Dr. Edward Schaeffer is the Chair of the departments of Urology a Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital.
In July, Prostatepedia spoke with him about the advances in urology. Subscribe to read the entire conversation.
What are the current points of controversy in the world of prostate cancer surgery—both for men who have been newly diagnosed and for those facing recurrence?
Dr. Schaeffer: Surgery for prostate cancer remains the gold standard, the best way to c
ure the disease. It is also the oldest treatment. Prostate cancer surgery was first performed in 1904; it’s withstood the test of time.
The big hurdle for prostate cancer surgery has always been maintaining its outstanding cure rates while continuing to minimize postsurgical toxicity and side effects.
The operation has certainly evolved over the last 30 years. Dr. Patrick Walsh at Johns Hopkins University was my mentor. He perfected the open radical prostatectomy. Many Johns Hopkins alumni have now brought minimally invasive laparoscopic robotic prostatectomy online.
Today, for almost all cases, the laparoscopic robotic prostatectomy offers a state-of-the-art approach. Still, it is important for a man considering surgery for prostate cancer to find the most experienced surgeon he can. Ultimately, experience trumps approach.
You need to find a surgeon you like, because you’re going to have your surgeon for the rest of your life.
You need someone who has enough experience to give you a good outcome. Patients ask, “Should I come to you?” I say, “I’m confident I can help you, but we need to have a great relationship as I’m going to take care of you for the next 30 years…”
Is there a learning curve for robotic prostate cancer surgery?
Dr. Schaeffer: There is a learning curve to prostate surgery, period. Prostate surgery is incredibly complex. In an average surgeon’s hands, it is a four-hour operation. The surgery requires an intense knowledge base. It’s difficult whether you choose an open approach or a laparoscopic robotic approach.
I believe there are some subtle things about a robotic approach that an experienced surgeon can translate into better outcomes for patients. Ultimately, an open operation is not that different from a laparoscopic approach. But, yes, there is a very steep learning curve to robotic prostatectomy.
My other general philosophy is that I don’t consider myself to be a technician—a robotic surgeon. Rather, I proudly consider myself to be a physician who takes care of men with prostate cancer. One of my skillsets is that I’m able to perform prostate cancer surgery well. I do both open and laparoscopic approaches in my practice, though I favor the robotic approach. Ultimately, though, I consider myself to be an expert in prostate cancer who offers patients a good understanding of which treatment approach may be right for them. That may be surgery or radiation or surveillance.