LOUISVILLE, Ky. (WHAS11) – Dr. John Eifler is a urologic oncologist specializing in surgical management for cancers of the urinary tract, including prostate cancer and testicular cancer.
I sat down with Dr. Eifler to learn more about what surgery options patients of these cancers have and what kind of treatments are on the horizon.
The following has been edited for clarity.
Will Weible: Can you give me an overview of some of the common surgery options for prostate cancer and testicular cancer?
Dr. John Eifler: Testicular cancer often-times will present as a firm nodule or a firm growth within the testicle and often-times men discover it during self-examination. So, we typically would remove the testicle at that point, and the pathologist will look and determine what type of testicular cancer it is, and depending on what exact “flavor” that patient has, we can individualize a treatment regimen for them, which may consist of surgery. It can be sometimes abdominal surgery, sometimes we recommend chemotherapy and then rarely we do radiation therapy.
One therapy we probably should talk about is a new ablative approach that we use for some patients with prostate cancer called High-Intensity Focused Ultrasound—also called HIFU—and HIFU is a therapy where there are no incisions. Essentially, we just use very high-energy ultrasound waves to heat a small area of the prostate, and we can march those small areas across the prostate until all the prostate cancer tissue is completely destroyed. And one of the great things about it is you can really target the areas of the prostate that you want destroyed and also the areas that you would like to preserve. And really, outside of the region of treatment, there is no damage to those adjacent structures. So, when we talk about sexual function, it’s remarkable how well patients do from a sexual function standpoint after HIFU.
WW: Is HIFU a common procedure now, or is it still gathering speed?
JE: It was FDA-approved in 2015 and since that time the number of patients who’ve been getting HIFU in the Louisville area has been rising dramatically.
WW: Can you explain some of the other options for prostate cancer?
JE: We’re blessed in that usually when we catch [prostate cancer] it’s still all confined to the prostate, and at that point there are a number of different options that we can offer. The first option you might think of is surgery, and traditionally people have used what’s called an open surgical approach where they make a standard incision [several inches] long, and they remove the prostate via that means. More recently we’ve adopted laparoscopic techniques to do that, and in particular the da Vinci surgical robot is something that I typically use in my practice at this point. That allows us to get a very good visualization of the prostate, the nerves that are adjacent to the prostate, and we’re very good at removing the prostate and sparing the important tissue around the prostate.
WW: Can you go into more detail on the da Vinci method?
JE: It is a form of laparoscopic surgery, so we typically make a few keyhole incisions, each of which is only about a centimeter big, and we use that to insert our surgical instruments. In this case these are robotic instruments and there’s a large machine called the da Vinci surgical robot that attaches to those instruments. The surgeon meanwhile sits at a console adjacent to the [operating] table and it’s almost like a video game, controlling the different surgical instruments, but it’s remarkable because the surgical instruments give you a lot of flexibility. But then also you have a 3D view of the prostate and the structures around the prostate, and it’s a difficult place to image, you know, to get good visualization if you do it through the old surgical approach. So, it has been a great advance.
WW: What are the short-term and long-term recovery processes like for these procedures?
JE: You know it depends a little bit. We should maybe talk about prostate first. Prostate cancer surgery typically, for robotic surgeries, I keep patients in the hospital overnight. The wide majority of patients go home the day after surgery. There are some long-term recovery issues in terms of regaining sexual function, regaining urinary function because the prostate is such an important structure for both of those systems. It can take a while for those processes to normalize.
In terms of testicular cancer, typically when we remove the testicle the patient goes home the same day, and while there may be some soreness associated with it the recovery is relatively quick.
WW: And removal of the affected testicle is a common treatment?
JE: That is almost always the first step in treatment, and then once we have an idea of how widely the disease has spread you may need additional treatments after that.
WW: If someone has their testicle removed how will that affect them in terms of fertility or day-to-day functioning?
JE: Remarkably it does not have much of an affect. There are really two big functions of the testicles, one is that it’s responsible for testosterone function and it turns out that having one testicle is more than enough to provide you with the normal testosterone level. The second function is for fertility of course and production of sperm, and there again having one testicle very rarely would limit someone’s fertility options. A professor of mine in residency used to say that men with two testicles have a 90% chance of fathering children and patients with one testicle have an 89% chance.
WW: What kind of factors determine what type of surgery a patient may get? Is it just how the cancer is progressing or are there other factors such as age or other health concerns?
JE: I think prostate cancer, because it’s so important in terms of urinary function and sexual function, treatment really needs to be individualized based on each patient’s preferences. So, patients who have a very firm interest in sexual function may choose a different treatment option versus other patients who are not as interested in sexual function and really just want to maximize their chances of cancer cure.
WW: What do you think people need to know about these diseases?
JE: I think that one thing, in 2017, is important to highlight is that we’re really in a renaissance period in terms of how we manage prostate cancer. Really, prostate cancer was managed the same way for about 20 years, maybe 25 years, ever since the adoption of PSA screening. But we’ve had a number of important discoveries in about the past five years that are really revolutionizing how we treat prostate cancer. And that’s on the imaging side—when we start talking about prostate MRI and some of the new PET scans that have come out in previous years, and even some better ones that are coming out right now—but also on the laboratory side. We’re making great strides in genetic testing for prostate cancer and really one thing that we want to do is individualize care towards the genes that are driving a patient’s prostate cancer.
And then on the treatment side, we now have robotic surgery, we have HIFU, cryotherapy, so there’s new therapies that are also helping us to really individualize care.
WW: You mentioned genetic testing. I know that if prostate cancer is in your family you’re at an increased risk—does that matter whether it’s on your mother’s side or your father’s side? Can that risk come down through your mother’s side of the family?
JE: Over the past five years—again talking about the renaissance in prostate cancer research—we’ve learned an incredible amount about prostate cancer genetics. And genes that have traditionally been thought of as breast cancer risk genes, like BRCA1 and BRCA2, we now recognize as important genes that can drive prostate cancer as well. And so, family histories of a number of different types of cancer can actually increase your risk of having prostate cancer and increase your risk of dying of prostate cancer. And I think we are just now at the tip of the iceberg of understanding how that process works and being able to utilize that new knowledge to treat patients in an optimal way.
One thing I really wanted to highlight was the genetic tests, which I do think have greatly changed the way that we’re managing prostate cancer patients in all levels of the spectrum. When they’re initially diagnosed it helps us to decide men who actually need active treatment and those who maybe we could monitor without doing any aggressive therapy. And then also, for patients who have more aggressive disease, it tells us, you know, was our surgery enough or do we really need to look at maybe radiation or certain medication that can reduce their chances of having the cancer come back?
WW: So that’s something we’re looking out for on the horizon in the coming years?
JE: We’re testing that right now. So, patients who come in and they have prostate cancers, we’re testing to see if they have these genes—in the appropriate circumstances—and if they do we can then notify family members that they are also at risk.
WW: So, no matter what side of the family it’s on, men need to be aware of previous cancers.
If you would like to learn more or get in contact with Dr. John Eifler or others at First Urology, click here.
If you would like to donate to WHAS11’s Movember fundraising effort to fight prostate and testicular cancers, or join our fundraising team, you can do so at moteam.co/WHAS11.
For more information on these cancers and the Movember initiative, read more here.