Response to an email submitted via my website...

Very valid concerns! The prostate is always removed intact.
There has never been any documented case of prostate cancer spread
by manipulating or puncturing the surface of the prostate. The biology
of
this cancer just does not support such a mode of spread. If I were to
remove the prostate and locate a tumor, remove some cancer cells,
and squirt them back in the pelvic fat where the prostate used to be,
it
would be improbable to cause cancer spread. Keep in mind that many
patients undergo multiple TRANS-RECTAL prostate biopsies, and there
has never been any case of this causing cancer spread. In fact, it is
almost unheard of for prostate cancer to ever spread into the adjacent
rectum, even in the most aggressive cases. Now, it is possible to leave
cancer cells behind in the peri-prostate fat.. especially if the cancer
has
already penetrated the capsule and extends into the fat. These are more
likely to be Gleason 7+ cancers. This is why I'm reluctant or cautious
to
do an aggressive nerve-sparing in these cases. I'd prefer to go wider,
so
even if the cancer has penetrated and is in the fat next to the
prostate, I
am more likely to get around it and take it all out with the prostate.
Many
open surgeons criticize the da Vinci robotic laparoscopic Prostatectomy
(dVP) because of an inability to "feel" the surface of the prostate for
cancer.
This is pretty bogus. I've done plenty of open radical prostatectomies.
In
most cases, especially with the predominance of cT1c cancer, no cancer
is palpable. Keep in mind there is usually lumps of BPH (aka. adenoma)
that are not cancer, but make the prostate feel bumpy. The cancer is
usually small and multi-focal. Conversely, during daVinci robotic lap
Prostatectomy (dVP) the bloodless surgical field, and enhanced,
magnified,
3-D vision puts my eye right down on top of the prostate so I can see
the
glistening prostate capsule and get those vital nerves and blood
vessels
atraumatically off the prostate. In open surgery, the surgeon is
standing,
with the prostate at arms length away, down in a deep hole, usually
with
bleeding.

Re: prostate removal during da Vinci robotic laparoscopic
Prostatectomy,
the umbilical poke hole is widened a bit to allow intact removal of the
prostate in a special bag. There is some FLV video of this on my
website:

  http://www.dryew.com/pages/resources.htm

The clip is about midway down the page, the 8th video clip under
"Media Library".

These are actual surgical videos and pictures, so please do not view if
you
think the graphic nature will upset you.

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http://www.DrYew.com
http://www.SanDiegoRoboticProstatectomy.com
*IMPORTANT* Any comments by me are for general informational purposes
only, and should never be used to diagnose or recommend  treatments for
any condition without face-to-face consultation with a qualified
health-care provider. Thank you.
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