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Prostate Cancer: Waiting vs Immediate Treatment

June 27, 2008 11:59 AM with Dr. Charles B. Brendler

Charles Brendler MD, Scientific Advisor, Program for Personalized Cancer Care within the Center for Personalized Medicine, will be fielding questions on weighing your options for treatment of a prostate cancer diagnosis.

Mike Lane, a patient of Dr. Brendler’s, will be joining to share his perspective and personal experience surrounding his own decision making process to have robotic surgery for the treatment of prostate cancer.

Dr. Charles B. Brendler (NorthShore) - 12:00 PM:
Hello and thank you for joining this important discussion on prostate cancer. As someone who has devoted my medical career to battling this disease, I know exactly what you're thinking and I'm here to tell you: you're not alone. My goal today is to allay some of your fears by answering your questions, especially about the topic of watchful waiting vs. immediate treatment.

Joining me today is Mike Lane, a recent prostate cancer survivor who chose surgery with the da Vinci robot. He will be able to offer a patient perspective on how and why he chose to have surgery. I now welcome your questions.

  Alan Lacy (Chicago, IL) - 12:01 PM:
Is WebMD a credible source for getting information of prostate cancer?
Dr. Charles B. Brendler (NorthShore)
In general, it is a credible source, but the accuracy of the information is variable and should be corroborated with that obtained from other sources including your personal physicians.

  Hal (Lake Forest, IL) - 12:03 PM:
I had my prostrate surgery May 20. Dr. Johnston said I can resume all normal activites on July 4. Would that include bike riding?
Dr. Charles B. Brendler (NorthShore)
Yes, provided you do not experience discomfort when you ride your bike. If you experience pain, you should stop.

  Ken (Chicago) - 12:04 PM:
Hello Dr. Brendler - First of all, I just would like to say that this live chat is a great thing you are doing. My question is: If I'm "Watchful Waiting", should I limit my exercising? Thank you for your answer.
Dr. Charles B. Brendler (NorthShore)
Dear Ken, thank you for your participation. On the contrary, you should continue exercising. An active lifestyle and healthy diet may help prevent your prostate cancer from progressing.

  Leo (Elk Grove Village, IL) - 12:05 PM:
Since diagnosed with prostate cancer, I am finding out that there seems to be two distinct views by urologists: those that embrace the robotic surgical approach and those that prefer a the traditional open prostatectomy. Besides what the surgeon might have been trained in (and comfortable with), why the relative large difference of opinion?
Dr. Charles B. Brendler (NorthShore)
Dear Leo, since robotic prostatectomy was introduced only a few years ago, many urologists who are unfamiliar with this technique continue to recommend and perform traditional open surgery. However, most studies suggest that robotic surgery is equally effective with less pain, blood loss and more rapid return to normal activities. I have asked our patient Mr. Mike Lane to comment further. He underwent a robotic prostatectomy in July 2007.

Mike Lane (NorthShore) - 12:13 PM:
When it was determined through tests and a biopsy that I had a presence of cancer in my prostate, I investigated through my urologist, Dr. Brendler, and was carefully informed by him of all of the options available to me. After discussions with him and the surgeon, Dr. Will Johnston, I felt that I would be far better off with the robotic surgery than with open surgery or some of the other procedures available to me. The reasons that I chose the robotic procedure were #1 - an opportunity for the surgeon to very clearly see what he was doing through the presence of the robot since their being minimal invastion to the abdomen and less loss of blood, the area in question could be observed more clearly. Additionally, after the procedure was completed, I had almost no pain. I took prescription medication for one or two days only and then transferred to Tylenol which was adequate to control the minimal pain I had. My recovery was swift and I was able to return to an active lifestyle.

  William Daryl Kennedy (Flanagan Illinois) - 12:13 PM:
What is your opinion on Proton and IMRT Therapy?
Dr. Charles B. Brendler (NorthShore)
Dear William, proton and IMRT are different types of external beam radiation therapy. There are no comparative trials between these different treatments. At ENH, we offer IMRT which we believe is equally effective as any other form of radiation therapy.

  Joe (Ottawa, IL) - 12:15 PM:
My physician recommends that I have a digital rectal exam, as a means of precaution with prostate cancer. What can I expect from the exam?
Dr. Charles B. Brendler (NorthShore)
A digital rectal exam is performed by inserting the gloved, index finger into the rectum. This examination takes about 20 seconds and should be mildly uncomfortable but by no means painful. It is an essential component of the male physical examination and should be performed annually in all men over age 50 to screen for prostate cancer.

  Sheldon R. Cohen (Lincolnshire, IL) - 12:17 PM:
I had my prostate surgery on May 21. On Wednesday of this week I experienced a day of blood in my urine. It stopped on Thursday morning. Is it normal to have such bleeding that long after surgery?
Dr. Charles B. Brendler (NorthShore)
Dear Sheldon, it is not uncommon for men to experience blood in their urine for up to six weeks after surgery. If it persists, I would contact your urologist.

  Alla Kimbarovsky (Chicago) - 12:19 PM:
My husband had De Vinci surgery exactly month ago. The entire prostate was removed and there is no tissue effected outside of the removed prostate. What are the chaces of any re-occurances?
Dr. Charles B. Brendler (NorthShore)
Dear Alla, if your husband's tumor was confined within the prostate, his chances of being cured are between 90-95%. However, he should continue to have regular PSA blood tests performed by his urologist to be sure that no cancer cells were left behind. I would like to invite Mike Lane to comment on what he was experiencing one month after his surgery.

Mike Lane (NorthShore) - 12:25 PM:
I was discharged from the hospital the day after my surgery and continued with a catheter for one week. When the catheter was removed I was experiencing no pain and only minor urinary leakage. Through continuous exercises, called Kegel exercises, I was able to regain complete control very quickly and was back to normal within two or three weeks after the catheter was removed. For a period of six weeks after the surgery I confined my activities to moderate exercise and no sexual functions. After six weeks, I was able to return to a more normal lifestyle which included more vigorous exercise including walking, golf, etc... Additionally, sexual function returned and was quite normal.

  Edward Kimbarovsky (Chicago) - 12:25 PM:
I had a Da Vinci surgery to remove prostate that was effected by cancer on the both side of the prostate. The recovery was not pleasant, but i am 'OK' now. Occassionally I have energy drop for almost a day. Is it normal? We had decided on the immidiate Treatment, but interested to know if Watchhful Waiting was maybe the better solution.
Dr. Charles B. Brendler (NorthShore)
Dear Edward, I do not know when you had your surgery, but it frequently takes three months to recover full strength after surgery. Without knowing your pathology report, I cannot comment on whether watchful waiting would've been an appropriate option for you.

  Jonathan (Country Club Hills, IL) - 12:27 PM:
Hi Doctor, just wanted to know what are some of the complications with untreated prostate cancer?
Dr. Charles B. Brendler (NorthShore)
Hi Jonathan. If prostate cancer spreads (metastasizes)it can cause severe pain, weigh loss, and, ultimately death.

  Mark (New Orleans,LA) - 12:29 PM:
Mr. Lane- Given that the robotic procedure was fairly new when you had your procedure last July, what research were you able to do when making your decision to go the robotic approach? Hope you are felling great!
Mike Lane (NorthShore)
Thanks, Mark. I had numerous discussions with my urologist, Dr. Brendler, and the surgeon that I ultimately engaged, Dr. Johnston. The robotic surgery was not that new at the time. It had been in active use since 2001. Dr. Johnston had undertaken more than 100 of these procedures. Other surgeons in the county had performed as many as 1,000. I was convinced that the three treatment goals; cancer cure, recovery of urinary control and recovery of sexual function, were best acheived through the robotic procedure. Hence my decision.

  Dr Wes (Evanston, IL) - 12:34 PM:
Great to see ENH climbing into the Web 2.0 experience for patients! On average, what's the recovery period for patients undergoing robotic versus conventional surgery?
Dr. Charles B. Brendler (NorthShore)
Dear Wes, recovery times vary but in general, patients undergoing robotic surgery are hospitalized for only one day compared to several days with open surgery, and return to normal activity several weeks earlier.

  Leo (Elk Grove Village, IL) - 12:36 PM:
Dr. Brendler: Due to my relative health, Gleason score (3+3), and consultation with two physicsians, I am in agreement that I need to pursue treatment via surgery. What are your thoughts on (and I hope I am using the correct term) the need for a lymphadenectomy as part of any prostate cancer surgery? And can it be done via the robotic surgery system?
Dr. Charles B. Brendler (NorthShore)
Dear Leo, the need for a pelvic lymphadnectomy (removal of the lymph nodes adjacent to the prostate) is somewhat controversial. In my opinion, if you have a low volume, Gleason score 3+3=6 prostate cancer, your risk of having positive lymph nodes is less than 1-2% and a lymph node removal is unnecessary. You should, however, follow the recommendation of your urologist. If a lymph node dissection is recommended, it can be done equally well using the robot.

  Ed Kim (Chicago) - 12:41 PM:
I had a Da Vinci 5 weeks ago, and woundering how soon my normal sex ability will come back. I have a drive, but my physical ability (my penis) does not get erected as well as it use to. I understand that it was a special procedure to save the nerve and muscle that control the erection, but I do not know if it will be restored to the original status. My doctor recommended and I am taking Viagra or other doctor's recommended medication and it helps my drive only. I, also, would like to ask about the energy level. When is my full energy level will return, and when I will be able to lift heavy items. I am in construction field and very often need to lift, but careful now after 1 month of surgery.
Dr. Charles B. Brendler (NorthShore)
Dear Ed, recover of sexual function is quite variable and may take anywhere from several weeks to more than 1 year to return. However, there are several treatment options to help restore sexual function and you should discuss these with your urologist. Regarding your strength, you should expect to return to normal activity after three months.

  Anthony (Oak Park, IL) - 12:44 PM:
I read about ‘watchful waiting’ as an alternative to taking immediate action on prostate cancer. What are some of the pros of waiting? Wouldn’t it just be best to take action?
Dr. Charles B. Brendler (NorthShore)
Dear Anthony, the pros of waiting are that you can postpone and perhaps make unnecessary treatment for prostate cancer since all treatments risk potential side effects. If you're followed carefully, there is very little risk to watchful waiting since prostate cancer is almost always slow growing. Watchful waiting is, however, most suitable for men over age 65 with very early prostate cancer.

  Jim (Glenview, IL) - 12:46 PM:
I am 40 years old and my family has a history of other types of cancer, including colon and breat cancer. Do these cancers increase my risk for prostate cancer? And if so, what age would you recommend I get this exam?
Dr. Charles B. Brendler (NorthShore)
Dear Jim, there may be an increased risk of prostate cancer in men with a family history of breast cancer. Therefore, I would recommend that you be screened for prostate cancer now (age 40) with a digital examination of your prostate and PSA blood test, and that you continue to be screened annually.

  Hal Bernthal (Lake Forest, IL) - 12:48 PM:
Dr. Brendler, As you know, I underwent robotic surgery by Dr. Johnston on May 20th. I am back to normal in every respect except for total control of my bladder. Even that is getting close to normal. I was three weeks short of my 80th birthday on the day of surgery. Thank you for recomending Dr. Johnston and robotic surgery.

  Lesley G (Algonquin, IL) - 12:48 PM:
My father, who is 50, has been experiencing a lot of pain when he urinates, but it comes and goes. When is it best to see a doctor? Should he wait until the pain is more consistent?
Dr. Charles B. Brendler (NorthShore)
Dear Lesley, I would recommend that your father see a urologist at this time. However, pain with urination is usually not due to prostate cancer but to some other benign urologic condition. He should, nevertheless, seek attention now before the problem worsens.

  Sheldon R. Cohen (Lincolnshire, IL) - 12:50 PM:
When we met in early May at the referral of Jon Kovler, you agreed with Dr. Mutchnil, my Urologist that I was not a candidate for the robotic procedure because of prior abdominal surgical scarring. The Pathology came back as a Gleason Score of 8 and only 5% of the Prostate Gland involved. Your consult and follow through after I had my procedure was greatly appreciated!!! At 5 weeks out I have regained control of my Urinary functions, but the sexual functiions are still dormant?!?
Dr. Charles B. Brendler (NorthShore)
Dear Sheldon, thank you for your kind words. I am glad you're doing well. If you need help with your sexual function, you can either contact Dr. Mutchnik or Dr. Peter Colegrove at the ENH Prostate Cancer Center, 847-657-5730. Dr. Colegrove is a urologist who specializes in the treatment of this problem.

  Leo (Elk Grove Village, IL) - 12:53 PM:
One more "technical" question. The claim is that certain prostate surgical techniques are better than others due to potentially “fewer positive margins.” Would you rate robotic surgery highest on the list when it comes to “fewer positive margins?” Or is it strictly the skill of the surgeon?
Dr. Charles B. Brendler (NorthShore)
Dear Leo, I believe that the skill and experience of the surgeon are the most important factors. That being said, I believe that robotic surgery is equally effective as open surgery in curing prostate cancer.

Kristin Philbin (Moderator) - 12:54 PM:
Hello everyone - our chat is almost complete. If you have any other questions, please submit them now.

  Leo (Elk Grove Village, IL) - 12:56 PM:
Dr.Brendler: If you were diagnosed, and surgery was the way to go, what would you do.
Dr. Charles B. Brendler (NorthShore)
I would have the surgery done robotically by a urologist who had performed at least 100 of these procedures.

  Marco (Urbana, IL) - 12:57 PM:
What are the chances of having prostate cancer if already diagnosed with benign prostatic hyperplasia (BPH)?
Dr. Charles B. Brendler (NorthShore)
As far as we know, there is no association between BPH and prostate cancer, and men with BPH do not have an increased risk for developing prostate cancer.

Dr. Charles B. Brendler (NorthShore) - 12:59 PM:
Mr. Lane and I want to thank you for your participation. If you would like further information about prostate cancer and the various treatments available, please feel free to contact me through the ENH Prostate Cancer Center at 847-657-5730. If you wish to speak with Mr. Lane directly, he can be reached at 847-604-8222.

Kristin Philbin (Moderator) - 1:00 PM:
Thank you again for participating in our chat today. For more information please visit our Prostate Cancer pages.

Also, our next chat will discuss "Long term effects of LASIK surgery" with Dr. Marian S. Macsai on July 11, 2008 12:00PM. If you are interested in participating sign up for a reminder.

This chat has ended.

Thank you very much for your participation.