Prostate Cancer
The ultimate goal of the surgical treatment of prostate cancer is the complete removal of the cancer located in the gland with the lowest perioperative morbidity (in terms of pain, blood loss, time in the hospital, and time lost from normal activities) and the absence of functional sequelae (in terms of urinary continence and sexual potency).
Therefore, the immediate research goals with respect to prostate cancer are to:
- Tailor the surgical technique to the individual patient and to his particular cancer. Taking advantage of the expertise at Memorial Sloan-Kettering in radiological imaging (especially endorectal MRI and MR spectroscopy), the ease of multiple mapping biopsies in the urological ultrasound laboratory, and the facility for nomogram, we will explore optimal techniques for identifying the location and extent of cancer in each patient and adapting the laparoscopic operation appropriately. Using medical informatics tools, such as nomograms and decision analysis models, we will investigate the optimal role and extent of lymph node dissection, as well as the indications for partial or total resection of neurovascular bundles.
- Compare outcomes after laparoscopic radical prostatectomy with those after other forms of treatment for localized prostate cancer. We have a unique opportunity at Memorial Sloan-Kettering to compare outcomes in large numbers of patients using modern comprehensive questionnaires to assess patient-reported quality-of-life results after each of the major forms of therapy, including laparoscopic and open radical prostatectomy, brachytherapy, external beam irradiation therapy, as well as expectant management ("watchful waiting"). Our goal will be to gain objective information that will lead to improved surgical techniques and better outcomes, and to provide objective data about the frequency and severity of complications that will help us, in collaboration with investigators in medical informatics, to construct decision-analysis models to facilitate patient decision-making. No other center will have the level of expertise in all of these approaches that would allow comparisons of state-of-the-art techniques in each discipline.
- Develop and test new instruments in laboratory animal experiments, to improve visibility and facilitate anatomically precise resection of the prostate with minimal damage to surrounding tissue. The focus of development will include nonrobotic stereotactic vision cameras and laparoscopic doppler probes to identify the arterial component of the neurovascular bundles responsible for erectile function. With improvements of instruments, the quality of surgery can improve and the ease of learning can diminish so that these techniques can be adapted more readily by surgeons.
- Evaluate the role of the robotic assistance in laparoscopic surgery, particularly for specific surgical steps necessitating extremely accurate gestures, such as interposition of nerve grafts of the cavernosal nerve in case of neurovascular bundle resection for extensive tumor in potent patients.
