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Return to Holistic Medicine Helps Patients Recover From Prostate Surgery Overview

More on Holistic Medicine Helps Patients Recover From Prostate Surgery

Holistic Medicine Helps Patients Recover From Prostate Surgery

New York (Oct 27, 2009)

Doctor and an older male patient talk

"In the wake of surgery for prostate cancer men have three common concerns", says Aaron E. Katz, MD, Director of the Center for Holistic Urology at NewYork-Presbyterian Hospital/Columbia University Medical Center. "They want to know: Is the cancer out – am I surgically cured? How can I ensure a quick return of urinary control? And how can I regain sexual function?" According to Dr. Katz, "Some men are much more concerned about the return of sexual function than about their disease, while others don't care if they are leaking if the cancer is out. There is not one factor that is the most important for everyone." Dr. Katz and Ketan Badani, MD, Director of Robotic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, collaborate with each other to ensure that their patients' primary concerns are answered and that they have a rapid return to health after surgery.

Robotic Surgery: Less Trauma, Faster Recovery

Robotic surgery itself helps ensure a speedy recovery, Dr. Badani notes. "Because the operation is minimally invasive it's also minimally traumatic."

Ketan Badani, MD
Ketan Badani, MD
The surgeon makes a very small incision so there is usually no pain, very little blood loss, and patients are not bedbound and are usually walking that night and go home the next day. "In the day or two following surgery, most men are up and walking one to three miles a day, their energy is better, they feel better overall. Once the catheter is removed a week after the operation, most men can go back to work."

In most men with prostate cancer, surgery is curative. But about 30 percent are found to have one or more unfavorable prognostic features – tumor cells outside the prostate or a Gleason score of seven or eight or a high volume of tumor – and these men have a heightened risk of recurrence. Dr. Badani refers men in this group who are interested in and might benefit from a holistic approach to Dr. Katz and his colleagues at the Center for Holistic Urology (CHU).

How Holistic Medicine Helps

Dr. Katz and his staff work with patients in this group to lower their risk of recurrence through dietary modification and supplementation.

Aaron Katz, MD
Aaron Katz, MD
"Studies have shown that men who have higher levels of fat in their diet have a greater chance of recurrence," Dr. Katz said. "Levels of low-density lipoprotein (LDL) have also been linked to a diagnosis of prostate cancer in a recent study. So we alter their diets so they take in less fat, no red meat or fried food, and we add more soy products and cruciferous vegetables like broccoli and cauliflower, and encourage them to eat steamed and raw vegetables rather than cooked."

For many patients, Dr. Katz also recommends antioxidants including lycopene and pomegranate extract pills, vitamin D supplements as well as a multivitamin, and a novel herbal formula called Zyflamend. "We then monitor patients very closely," he said. The CHU is studying the effectiveness of soy compounds such as genistein, a potential angiogensis inhibitor, and a medicinal mushroom compound that may improve the immune system function.

Regaining Urinary Continence

Most men who have undergone prostate surgery hope for a quick return to urinary continence. Newer robotic techniques are making that possible, notes Dr. Badani. "The muscles that control urination are in the deepest part of the pelvis, where they are hard to reach and to see during traditional surgery. With robotic surgery we have a camera and tools that allow us to get to that deep part of the pelvis, so our ability to identify and preserve those muscles is much better than with traditional surgery." After removing the prostate, Dr. Badani now reconstructs the structures surrounding it in a way that more closely emulates normal anatomy. "We not only reconnect the bladder and the urethra, but connect all the muscles back together and put all the layers that enclosed the prostate back together," he mentions. Using this approach, most men return to continence about three months sooner than men who underwent traditional reconstruction techniques. At the CHU, Dr. Katz helps patients recover urinary control more quickly through a program designed to build up the pelvic floor muscles including kegel exercises.

Regaining Sexual Function

Restoring sexual function after prostate surgery is challenging, said Dr. Badani, but urologists are gaining a better understanding of how to do this. "Sexual function is controlled by a network of millions of tiny microscopic nerves that envelope the prostate. During an enhanced nerve-sparing procedure we not only peel off and preserve the nerves at the back of the prostate, but we can use the tiny hands of the surgical robot and preserve the nerves from the sides of the prostate as well." At one year following surgery, 65 percent of men with traditional nerve-sparing surgery have a regained potency compared with 78 percent of men who have had an enhanced procedure.

"The other half of the story is rehabilitation," Dr. Badani said. "We put most of our patients on a rehabilitation regimen for the sexual nerves that includes the use of drugs such as Viagra, Levitra, or Cialis immediately after surgery as well as daily use of a vacuum erection device, a simple cylinder that is put over the penis and mechanically draws blood into it. This regimen prevents scarring and hardening of the spongy tissues in the penis during the time the nerves are healing," he said.

Dr. Katz takes the exercise and blood flow connection even further by having patients incorporate daily exercise that increases blood flow throughout the body, not just to the penis, to engage the entire body in the healing process.

Collaboration

"Dr. Katz and I work very closely together, from the very first decision point: does this patient need surgery or not?," said Dr. Badani. "If they don't need an operation but would benefit from holistic therapy I send them to Dr. Katz. After surgery we decide together what therapies will help patients most quickly recover. We are continuously working together. The team approach that we have established for the patient at Columbia is extremely important and leads to overall improvement in quality of life and cancer-free outcomes."

Faculty Contributing to this Article:

Aaron Katz, MD is Director of the Center for Holistic Urology at NewYork-Presbyterian Hospital/Columbia University Medical Center, and a Professor of Clinical Urology at Columbia University College of Physicians and Surgeons.

Ketan Badani, MD is Director of Robotic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Urology at Columbia University College of Physicians and Surgeons

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