This was a study that showed that if you had more cancer in the prostarte, you had a higher risk of teh cancer coming back after surgery. Although this is obvious, it is important to show these type of things with studies.

Would I would like to see is if patients with the same gleason score and stage (meaning the extent of cancer spread) have different rates of recurrences.

For example, 2 men with organ confined prostate cancer that both have gleason 6 cancers. If 1 man has 1% of tumor volume in his prostate and the other 30%, I would imagine the man with 30% would be more likely to have a recurrence. I am not aware of any studies that have looked at this.

This one study shows that men that did active surveillance, needed therapy about half of the time. The results seemed similar for both groups. My main concern is that we do not know the cancer characteristics of the patients. It is possible that the active surveillance patients had less cancer than the treated patients and should have done better.

I also think that waiting 3 years to treat someone may later the treatment approach and possibly lead to more side effects after therapy.

This one study did not reveal any benefit from Vitamin D. There have been others that do show a benefit. This is why it is important to continue to do studies and use scientific method to assess things.

I ask patients to take a multivitamin a day, but not extra Vitamin D.

Prostate cancer control after radical prostatectomy improves with increasing surgeon experience, regardless of patients' risk, say US scientists who suggest that the primary reason for recurrence in low-risk patients is inadequate surgical technique.

The team, led by Eric Klein from the Cleveland Clinic in Ohio, previously discovered that open radical prostatectomy has a learning curve, and other studies have indicated that patients treated by higher-volume surgeons have shorter hospital stays, fewer peri-operative complications, and better urinary continence than those treated by lower-volume surgeons.

This study was done for open radical prostatectomy patients.

My guess is that we will have similar results for robotic surgeons, but I think novice robotic surgeons that have vast experience with laparoscopic or open prostate cancer surgery will have better results than those who do not.

The surgical margins were similar between the two groups. No significant difference was found in the postoperative urinary bother score or the interval to social or perfect continence between the two groups.

The results of this study have shown that the presence of a median lobe does not alter the outcomes in patients who undergo robot-assisted prostatectomy.

The median lobe can be a scary finding for the novice robotic surgeon. My team at NBI has developed several techniques to handle median lobes while preserving as much bladder as possible.

I have put a video from about 18 months ago on google video showing one of our techniques:

I have changed by preoperative management to include a cystoscopy about 1 year ago on all patients to assess for prostate shape. I can now predict these in all patients.

I am a little surprised that these patients did not have differences except more needed bladder neck repairs. I think these patients are more likely to have bladder symptoms since most have obstruction and over active bladders to start with. In my series, they usually get their catheters out in 5 days instead of 3, and I warn them of expecting more urinary problems in the short term than others.

I usually use the PCA 3 test for men who have had a negative biopsy and we are considering performing a second one. I usualy use it for men with high grade PIN after one biopsy. If the PCA 3 is positive, I usually perform a second biopsy. I have not looked at my data to see if the above correlation exists, but that would be interesting.

I also am not sure if you can use PCA 3 tests that are taken a few months apart to mean anything. For example, would a rise in PCA 3 be expected if a man develops cancer or the cancer is growing?

The only study I am aware of does not sure a large difference between the open and minimally invasive prostate cancer surgeries.

I agree with Dr. Sawczuk, a friend and colleague, that more experienced surgeons are more likely to have better results. The surgeon is important, probably more so than the technique. I think the best way to analyze this would have been to set up a study looking at high volume robotic vs. lap vs. open surgeons andhaving a 3rd party analyze the results. I do not think this is something that would ever be done.

My feeling after performing many open prostate cancer surgeries, a few laparoscopic ones, and over 400 robotic ones is that robotics gives me the ability to perform more accurate surgery, and the difference is more pronounced with more difficult cases.

Being able to remove the catheter within 3 days routinely without needing X-Rays would be difficult for me to achieve with open or laparoscopic surgery.

Functional results with regard to erectile function and urinary continence after prostate sparing cystectomy are good. Oncological results have been promising, but need to be confirmed after longer followup and in larger trials.

For men in need of a bladder removal for bladder cancer, my practice has always consisted of removing the entire prostate as well. This is what I learned at Indiana and have continued to do in NJ. As far as I know, urologic oncologists in the USA all agree on this.

In Europe I have read several studies that have left the prostate capsule or most of the prostate in place. I think you will see a higher rate of pelvic recurrences and bladder cancer recurrence in the prostate, as well as new prostate cancers this way. I do agree that men will have less side effects in regards to erections and continence potentially.

I have been performing robotic cystectomies for about 3 years now and feel that I can perform a more careful operation around the erection nerves and urinary muscles. I hope to improve on our past results while still removing the entire prostate wih the bladder.

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Patients often ask how soon they have to have surgery when diagnosed with a likely cancer. This study shows that for kidney cancer it does not seem to make much of a diffference. The main problem with tihs study is that patients with larger tumors often get counselled to have surgery right away, whereas smaller ones are often given the option to wait a few months if the patient wants to.

Spanish researchers have found a means of distinguishing between high-grade prostatic intraepithelial neoplasia (HGPIN) lesions destined to become cancerous and those that will remain benign, which may spare patients the discomfort and inconvenience of unnecessary needle biopsies, according to a study in Clinical Cancer Research (2008; 14:2617-22).

This is teh first studay that I am familiar with that has a genetic marker for patients with diagnosis of high grade PIN. High grade PIN was once thought to be higly associated with prostate cancer (about 50%) and warranted a repeat biopsy. This was when urologists performed 6 biopsies routinely.
Now that we are performing at least 10, the finding is not as ominous as before. About 20% of pateints wil develop cancer.

A new study by the Pacific Research Institute, US Tort Liability Index: 2008 Report, measures the best and worst tort systems in America. In the report, the authors examine evidence provided by top economists and legal scholars on the benefits of tort reform in peoples' lives and conclude that, among other things, reform improves health care and health care access. The report also discusses the cost of defensive medicine - most of which is prompted by medical liability concerns - which has now reached the astounding total of $163 billion a year. This is the sum of the direct costs of defensive medicine, estimated to be $124 billion a year by PriceWaterhouse Coopers, and PRI's own estimate of the $39 billion indirect costs from lost productivity due to reduced access to health care attributable to defensive medicine. According to PRI, increased health-care costs brought on by defensive medicine have also added some 3.4 million Americans to the rolls of the uninsured.

I used to work in Indiana, which has one of the more doctor friendly malpractice systems. Potential lawsuits are brought before a panel for an opinion prior to a lawsuit being filed. Indiana also has a cap, or limit, on how much money a plaintiff can win for pain and suffering. All this led to low malpractice insurance costs. In New Jersey it is quite different.