UAB Urologists Christopher Amling, M.D., and Donald Urban, M.D.
by Virginia Miller Crittenden
Pat Martin knew he was at risk for prostate cancer because his father was diagnosed with the disease in his early 80s. However, Pat was surprised when he was diagnosed with the same cancer at the relatively young age of 58.
Pat’s cancer diagnosis became a family affair when his three brothers got tested. His brother Robert, an ER physician, also tested positive for prostate cancer. Their sister Peggy, a UAB nurse, became involved in their search for the best treatment, and referred Pat to UAB urologist Donald Urban, M.D.
In this conversation with ehealth, Pat, Dr. Urban and Christopher Amling, M.D., director of UAB’s Division of Urology, explain his decision to undergo a radical prostatectomy with the new da Vinci® robotic procedure and discuss his recovery from prostate cancer.
The prostate is a walnut-sized gland in the male reproductive system located deep within the pelvis, surrounded by a dense network of delicate blood vessels and nerves. It produces fluid that makes up part of the semen.
Prostate cancer is second only to lung cancer as the most common form of cancer found in men in the United States. Approximately 16 percent of American men will be diagnosed sometime during their lifetime. Thanks to new treatment options and earlier detection, a majority of patients will continue to live active, productive lives.
You can test your understanding of prostate cancer by taking our quiz at uabhealth.org/pcquiz.
A Routine Test Reveals Prostate Cancer
Pat Martin: “In May 2005, my internist did routine blood tests and my PSA (prostate-specific antigen) was marginally high, although the digital rectal exam was OK. Two weeks later, my PSA level was slightly higher, so I went for a biopsy in August. I had cancer through portions of my prostate. The treatment options presented to me at the time were surgery or radiation.”
PSA is a protein made by normal cells and prostate cancer cells. PSA is found in the blood and is measured with a blood test. Doctors sometimes watch the rate of change in your PSA levels over time. An increase in PSA levels can be caused by either benign prostate conditions or prostate cancer, so your doctor will perform further testing if the level is raised.
Dr. Amling: “Prostate cancer is now being diagnosed in younger and younger men—not because of an increased incidence, but because more men in their 50s are getting screened.”
Pat: “My father died at age 91 in 1999. The last 10 years he knew he had prostate cancer but it was slow growing, and was not a cause of death. I had read that I was more at risk for prostate cancer but I didn’t worry much about it, especially since my dad’s doctors took a wait-andsee approach because of the slow growth of the cancer and his age. “I wanted to make sure I had the best possible treatment. My brother who’s a neurologist in North Carolina told me, ‘You live near a major medical center (UAB)—why not start there?’ My sister Peggy asked the operating room staff and the staff at UAB’s urology clinic for a doctor’s name, and they all said Dr. Urban.”
High-Tech, Nerve-Sparing Surgery
Pat: “I already knew I wanted to have surgery. The options were traditional open surgery or robotic surgery. I asked Dr. Urban what he would do if he were the patient. He said he would choose the minimally invasive da Vinci procedure for several reasons: The recovery period is shorter because they don’t have to cut muscles in the lower abdomen and there’s less trauma to the nerve bundle surrounding the prostate than with traditional surgery and therefore fewer resulting problems with incontinence and impotence.”
Dr. Amling: “The da Vinci surgery is robotic-assisted laparoscopy requiring just a few small incisions. This surgery offers two definite advantages over traditional open surgery: less blood loss and a shorter recovery period, which means a quicker return to normal activity.
Dr. Urban: “We believe that, with the increased visualization provided by the da Vinci system, we’re able to remove the prostate with less impact on the nerves that serve erections.”
Return to Quality of Life
Pat: “With the da Vinci surgery, I had no muscle problems, just an achy sensation from where the prostate had been. This all passed within four to six weeks. I had as easy a time with it as I could imagine.
“After a month I was told I could return to my usual schedule of exercising almost every day with weights and the rowing machine; I was also back to gardening.”
Dr. Urban: “Pat did very well. He regained urinary control quickly and his urinary continence level continues to be good.”
Pat: “By six weeks I had no problem with incontinence. In fact, I had planned a trip to Paris with some old college friends. I was concerned that incontinence might be a problem, but it resolved itself and I had a great trip.”
Dr. Urban: “Hopefully Pat is beginning to see some improvement in sexual function. With a young, healthy, sexually active man like him, I would expect to see recovery of sexual function by the end of the second year.
“Pat will now have annual checkups. We use the PSA to check for cancer, so the same blood test we used for the initial diagnosis can be used to determine if the cancer returns—that as well as digital rectal exams.”
Pat: “I already had a healthy lifestyle, so the doctors didn’t recommend any diet or exercise changes.”
Dr. Amling: “Lifestyle modifications have not yet been proven to decrease prostate cancer recurrence, although there are ongoing studies. But we do recommend exercise and a low-fat diet; most men who have prostate surgery are still more at risk of dying of heart disease than of prostate cancer, so a heart healthy lifestyle is always a good idea.”
Ongoing Studies
Dr. Amling: “Because we are diagnosing prostate cancer in younger and younger men, we need to be able to offer a minimally invasive approach to prostate cancer surgery that allows them to recover more quickly, and the da Vinci system offers that.
“Mature five- and 10-year follow-up data on prostate cancer recurrence after robotic surgery are not yet available, but we believe the recurrence rates are equivalent to open surgery.”
Advice for Others
Pat: “I would tell others diagnosed with prostate cancer to do the research—get ahold of all the information you can. Most importantly, find a physician you trust and respect.
“Dr. Urban was my surgeon, and he was very approachable—I had a lot of questions and he took time to answer them. In fact, a friend who was diagnosed with prostate cancer came from Jackson, Miss., to have the surgery at UAB because of my experience. My brother Robert also had surgery with Dr. Urban in January and is recovering well.
For more information about The UAB Prostate Center at The Kirklin Clinic® or to schedule an appointment with a UAB physician, call UAB HealthFinder at (205) 975-8222 or 1 800-822-0933. Or visit uabhealth.org.