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A Quick Hit for Prostate Cancer

Christine Morris, Miami Herald - Sep, 07 2000

Dennis Lincoln of Plantation says the anesthesiologists couldn't believe he was smiling when he woke up from prostate cancer surgery. Two days later, he was back at work.

Bill Stewart brags about driving home from Miami to Jacksonville the day after his prostate surgery. A week and a half later, he played 18 holes of golf.

Judy Lincoln says her husband felt so good they earned their scuba diving certification in the two months after the surgery and took a dive trip to the Bahamas.

Susann Stewart says of husband Bill: "He's not letting it stop him, that's for sure."

Arnon Krongrad, the Miami Beach urologist who performed laparoscopic prostate surgery on Dennis Lincoln and Bill Stewart, says, "These people are brave. I asked them to take a leap of faith with me."

It was a leap of faith because even today, four months after Dennis Lincoln's surgery, Krongrad has performed the robot assisted operation only nine times. Few doctors in his country do it yet; Krongrad learned it from the French team that perfected it.

Laparoscopic radical prostatectomy is a possibility for anyone who has chosen to deal with prostate cancer by removing it, says Krongrad, who has done traditional open prostate surgery for more than 15 years. An estimated 180,400 new cases of prostate cancer will be diagnosed in the United States this year, according to the American Cancer Society.


In laparoscopic surgery, a robot arm holds a tiny camera, inserted into the patient's abdomen through a small incision. The surgeon's voice controls the movement of the camera inside the body.

The camera projects an image on a monitor that guides the surgeon and his assistant as they remove the prostate gland using instruments inserted through four other tiny incisions. "The beauty of this operation is you can see what you're doing," Krongrad said.

The patient leaves the hospital with five bandaid dots over the holes. Very little bleeding, very little pain, and a return to near-normal life within days.

Patients commonly take four to six weeks to recover from open prostate surgery, which requires a large incision.

"Just think if someone told you they were going to give you back 30 to 45 days of your normal life," said Bill Stewart, whose surgery was Aug. 1. "That's amazing that somebody can give that back, and that's what happened."


Laparoscopy is widely used in gall bladder surgery, said Dr. Carlos Suarez, who does minimally invasive surgery and is a trustee of the Society of Laparoendoscopic Surgeons. It is gradually expanding to other operations, including hernia repair and some colon and cardiac procedures.

"I think this trend is going to continue," said Suarez, who trains other doctors and assisted at one of Krongrad's operations to see how it's done.

Prostate cancer is a complicated diagnosis, with little solid information to guide predictions of its course, leaving patients to make their own treatment choices. "We have a lot of questions to answer about this disease," said Krongrad, founder of the Prostate Cancer Project, not-for-profit research foundation. "My dead patients bear witness to that."

The choices include surgery, radiation -- and waiting to see how fast the disease develops. The latter can be a reasonable alternative because in many men, particularly the elderly, the cancer may grow slowly and other causes of death are more likely.

But as Dennis Lincoln says, "If you have the opportunity to get rid of it, I can't understand why anybody wouldn't do it. The cure is a long way off."

Krongrad -- along with his little fraternity of patients and their families -- believes in laparoscopic surgery because it allows for greater precision and greatly reduces the pain, blood loss and recovery time.

"This doesn't solve the problem of prostate cancer, but it addresses a fundamental concern: First, do no harm," Krongrad said. "This is about reducing the price we pay."

His recent patients, including Stewart and Lincoln, were in their mid-50s, eager to get back to work and play.

And they came upon Krongrad by chance. In the case of Bill Stewart, who sells anesthesia and critical-care equipment for a company called Datex-Ohmeda, a South Florida sales representative of his company knew Krongrad. Judy Lincoln's sister, a former urology nurse who now sells medical equipment, knew of Krongrad's work.

Both couples did lots of research, talking to other doctors, former patients, even each other. They spent hours interviewing Krongrad.

Judy Lincoln laughs when she remembers Bill Stewart's call asking about their experience. "His whole priority was, how soon can I get back on the golf course?"

The Lincolns work with computers in their Davie business, Universal Data Consultants. Dennis Lincoln said he wasn't at all intimidated by the technology or by Krongrad's relative inexperience with the procedure.

"The guinea pigs were in Europe," he said. The French team has performed 400 or more laparoscopic operations, Krongrad said, and the surgery has been done 1,500 to 2,000 times throughout Europe.

The Lincolns made a quick decision, but then delayed the surgery -- for their daughter's long-planned wedding.

"It was a pretty emotional time," Judy Lincoln said. "Our daughter is our baby and our only girl. I know it took a lot of the fun out of it for her.

"But the wedding was wonderful, and the surgery was as good as it could possibly have been," she said, concluding with a sigh: "I'm a lot older this year than I was last year."

Insurance coverage remains a question mark: In some cases laparoscopic prostate surgery has been approved, and in some cases it has taken a lot of negotiation. "Battling the insurance company is probably the toughest thing we had to do," Bill Stewart said.

But Krongrad said insurance companies have expressed interest in the treatment and he is optimistic it will become the "standard of care."

Some patients report grim side effects including incontinence and impotence after prostate surgery -- and after radiation. Krongrad says there are no conclusive comparisons of longer-term side effects in open and laparoscopic surgery.

The Stewarts and Lincolns laugh and joke now about what they see as relatively minor complications.

Krongrad "told me the possibilities about incontinence and impotence," Stewart said. "That wasn't my concern. I think of the big picture, and the big picture is getting this thing out. We don't have that many years on this Earth."

Judy Lincoln felt a similar urgency about her husband's cancer. "Emotionally it disrupts your life, and certainly physically it disrupts your life, so you have to be aggressive and go beat it up."

The families are grateful they found Krongrad and took the leap of faith. "He is truly dedicated to finding a cure for this," Judy Lincoln says. "In the meantime, he's learned the best possible way to do the surgery."