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Treating Prostate Cancer With Robotic Surgery

Dr. Weise
Dr. Erik Weise is able to perform more precise prostatectomy surgeries with the assistance of a da Vinci robot, shown in the background.
In 2006, Miami Valley Hospital was first to introduce robotic surgery to the region. Lately, MVH’s three da Vinci robotic surgical systems have been experiencing an increased workload.

One reason for this is the recent arrival of Erik Weise, MD, an authority on robotic surgery, who has performed more than 1,000 robotic-assisted procedures. Dr. Weise has had extensive training in his medical specialty, including two fellowships: one in urologic oncology, the other in endourology, the branch of urology dealing with minimally invasive procedures.

One of a handful of urologists in the country with double-fellowship training, he has been involved with robotic surgery since 2003 and has concentrated exclusively on it since 2005.

Dr. Weise is medical director of urological robotic surgery at MVH. He is also a member of a large multispecialty practice, Dayton Physicians, where he joins David Key, MD, Mark Monsour, MD, and Michael Yu, MD, on the existing robotic urology team.

While robotic surgery is used for various urologic diseases and in many other surgical specialties, the first and most common application is radical prostatectomy, removal of the prostate for cancer. “Virtually every man is a candidate for this advanced surgery,” Dr. Weise says. “And virtually everyone goes home the next day.”

Dr. Weise notes that “98 percent of all urologic cancer surgeries, including surgery for kidney cancer, bladder cancer and adrenal cancer, can also be performed robotically.”

More Precision, Less Chance of Complications

Robotic procedures afford surgeons the ability to perform more exact hand movements using a highly magnified, three-dimensional system.

Additionally, Dr. Weise stresses, the three-dimensional component of robotic surgery offers him depth perception. Both the micro instruments used inrobotic surgery and the dramatic magnification provided by this procedure allow Dr. Weise to perform motions conducive to removing all of the prostate cancer, and saving urinary and sexual function.

As Dr. Weise explains, “The microinstruments used in robotic surgery afford me extra precision for delicate parts of the operation.”

Faster Recovery

Robotic surgery is considered minimally invasive surgery. Rather than making a large incision, Dr. Weise uses several pinky-sized puncture holes to remove the cancerous prostate. When compared to traditional (open) surgery, minimally invasive (closed) surgery offers a faster recovery.

Prostatectomy Ills.
Patients who receive robotic surgery can return to non-strenuous activity within a few days,” says Dr. Weise. “Most patients, depending on what they do, take somewhere between one and four weeks to return to work.”

One Patient’s Story

The benefits of robotic surgery got the attention of William E. Roberts, pastor of the Second Covenant Apostolic Church in Butler Township and a resident of Vandalia.

When the results of a PSA (prostatespecific antigen) test indicated the need for further evaluation, Pastor Roberts underwent a biopsy and learned he had prostate cancer.

William Roberts and wife
Early detection of his prostate cancer and a quick recovery from robotic surgery enabled Pastor William Roberts, shown with wife Angela, to resume a normal life.
Fortunately – because Pastor Roberts followed prescribed screenings – his prostate cancer was caught early and that allowed him a variety of treatment options, including robotic surgery.

Before deciding if robotic surgery was right for him, Pastor Roberts researched other options, assisted by his niece, whom he calls “an internet whiz”; his son, an operating room nurse; and his wife, a retired RN.

His research revealed several options, including radiation treatment and surgery, either traditional or robotic.

“You have to be active in your own health,” says Pastor Roberts, who settled on robotic surgery with Dr. Weise. “I asked him about his success rate and was satisfied that I was in good hands. He told me what to expect and – with his history in performing this type of surgery – I had complete confidence in him.”

It turns out his patient made the right decision, reports Dr. Weise. “He had excellent results and a routine recovery.”

Misconceptions about Prostate Removal

Dr. Weise says many prostate cancer patients who receive surgery to remove their prostate have a great deal of fear about possible side effects such as sexual dysfunction and urinary leakage.

He explains that, because the prostate is located close to the urethra, rectum and other vital organs, surgical removal of the prostate is a delicate, complicated procedure. But, depending on one’s specific situation, nervesparing prostate cancer surgery can be performed to avoid sexual dysfunction.

Men whose cancer is diagnosed early have the best chance of being a candidate for nerve-sparing surgery, according to Dr. Weise. Even if prostate cancer is more advanced and the nerves have to be removed, a range of options exist to address the problem of sexual dysfunction after surgery.

Patients who experience initial urinary leakage tend to improve and regain control over time, says Dr. Weise. A surgical repair can correct the problem if it does not resolve on its own, but it is rarely needed.

In part because his prostate cancer was caught early, Pastor Roberts experienced neither post-surgery complication.

Thanks to Dr. Weise and robotic surgery, Pastor Roberts returned to his active lifestyle of serving his church and walking for exercise. “If anyone asks, I tell them I’d do it all over again as long as I have the same surgeon.”

Early Detection

In addition to a PSA test, prostate cancer can be detected by a digital rectal exam (DRE).

Dr. Weise recommends following the testing guidelines established by the American Urological Association: Men age 40 and older should receive a PSA and DRE once per year.

Frequently Asked Questions

What is the prostate?

Dr. Weise with patient
The prostate is a small gland within the male reproductive system that secretes part of the seminal fluid. It is located under the bladder at the neck of the urethra.

What is PSA?

Prostate-specific antigen is a protein produced by the prostate gland. A high level of PSA, or a level that quickly rises, can be a marker of prostate cancer.

What are the risk factors for prostate cancer?

  • Age: About two-thirds of all prostate cancers are diagnosed in men age 65 and older.
  • Race: Prostate cancer occurs about 60% more often in African American men than in white American men.
  • Diet: High dietary fat may be a contributing factor.
  • Heredity: A family history of prostate cancer raises one’s risk of developing the disease.

How common is prostate cancer?

“Prostate cancer is the most common non-skin malignancy in men and is responsible for more deaths than any other cancer, except for lung cancer . . . About 1 man in 6 will be diagnosed with prostate cancer during his lifetime. A little over 1.8 million men in the United States are survivors of prostate cancer.”

(Source: National Cancer Institute)

Learn more about robotic surgery.