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In The News:

The Miami LRP Fraternity

Lee Haberman, MD News - Jul, 01 2002

They are men from all walks of life, but they belong to a common club. The stories told here are of a group of patients belonging to a unique fraternity - men who have had their prostate cancer treated with laparoscopic radical prostatectomy (LRP). In their medical decisions, camaraderie, and generosity, these are special men who opened the door to a revolution in prostate cancer surgery

In 1999, laparoscopic radical prostatectomy was introduced to the United States by Miami urologist Arnon Krongrad, M.D. At that time, few had even heard of laparoscopic radical prostatectomy, let alone seen one. The new operation, as reported then in MD News and today routinely done at North Shore Medical Center, is the first minimally invasive option for men with prostate cancer and delivers reductions in bleeding, pain, hospital days, and recovery time.

As word of laparoscopic radical prostatectomy spreads, the fraternity grows. Standing today at over 100 members, Miami's pioneering laparoscopic radical prostatectomy fraternity includes established doctors from Florida, macho ranchers from Texas, jet-setting businessmen from Central America, a 330-pound tractor dealer from Illinois, and a somewhat surprised 39-year old executive from Michigan. Every member of the fraternity is resourceful. Nearly every member consulted widely, including with other members, before choosing laparoscopic radical prostatectomy. In turn, in recognition of patient anxiety and the general deficiency of information on laparoscopic radical prostatectomy, many have spent time supporting other men. 

Who are the men who have had laparoscopic radical prostatectomy? What are their stories? How did they decide to have a new type of operation? How have they fared? And what do they view their roles vis-à-vis others?

To explore these questions, MD News brought together local members of the fraternity; many had previously spoken to each other, but this was their first group meeting. What came from the meeting, at times festive and at times reflective, are individual stories and the clear sense that here was a special group of patients, characterized by sophistication, the drive to find the best options, and, most uniquely, the collective conviction that others can benefit from their experience.

The Pioneer

Billy Joe Ewing, age 72, is an unassuming retired meteorologist, a military man who served in WWII and now occupies his time as an amateur tuba player. Billy was diagnosed with prostate cancer about the time that Dr. Krongrad was working with Frenchmen Bertrand Guillonneau and Guy Vallancien on a technical manual for laparoscopic radical prostatectomy. Billy had quickly decided to not have radiation. He then also decided that, having had two previous abdominal operations; he was not having surgery again. He searched for a third way and, after several consultations with other physicians, was sent to Dr. Krongrad.

According to Dr. Krongrad, "Billy walked into my office, lifted his shirt and showed me two scars, one from gall bladder surgery and the other from having his appendix removed. Billy told me he was not going to have any more surgery and wanted to know about his options. I told him he could have traditional prostate surgery to which Billy replied, "What else do you have?" I told him he could have radiation to which he again said, "what else do you have?" I started to tell Billy about LRP but told him I had never performed the procedure before."

Said Ewing, "I told Dr. Krongrad that I didn't care if he had done the procedure or not, I just asked him if he knew how to do it. Once he told me yes, I told him that I was going to be his first patient, and that was two years ago. At that time, I didn't give that much thought to being the first, I just wanted the cancer removed, but now I feel like I'm part of a team, something larger than me."

"I came through the surgery a bit groggy and with a sore throat. Everyone was smiling and the only thing that hurt was the catheter. I waited for more pain but none came. The nurses begged me to take two Tylenol for their sake, so I did. By the second day, I was bored, restless and ready to go home. Finding no reason to keep me in the hospital, Dr. Krongrad discharged me, and I was back to playing my tuba and minding my business back home."

The Pathologist

Dr. Njoek San Ie, M.D., a retired 71 year-old diabetic and hypertensive pathologist was concerned by his increasing PSA for several years. Two biopsies showed nothing but prostatitis, and he wasn't worried because "everyone knows Chinese men don't get prostate cancer." That was until this past year, when Dr. Ie's biopsy showed a Gleason 7 carcinoma.

"Being a doctor, the decision about what to do was easy for me," according to le. "I knew about radiation and surgery, and I just wanted my prostate out, and get back home to tend to my garden. The trouble was that at my age, not everyone supported my decision. However, after speaking with several urologists and getting some information about LRP, I was referred to Victor Politano, a famous urologist and former president of the American Urological Association. Dr. Politano had been present at Dr. Krongrad's first laparoscopic radical prostatectomy and endorsed my decision."

Dr. Ie's operation lasted just over three hours. He barely lost any blood at all, was walking around the hospital a few hours after surgery, and left the hospital 15 hours after the procedure. His diabetes was under control and there was no pain to speak of. Says Ie, "it was nice to see my prostate pickled in a jar of formaldehyde. As an old pathologist, it did my heart good."

The City Planner

Luis Carrasquillo, 52, retired city planner and avid diver and fisherman, began his odyssey in the spring of 1998, when the first of many physicals included PSA results between 5.5 to a PSA of 10.5 by the summer of 2000. Three biopsies later, a moderately differentiated cancer was discovered.

According to Carrasquillo, "Every treatment option I heard about terrified me. I spent as many hours as I could researching options, speaking with different urologists and looking for alternatives. In September of 2000 I saw an article in The Miami Herald about Dennis Lincoln, patient number four. I knew it was the choice for me."

Unfortunately, it wasn't that simple for Carrasquillo, as it took several months and a face-to-face meeting with the insurance company before getting approval to go out of network. Says Carrasquillo, "I'm sure the personal meeting played a role in their reversing their position. They all realized that if this was their prostate, they'd all be making the same decision ."

Once approved, Carrasquillo had the surgery shortly thereafter and was released from the hospital the following day. Within 5 weeks, Luis had regained continence, built a new shed, and had completely recovered. His PSA is < 0.1 ng/ml.

The Lawyer

Ivan Tobias, 55, an attorney whose problems began with abnormal kidney function, was amazed to learn that he was retaining urine and had an enlarged prostate. To his dismay, a biopsy then added cancer to his list of medical issues. Immediately scheduling several meetings with other urologists to discuss traditional radical surgery, radiation and other options, Ivan discovered laparoscopic radical prostatectomy only on casual conversation with a business associate.

"All I wanted was to be rid of the cancer," said Tobias, "and to have the surgery as soon as possible. I was never told about laparoscopic radical prostatectomy from any other urologist I talked with, which leads me to believe there's a lack of education out there, even within the medical community, and that's frustrating. I want to help get the word out about LRP. Never in my wildest dreams did I think I'd have prostate cancer."

"I decided that laparoscopic radical prostatectomy was the right procedure for me. My diagnosing urologist had told me that I should have a radical prostatectomy through an abdominal incision, and advised me to close my law practice for 4 to 6 weeks. The long recovery presented a major problem for me. With laparoscopic radical prostatectomy, knowing I could be back at work within hours, with no down side, it was a fairly easy decision."

"I was walking around four hours after surgery and went home the next morning. Less than two weeks later, I was playing golf, continent, no longer in retention, with my kidneys no longer at risk, my cancer gone. With virtually no inconvenience and no pain, LRP delivered three cures in one step. "

The Businessman

Dennis Lincoln, the 4th member of the Miami fraternity, is now two years removed from his surgery. Lincoln found the doctor through his sister-in-law, a registered nurse who was selling medical equipment at the time, and had heard of laparoscopic radical prostatectomy through the medical grapevine.

Lincoln, an active fisherman and diver, did not want to be down and out for any length of time. "I did a lot of research on the Internet, he said, "and also spent a great deal of time investigating the laparoscopic radical prostatectomy. I learned about LRP in detail and knew that Dr. Krongrad had done only three. I had also talked with friends who had traditional prostate surgery, whose outcomes didn't excite me very much, and with other doctors."

"I gained confidence in my surgeon," said Lincoln, "and was very pleased to know that recovery would be so quick. I woke up from surgery and asked the doctor when we were going to start. The procedure was done! I had no pain, stayed just overnight, and went to the office the next day. My wife and I went shopping for a new car the following day. And my cancer is gone. What more could one ask for?"

The Referee

Charles Yatman, 70, is a kayak competition referee with the International Olympic Committee. A PSA was high and a biopsy showed cancer. All of his research led him to men who had had traditional radical prostatectomy, all of whom described long and painful recovery. "I chose laparoscopic radical prostatectomy," said Yatman, "because I wanted to avoid any long dysfunction. I wanted the cancer out. I wanted to get back to resuming my life, and I wanted to get back to doing that as quickly as possible."

Yatman had surgery in August of 2001 and was released after an overnight stay. Two weeks after surgery, he was kayaking on Biscayne Bay. His friends from the world of canoeing were astounded by his recovery and his return to full life. Nobody suspected he had been hospitalized, and certainly nobody could have known he had successfully had a malignant tumor removed.

According to Yatman, "I learned from the pathologist that my cancer had grown outside my prostate. It's a good thing we did not spare the nerves on the side of the tumor, since that choice still gave me negative margins and a zero residual prostate specific antigen. I'm doing great, I'm traveling and am as active as I ever was."

The Air Force Pilot

Don Reed, a 67 year-old retired U.S. Air Force pilot and self-proclaimed "golf nut," also learned of laparoscopic radical prostatectomy through an article in The Miami Herald. Incredibly, within a month or two of reading that article, Reed found on that his PSA had jumped to a 6.5 and a subsequent biopsy confirmed the presence of prostate cancer.

According to Reed, many of his golf buddies had undergone various treatments for prostate cancer, including taking Chinese herbs and radical surgery, which resulted in a large scar, large loss of blood and several weeks in the hospital. "For me, it was a no-brainer," said Reed. "I wanted the prostate removed and the LRP seemed like the way to go. Three hours after the anesthesia had worn off, I walked around the room and left for home the next morning. My blood tests this year revealed a PSA level of zero."

The Retiree

Steve Rosner had retired from a successful business up North and planned for an uneventful and pleasant time in South Florida. He was also one of the few laparoscopic radical prostatectomy patients present at the meeting who was diagnosed by Dr. Krongrad. After complaining of some mild symptoms, a blood test showed a PSA of 2.7 ng/ml. A biopsy showed cancer.

After doing much research, speaking with other doctors and hearing more negative than positive feedback about laparoscopic radical prostatectomy, Rosner really needed to be convinced that this was the right procedure for him. With his son by his side, they spent two hours with Dr. Krongrad, hearing everything about LRP, and ultimately decided it was the best treatment option available for him. Says Rosner, "Though Dr. Krongrad instilled confidence in me about the procedure, I really need to thank the men who went before me. If not for them, if not for learning about them and hearing their stories first, I don't think I would have opted for LRP. For that, I am thankful and appreciate their courage and kindness in sharing their stories with me, and all of us."

The Senator

George Firestone, who served 5 years in the House of Representatives as well as terms as Secretary of State for the state of Florida, was referred to Dr. Krongrad through a mutual friend. George had already had a conventional radical prostatectomy and fully understands the concerns of active men with a cancer. Along with others, George has thrown his support into public education and research efforts to help men with prostate cancer. "This afternoon was inspiring, a very special event. I wish I had the LRP option when I was diagnosed. Too late for me, but let's get the word out for the others."

Each member of the Miami LRP Fraternity has a story to tell. Some stories overlap. Jack Kleban, a business professor at FIU and the 13th member of the fraternity, works with Pat Lee, Provost of Barry University and 85th member; the two met for the first time at the meeting. Marc Mervis, realtor and 5th LRP member, is an active and continent tennis player who has counseled other men. Jaime Carvajal, a boatyard foreman, cancelled traditional surgery and was back building boats within days after his laparoscopic radical prostatectomy. Birgir Arnason, banquet manager at Loew's Miami Beach Hotel, went back to work 4 days after surgery. Bill Rodriguez, with the BrowardSchool District, had the same story. Alan Seat, importer/exporter, was temporarily, at age 49, the youngest member. Glenn Broch, who plays football, baseball, basketball and more with his 5 sons, was in the gym continent and doing crunches 10 days after surgery.

The first meeting of the Miami laparoscopic radical prostatectomy Fraternity was a chance to reminisce, tell stories, and learn from each other of their common objectives. Most notably, the meeting seemed to reinforce the thoughtfulness and decency of the members, expressed in their commitment to present and future members.

For Dr. Krongrad, the meeting presented a chance to watch as men he knows well got to know each other. "For me, it all started with Billy walking in saying that he was going to be my first patient. Victor Politano, who has pioneered numerous urological surgical techniques, tagged along that first day and has since stayed involved with a few of the patients. The program got help from others, including surgeons Raleigh Thompson and Carlos Suarez, my assistant Max, and the wonderful surgical team at NorthShore."

"We started one at a time. First Billy, then Dennis, and Jack, and Don, then all the others. Patients are coming from all over. Last week, I operated on a 39-year old businessman from Grand Rapids. This young man broke the time-to-erection record, having achieved his first erection 3 days post-op. He still had a catheter and so was rather alarmed," jokes Krongrad," but all ended well."

"It's nice to see the patients involved in eliminating the information gap, something that bothered many of them. They are pioneers in the truest sense, with generosity of spirit that will blaze trails for the men who follow."

About Laparoscopic Radical Prostatectomy:

Laparoscopic radical prostatectomy offers the patient many advantages, including:

Better visualization
Reduced blood loss
Better preservation of anatomy
No abdominal incision
Easier feeding
Earlier removal of intravenous lines
Greater mobility
Shorter hospital stay
Reduced convalescence

Laparoscopic radical prostatectomy  is the latest technical innovation found in prostate cancer treatment. For the surgeon, LRP offers improved visualization of the anatomy, reduced blood loss, and the preservation of anatomical structures. For the patient, laparoscopic radical prostatectomy virtually eliminates post-operative convalescence.

LRP benefits from the introduction into the urological operating room of surgical robots. Already in use in other disciplines, robots today perform a range of surgical functions. In laparoscopic radical prostatectomy, a voice-controlled AESOP robot is used to hold the laparoscope. Replacement of a human assistant with the robot permits a less crowded operating table and assures the operative team a steady and responsive view of the field.

For more information on laparoscopic radical prostatectomy and the men who have had LRP: www.laprp.com

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