Mike Erice was shocked when a biopsy determined that he was one of the more than 220,000 men diagnosed with prostate cancer each year. Just a year earlier, results of his annual prostate specific antigen test (PSA) had been excellent, giving the 60-year-old private investigator a sense of security.
This time, however, his doctor included a digital rectal exam and ordered the biopsy when he felt something suspicious. Because prostate cancer kills 28,000 men each year, Erice and his wife quickly researched their options, which included radiation therapy, watchful waiting and radical prostatectomy - major surgery to remove of the cancerous gland.
"If you have cancer, you just want it out. That is how I felt," he said. "I just didnt like the idea of major surgery that was painful and would keep me off the job for six weeks."
Therefore, when they found out about a minimally invasive surgical procedure that removes the gland through small incisions with less pain, fewer days in the hospital and quicker recovery, they came to the Cedars-Sinai Medical Center Endourology Institute, one of about 50 centers nationwide offering the new approach.
"Using minimally invasive techniques to treat prostate cancer became a natural extension of my previous experience in laparoscopic surgery in other areas of urology," said Gerhard Fuchs, M.D., director of the Institute and one of the worlds pioneers in endourology. "This application was adapted and improved over time and became a viable option for men about five years ago."
Endourologists use scopes and instruments to perform surgical procedures on organs and structures accessible through the urinary tract, without making an incision in a patients skin. In situations that do not permit the use of endourologic procedures, the least invasive approach - such as laparoscopic techniques that are accomplished with thin instruments inserted through tiny incisions - are employed. Dr. Fuchs has more than 20 years of experience in this specialty field.
The use of a laparoscope - a lighted tube with a tiny camera lens at the tip - provides a clear, magnified view of the prostate and surrounding nerves, resulting in greater precision, minimal blood loss, and greatly reduced risk of complications such as impairment of urinary continence and erectile function.
"An internal structure that the surgeon sees clearly can be better saved from damage during a procedure," explained Dr. Fuchs, noting that he expects his patients to maintain functions that are considered essential to quality of life. At least 95 percent of them are fully continent within a year of surgery, for example.
Like most of Dr. Fuchs patients undergoing laparoscopic prostatectomy, Mike Erice was out of the hospital in two days, experienced little pain, and said he felt almost like normal within five days. His body continues to function as it did before surgery. "I went back to work after 12 days and was very pleased that my life could continue almost without interruption," he said. He also recommended Dr. Fuchs and the Endourology Institute to a friend who was recently diagnosed with prostate cancer.
The PSA test, which measures a protein in the bloodstream produced by the cells of the prostate gland, is considered a fairly reliable indicator of the likelihood of prostate cancer, but Erice feels fortunate his physician was thorough.
"Dont rely on your PSA results alone," he said. "Get a digital rectal exam because you want to be sure. I am living proof that prostate cancer can hit any man and surgery today is not what it used to be."
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern Californias gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities.
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