Guest post featuring Caner Z. Dinlec, MD Physician-in-Charge, Division of Endourology and Stone Disease at Mount Sinai Beth Israel
Howard has always taken great care of himself. The 60-year-old is active, doesn’t smoke, eats a healthy diet and is diligent about seeing his doctor for annual wellness exams — through which his PSA (prostate-specific antigen) levels have been tested for years. About five years ago, Howard’s PSA levels started increasing. It wasn’t long before Howard’s PSA levels exceeded the 4 mg/mL mark, which is when levels are considered abnormal or high.
Howard was then referred to a urologist. And that’s when he met Dr. Caner Dinlenc, a urologist at The Sol and Margaret Berger Department of Urology at Beth Israel Medical Center. “Based on my age and my PSA level, which at that point was at a 5 or a 6, Dr. Dinlenc recommended more testing,” Howard says. In the spring of 2010, a biopsy was performed, and no evidence of cancer was found.
Life-changing diagnosis
His follow-up blood tests every six months showed that Howard’s PSA levels were still rising, so another biopsy was done in July 2012. “When I got the cancer diagnosis, it was anxiety-inducing,” Howard says. “I was glad it was caught at a very early stage, but nobody likes hearing that word.” Like most early-stage prostate cancer patients, Howard had three options: surveillance, radiation or surgery.
Surveillance is another term for “watchful waiting” — when a doctor and patient hold off on treatment while they continue to monitor PSA levels every three to six months.
Robotic surgery is a state-of-the-art treatment option
Though Howard initially decided to wait for another biopsy six months later before making any decisions, he felt uneasy. “The more I thought about it, the more I realized that one of two things was going to happen: either the biopsy would show no change and I would still be waiting. Or, it would show that the cancer had spread and I would be upset that I didn’t have it removed earlier on.” He called Dr. Dinlenc a short while later and scheduled a prostate removal surgery, or prostatectomy.
Dr. Dinlenc specializes in minimally invasive robotic surgery and sees it as a very good option for patients like Howard. Contrary to what its name might imply, “robotic” surgery is very dependent on the surgeon. “In my hands, it is a very, very predictable, safe and effective operation,” explains Dr. Dinlenc.
The surgery requires just four very small incisions – one for each arm of the robot. One arm is a camera that acts as a microscope to guide the movements of the other three arms, which are equipped with all the necessary surgical tools to remove the prostate and complete the procedure. Though each movement is controlled by the surgeon, the robot’s motion is much more smooth, predictable and fluid than that of a human’s hand, according to Dr. Dinlenc.
“The small incisions create much less blood loss, so patients recuperate faster, have less pain, go back to work faster and usually have a quick resolution with their incontinence and erectile dysfunction,” Dr. Dinlenc says. Bladder control problems and erectile dysfunction are the two biggest post-operative concerns, but both can be treated to reduce the symptoms and maintain a high quality of life.
Putting it in the rear-view mirror
In December of 2012, Howard had his robotic prostatectomy. He was able to get out of bed the following day and was walking around the day after that. He spent only three nights in the hospital, but, Howard says, it is still surgery so men should give themselves adequate time to recover. “I was feeling quite good again within four to six weeks after surgery,” he says. “My experience has been very positive and I’m very glad to have this in the rear-view mirror now.”
At his surgical follow-up visit, Howard’s PSA level was “undetectable” and there was no evidence that the cancer had spread. He will continue to see Dr. Dinlenc for check-ups and PSA tests.
For more information about robotic prostate cancer surgery options visit Mount Sinai Beth Israel’s Sol and Margaret Berger Department of Urology website.