Advancing Treatments for Prostate Cancer
Physicians at The Mount Sinai Medical Center’s Department of Urology continue to innovate and expand treatment options for patients with prostate cancer.
Each week, David Samadi, MD, Chief of Robotics and Minimally Invasive Surgery, and his surgical team perform robotic-assisted laparoscopic prostatectomies (RALP) on patients with localized prostate cancer. Using his own technique called the Samadi Modified Advanced Robotic Technique (SMART), Dr. Samadi, Vice Chair of the Department of Urology, is able to perform the RALP procedure in less than two hours, with a 24-hour hospital stay and no blood transfusions.
The unique, endopelvic fascia-sparing SMART technique removes the entire prostate, seminal vesicles and lymph nodes. It yields continence rates of 96 percent, and potency rates of 79 percent in preoperatively functional men, according to a report that Dr. Samadi recently published in the Journal of Endourology. In September 2011, Dr. Samadi and his team performed their 2,000th procedure at Mount Sinai.
Dr. Samadi attributes this success rate to his dedicated surgical team, the support of Mount Sinai Hospital, state-of-the-art technology, and to his own expertise in oncology, and open, laparoscopic and robotic surgery. He says there have been no major complications following his surgeries; none of his patients has returned to the operating room, and none has had rectal perforation. In complicated prostate cases, Dr. Samadi works very closely with general surgeons.
"Our patients come to Mount Sinai from all over the world," says Dr. Samadi. "We have a very high rate of satisfaction. Only 5 percent to 10 percent of patients have radiation after surgery." He adds that caring for patients is a critical part of the equation. "The journey has to be seamless. We are there guiding our patients from the beginning. They choose this procedure because it is associated with less pain, less blood loss, improved cosmesis, and a quicker return to daily life."
During RALP, Dr. Samadi operates a console with two controls that allow him to use a robotic interface to manipulate instruments that are inside the patient. The movement of the instruments mimics the flexibility of a human wrist, and the 3-D surgical field provides him with the same depth as if he were looking directly at the image.
The success of RALP has driven demand for the procedure—from 9,000 robotic prostatectomies in the United States in 2004, to more than 66,000 in 2009, making it the most popular surgery for localized prostate cancer.
New Drugs for Late-Stage Prostate Cancer
The U.S. Food and Drug Administration recently approved three new treatments that prolong the lives of patients with late-stage prostate cancer. Simon J. Hall, MD, Chair of Mount Sinai’s Department of Urology, served as a lead investigator for one of the treatments, Provenge® (sipuleucel), a vaccine that uses a patient’s dendritic cells to generate an immune response that fights the cancer.
Dr. Hall and his researchers at Mount Sinai participated in five clinical trials, and co-authored two peer-reviewed articles on Provenge®, a form of active cellular immunotherapy, and the first treatment of its kind approved in the United States. He says Provenge® has little toxicity and is routinely well tolerated by patients.
Two other new therapies available to patients with late-stage prostate cancer are Jevtana®, a microtubule inhibitor used in combination with prednisone that is delivered intravenously and prevents the growth and division of cancer cells, and abiraterone acetate, a pill that decreases the production of testosterone, which stimulates prostate cancer cell growth. All three treatments can be used sequentially.
"Things have changed for the better for patients with fatal prostate cancer," says Dr. Hall. "While these treatments aren’t a cure, we want to be able to tell patients there is something we can do to help."
Making Informed Decisions
Roughly one man in six will be diagnosed with prostate cancer during his lifetime, and one man in 36 will die of the disease, making it the second leading cause of cancer death in American men after lung cancer, according to the American Cancer Society. Patients face several treatment options and often find it difficult to choose whether to have surgery, external beam radiation, radioactive seed implantation, or active surveillance. Michael Diefenbach, PhD, Associate Professor of Urology, and Oncological Sciences, is the principal investigator and developer of the Prostate Interactive Education System (PIES), a Web-based patient education and decision software that also is available on CD ROM. The software features interviews with Mount Sinai’s prostate cancer specialists who provide answers to frequently asked questions on all recommended treatment options. Users can also enter virtual support groups to hear from patients who have undergone the procedures. A special section in the program is available to address concerns of spouses and partners.
Dr. Diefenbach says patients have reacted favorably to the PIES program. "They rated the information in the program as highly helpful, felt more confident about their treatment decision, and felt the information they received was emotionally reassuring," he says.