I wanted to let you know about an exciting men’s health and educational awareness event I'll be involved with for Men's Health Week (June 9-15): the Drive for Men’s Health 2014. As we all know, men are much less likely to make an appointment to see a doctor and to discuss their health issues than are women, yet their health is equally important. This event aims to promote health awareness among men and get them to take charge of their well-being.As part of the event, from June 12 to 13 urologists and robotic surgeons Dr. Sijo Parekattil and Dr. Jamin Brahmbhatt of the PUR Clinic (Personalized Urology & Robotics) in Central Florida will drive 1,100 miles from Clermont, Florida to New York City – a 23-hour marathon drive – as they attempt to set the Guinness World Record for the fastest time ever in an all-electric TESLA S car. They'll be documenting their journey through live footage using Google Glass, and every 150 miles or so when they stop to recharge their car, they'll have more than 40 speakers from 30 medical institutions talking about men's health topics both in person and via webcast. Topics will include The Future of Men's Health, Erectile Dysfunction, New Treatments for Kidney Cancer, and many others. The event raises funds for genetic research in men's health issues as well as scholarships for students to attend the Florida Polytechnic University in Lakeland, Florida. I am the featured speaker when they arrive in NYC, and I’ll be speaking about genetic testing in prostate cancer and robotic surgery in kidney cancer. I’ll also have a daVinci robot with me! You can hear me speak at the Manhattan TESLA Showroom at 511 W. 25th Street on Friday, June 13 at 8:25 am, or watch a webcast of my talk online at www.driveformenshealth.com. I hope you’ll join me in helping men’s health issues get more of the attention they deserve and, on a personal level, making an appointment with your own doctor to keep yourself in the best of health. Tesla Motors has sponsored the NYC event, and all are welcome to join us at the Tesla Showroom, at 7:45 am on Friday, June 13. The address is 511 W. 25th Street, New York, NY 10001.
Dr. Ketan Badani's Blog
Read on for Dr. Badani's latest updates -- and his notes on developments in the fields of robotic surgery and urologic oncology.
As men become older, it's likely they will develop a condition called benign prostatic hyperplasia, or BPH. This is a non-cancerous enlargement of the prostate that affects about half of men by age 60 and about 90 percent of men by age 80; of those affected, only a small percentage with significant symptoms usually require treatment.
Though BPH is not cancer, symptoms can be mistaken for prostate cancer, including slower and/or more frequent urination, difficulty urinating, and a feeling of urgency around urination. What’s less clear, however, is how having BPH can affect a man's risk of developing prostate cancer.
A large Danish study, which analyzed data from more than 3 million men between 1980 and 2006, showed that in men who were hospitalized for BPH, the risk of prostate cancer was higher, and death from prostate cancer was higher than the general population. However, while the European study made an association between BPH and prostate cancer, this data does not show causation; in other words, it does not answer the question as to whether BPH causes prostate cancer and, more importantly, aggressive prostate cancer. Also, the study examined a very selective group of men who were hospitalized for BPH, so they already had a severe problem with their prostate and this cannot be extrapolated to a healthy man with BPH.
There are also several conflicting studies suggesting that BPH is actually protective against advanced prostate cancer, and that the risk of having cancer spread outside the prostate is lower than in men with smaller glands.
Based on the available studies, no definitive conclusion can be made regarding BPH and prostate cancer risk; certainly this topic needs to be better researched before such a conclusion can be made. My advice at this time is that while men with BPH should certainly consult a urologist, they should not be overly concerned that their BPH will lead to aggressive prostate cancer.
Since it's Prostate Cancer Awareness Month, I wanted to discuss an important topic that's been in the news a lot lately. Diagnosing prostate cancer, i.e., PSA (prostate-specific antigen) screening, has become a highly controversial subject recently in the media and medical community. While I strongly believe that PSA screening saves lives, I think the larger and more important point is which prostate cancers are deadly and which can be safely monitored, as many prostate cancers are not deadly and do not spread or cause illness.
It's important to know that prostate cancer can come in many different forms, from very aggressive, to intermediately aggressive, to indolent (slower growing). Those men with less aggressive, "low-risk" prostate cancer are candidates for active surveillance, when a doctor continues to monitor a patient’s health rather than suggesting more aggressive treatment options like surgery. "Low-risk" prostate cancer is defined as a Gleason score of less than 6, a PSA of less than 10, and/or no evidence of an aggressive feature.
That said, biopsies, Gleason scoring, and PSA testing are not perfect, and many men may harbor more aggressive disease. Up until now we have not had a good way to indentify those men.
I strongly believe that personalized genomic information is the future of risk assessment. I am the primary investigator of a large multicenter trial utilizing genomic information from the original prostate biopsy to determine which men can be observed safely and which men should be treated for prostate cancer. The test is called Oncotype DX (Genomic Health, Inc.). We are researching how this information affects doctor and patient decision-making when it comes to prostate cancer. As always, when it comes to helping you make the best decisions about your prostate cancer treatment options, we at the NYC Robotic Institute are leading the way.
I recently returned from participating in the American Urological Association (AUA) annual meeting in San Diego, the largest gathering of urologists in the world. As always, there were many stimulating discussions on new developments and studies around urologic medicine and prostate procedures. I was involved with presenting a large number of studies this year, some of which may be of interest to you:
- One study looked at how to reduce the discomfort caused by urethral catheterization after a robotic assisted radical prostatectomy. Our evidence suggested that a bupivacaine (local anesthetic) dorsal penile block injected after the prostatectomy may be an effective way to reduce penile irritation post-surgery.
- We also looked at how minimally invasive robotic nephroureterectomy – the gold standard approach to the management of cancer in the upper urinary tract – can be done safely and efficiently without repositioning the robot, even further reducing the risks of this surgery. I presented a video showing this procedure.
- Dorsal vein ligation helps reduce bleeding during robotic assisted laparoscopic prostatectomy. We presented a review of patients who had undergone standard dorsal vein ligation vs. delayed dorsal vein ligation. Delayed ligation was found to decrease positive margin rates at the apex, which means a decreased risk of disease progression, so this technique has now become standard practice at the NYC Robotic Institute.
- We also presented a study that looked at whether exosomal RNA derived from urine could provide a non-invasive method to examine prostate cancer-related gene signatures and give us information regarding underlying disease prior to a more invasive prostate needle biopsy. We found that exosomal RNA can indeed help accurately predict whether a positive vs. negative needle biopsy will be most likely.
- We found that patients who have a “close margin” after radical prostatectomy – when the edges of the tumor show cancer cells close to the surgical margin – have a similar risk of biochemical reoccurrence to those with a “positive margin” – when the edges of the tumor definitely show cancer cells – and suggest the same counseling and following up with “close margin” patients as with “positive margin” patients.
I am always striving to contribute new knowledge and the latest research to help bring the best care possible to my patients. Don’t hesitate to get in touch if you have any questions or would like to make an appointment at (212) 305-0114 or (212) 305-9722.
It's been a little over a year since I first wrote here about our revolutionary FAST partial nephrectomy procedure, where steps usually performed by a surgical assistant are now incorporated into the robotic process – and I now have even more exciting news to share!
In a study published in the Journal of Endourology (June 2012), my colleagues and I confirmed that FAST – which, as you may recall, stands for "first assistant sparing technique" – reduces the time in which the kidney is without blood flow (called the "warm ischemia time") by almost 25 percent. In fact, we were able to cut warm ischemia time to an average of 15 minutes for most tumor surgery, and 18 minutes for more complicated tumors. So not only does FAST achieve the same results as standard robotic partial nephrectomy surgery, but it takes much less time – regardless of the tumor size, location, or complexity.
What does this mean for you or your loved one? Since blood flow is cut off from the kidney for less time using FAST, it's better for the patient, better for recovery, and achieves the same result: cancer removal.
We're constantly trying to improve what we're doing and hope to continue to further refine our surgery offerings going forward. Another advancement in this procedure is the use of immunofluorescence imaging during FAST partial nephrectomy. This allows us to perform "selective arterial clamping," which means that we can identify and isolate only the smaller artery that feeds the tumor and maintain blood flow to the rest of the kidney during the surgery. In these instances, there is ZERO warm ischemia time! Our ability to perform this technique is based on tumor location and some other factors, and during review of the CT or MRI, we can make that determination.
Don't hesitate to contact me at (212) 305-9722 if you have more questions about FAST robotic partial nephrectomy or are considering whether it’s the right procedure for you or someone close to you.