says Dr. Frank. "It allows you to do micro-dissection and be very precise, but less invasive."
Surgeons require special training to use the robotic system. In addition to four systems used for patient care, Mayo Clinic in Minnesota has one system in research for developing new procedures and training surgeons in the system's use. Robotic surgery also is being integrated as part of Mayo Clinic's standard curriculum for certain types of surgical training.
"The surgery was done brilliantly well and I don't have any side effects or limitations from my treatment," says Dr. Minion. "I would refer all my patients — and anyone — to Mayo Clinic for treatment."Posted by Margaret Shepard