Prostate Cancer
Prostate Cancer is rarely the same in each individual and needs to be treated according to the disease. After diagnosis is made, we offer a full spectrum of treatment options including da Vinci® Robotic Prostatectomy, RapidArc™ 360° Radiotherapy, High Dose Rate Brachytherapy, Radioactive Seed Implants and Cryoablation Therapy.
da Vinci® Robotic Prostatectomy
Dr. William Figlesthaler with the da Vinci® S Surgical System
Nearly five years ago at Naples Community Hospital, William M. Figlesthaler, MD, FACS, successfully performed the first da Vinci® robotic prostatectomy in southwest Florida. Since that time, he and his partner, Michael F. D'Angelo, MD, FACS have performed over 1500 of these cases at both Naples Community Hospital as well as Physician's Regional Medical Center, Pine Ridge. Their experience and results have lead to a broad referral base, including physicians and patients from our area as well as from nearly every state and from around the world.
Drs. Figlesthaler and D'Angelo have mastered and then modified the original da Vinci® prostatectomy procedure to enhance the return of bladder control and sexual function as well as to cut down on operative times and minimize blood loss while optimizing cure.
The da Vinci's camera provides three dimensional viewing and also magnifies the surgeon's vision by ten times while he uses the tiny instruments to perform microdissection of the cavernosal nerves which run along the prostatic capsule. This technique allows for return of erectile function post operatively. In addition, the ability to maneuver throughout the surgical field with seven degrees of freedom allows the bladder neck and urinary sphincter muscles to be spared while detaching the cancerous prostate. Operating through keyhole incisions minimizes pain and blood loss thus allowing a rapid return to normal activities. Most patients are discharged to home the day following surgery and begin driving with in a week or two.
In experienced hands this miraculous technology provides patients with an outstanding option for successful treatment of prostate cancer, while allowing for a rapid return to the quality of life they deserve.
RapidArc™ at the Naples Prostate Center
RapidArc 360° Radiotherapy
The Prostate Center is the first facility in southwest Florida to offer RapidArc™ treatment to people who are battling prostate cancer. RapidArc™ radiotherapy is a breakthrough technology for delivering fast, precise treatment to many different types of cancer. RapidArc™ is two to eight times faster than conventional radiotherapy. Its precision enables doctors to target tumors in three dimensions and with pinpoint accuracy such that more radiation goes to the tumor and less to the surrounding healthy tissues.
RapidArc™ radiotherapy delivers image-guided IMRT (intensity-modulated radiation therapy) in a single rotation of the treatment machine around the patient in approximately two minutes. During the treatment, the radiation beam is shaped and reshaped as it is continuously delivered from virtually every angle in a 360-degree revolution and with sub-millimeter precision. The beam shaping is accomplished using a multi-leaf collimator (MLC), which is a device with 120 computer-controlled mechanical “leaves” or “fingers” that move to create apertures of different shapes and sizes. During a RapidArc™ treatment, specialized software algorithms vary three parameters simultaneously, the speed of rotation around the patient, the shape of the MLC aperture, and the dose delivery rate. Sophisticated treatment plans, generated by computer on the basis of each patient’s unique anatomy and tumor size, shape, and position within the body, guide the treatments.
The faster RapidArc™ treatments are easier on the patient as it is not necessary to hold still for long periods of time. By reducing the time it takes to deliver IMRT, RapidArc™ has the potential to improve the quality of care and patient comfort, while making radiation oncology a more affordable treatment for some types of cancer.
Dr. Michael Smith, our board certified radiation oncologist, is available to provide additional information. We can also arrange a tour of our new Prostate Center as well as a demonstration of this technology using one of our board certified radiation therapists.
High Dose Rate Brachytherapy
With the patient under general anesthesia, a template is used to guide the placement of a number of needles into the prostate by passing the needles through the skin in the area between the scrotum and anus. A CT scan is obtained to determine the position of each needle relative to the prostate. This information is then transferred into the treatment planning computer and a treatment plan is formulated. A computer controlled machine then runs a tiny radioactive pellet out into each individual needle. The radioactive pellet is then stopped at pre-determined locations within each needle for a pre-determined period of time to deliver a precisely sculpted dose of radiation to the entire prostate. A second application is delivered later the same day. The needles are then removed and the patient goes home. A second set of two applications is typically delivered a few weeks later.
Radioactive Seed Implants
With the patient under general anesthesia, the entire prostate is imaged using ultrasound. This information is transferred into a treatment planning computer a radiation plan is generated specifying the precise number of radioactive seeds and the precise location of each individual seed required to give a precisely sculpted dose of radiation to the entire prostate. Hollow needles containing the radioactive seeds are then inserted into the prostate using template and ultrasound guidance by passing through the skin between the scrotum and anus. Each needle is inserted individually, and contains a pre-determined number of seeds located in pre-determined areas of the needle so that when all needles have been inserted and all radioactive seeds have been placed an ideal dose of radiation results. The seeds remain in the prostate permanently and gradually give off their radiation over time.
Cryoablation Therapy
Prostate cryotherapy is a minimally invasive treatment for prostate cancer that is performed under anesthesia in an outpatient setting. The procedure involves the precise placement of ultra-thin needles directly into the prostate gland under ultrasonic guidance. Cold gas (liquid Argon) flows through these needles and literally creates an iceball around and through the entire prostate gland. The ice crystals that result cause the prostate cancer cells to swell and rupture which results in their destruction. The process is monitored closely with temperature sensors and this helps to protect adjacent structures including the rectum and bladder. Long-term data demonstrates excellent cure rate in appropriate cases with low morbidity. This procedure is FDA-approved and is covered by Medicare and most commercial health plans. Recovery is quick and patients are generally able to return to normal activity within a few days.