“We’re thrilled. I’m grateful my father was treated at a hospital that offers the most progressive treatment possible.”
Robotic surgery, combined with an experimental therapy, stopped one patient's aggressive cancer in its tracks.
The lab report was in: David Chandler had prostate cancer. What’s more, tests indicated that David had an aggressive form of the disease. That was in 2016. Today, tests detect no sign of cancer in David, 65, of Bound Brook, thanks to specialists at Robert Wood Johnson University Hospital (RWJUH) Somerset’s Steeplechase Cancer Center.
A fast-moving disease
David’s primary care physician first became concerned when she noticed that his prostate—a walnut-sized gland that produces fluid that carries sperm—was enlarged and firm. Then a blood test showed that his level of PSA, or prostate specific antigen—a marker of prostate cancer—was 103 ng/dL. A normal level for a man his age is less than 4 ng/dL. A biopsy, in which tissue samples are extracted from the prostate and tested in a lab, found cancerous cells. Taken together, these signs indicated that David had a fast-moving disease that may have already begun to spread outside the prostate gland, says Dhiren Dave, MD, a urologist at RWJPE Somerset Urological Associates in Somerville. David, who has his own home-repair business, was stoic in the face of worrisome news. “It is what it is,” he recalls thinking. His family wasn’t so sanguine. “It was scary,” says his oldest daughter, Ashley Salmon, 32, of Wall Township, who accompanied David to his appointments along with her sister, Lexie, 30. “But Dr. Dave was great. He was optimistic but realistic. We felt like we were in really good hands.”
Multidisciplinary care
Dr. Dave knew that treating David would be complex. “When someone has what we call high-risk prostate cancer, he requires multiple modes of treatment,” says Dr. Dave. “David needed care from a multidisciplinary team.” His team included Jonathan Rosenbluth, MD, a medical oncologist, and Joel Braver, MD, a radiation oncologist. Prior to David’s treatment, his case was reviewed at the team’s monthly Urologic Oncology Multidisciplinary Conference, during which various specialists meet to create a personalized care plan.
The primary goal was to remove David’s prostate, but first he started receiving hormone therapy to reduce his natural levels of testosterone. “That takes the fuel away from the cancer,” says Dr. Dave. In addition, he was given a chemotherapy drug, which is normally administered after a man’s prostate has been removed. This experimental use of the drug was possible because Dr. Dave and his colleagues at the Steeplechase Cancer Center are co-investigators, in partnership with Rutgers Cancer Institute of New Jersey, in a larger clinical trial designed to determine if combining hormone therapy with the chemotherapy drug improves the results of surgery.
While David was not included in the trial, he was eligible to receive the experimental drug combination. After completing the chemo regimen (and continuing on hormone therapy), David underwent surgery to remove the prostate. The procedure, known a radical prostatectomy, is traditionally performed in an “open” manner, meaning it requires an incision above the navel that can be up to four inches long. However, some surgeons perform radical prostatectomies using small laparoscopic tools, which require only a few tiny incisions, most a half-inch or smaller. Smaller incisions mean less post-op pain and a shorter recovery period.
To remove David’s diseased tissue, Dr. Dave performed a robotic prostatectomy, which takes the laparoscopic approach a leap forward. During this procedure— which Dr. Dave has performed more than 500 times—he sits at a console and views the patient’s internal tissues on a monitor. This highly magnified, three-dimensional view allows for precise dissection of tissue, which dramatically reduces bleeding during surgery. Using controls, Dr. Dave manipulates the camera and other delicate robotic instruments. Unlike the rigid instruments used in laparoscopy, robotic tools have “wrists,” allowing them to bend in different directions. But unlike human hands, “robotic instruments don’t shake— they’re steady,” says Dr. Dave. After the surgery, David spent one night in the hospital (open procedures require two or three nights) before going home. “I didn’t feel much pain at all,” he recalls.
Successful treatment
Tests indicated that David’s pelvic lymph nodes contained prostate cancer cells. To eliminate them, David underwent a course of radiation treatments. Today, two-and-a half years after his diagnosis, David’s treatments are complete and his PSA has dropped to 0 ng/dL. “It’s been a long journey, but right now, David shows no evidence of disease,” says Dr. Dave.
David, who is regaining strength and some of the weight he lost, says, “The medical team did a great job.” His family agrees. “We’re thrilled,” says Ashley. “I’m grateful my father was treated at a hospital that offers the most progressive treatment possible.”
Know your Number
30% Studies indicate that early detection of prostate cancer with the PSA test saves lives. A 2017 analysis published in the Annals of Internal Medicine found that men who undergo PSA screening reduce their risk of dying from prostate cancer by about 30 percent.
The PSA test can spot prostate cancer at an early stage, says Dhiren Dave, MD, a urologist at RWJPE Somerset Urological Associates in Somerville. “The earlier we pick it up, the better the patient’s prognosis,” he says. The American Urological Association (AUA) recommends that men at average risk begin screening at age 55 after a discussion with their physician. For those who are at high risk, the AUA recommends screening starting at age 40.
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