Robotic Surgery, the most recent solution for prostate, kidney and bladder cancer

Uro-oncology is one of the areas of medicine that currently performs the best in the treatment of malignancies. That's because doctors' experience, state-of-the-art drugs and cutting-edge technology make the long-term healing possible. One of the best experts in the world in the treatment of malignant urological diseases is Prof. Dr. Saadettin Eskicorapci from ACIBADEM Atakent University Hospital. With over 20 years of experience in the field of uro-oncology, the top surgeon offers today tp his patients the opportunity to treat their urological malignancies by the most advanced method, the Da Vinci robotic technology. Here are some examples of the ACIBADEM expert in performantly treating urological cancers.

What are the most common health problems you diagnose and are currently working with men?

Prof. Dr. Saadettin Eskicorapci: I am a urologist, but I do not feel like it just because I treat cancer patients, so I'm rather a uro-oncologist. I am very attracted to this side of medicine, oncology, because cancer is a serious condition and it is a challenge for me. I like to help people, and that's why I chose this job. So, in my current practice, most patients are cancer patients. I'm doing everything I can to help them, and robotic surgery helps me a lot on the way. Patients operated with this technology heal much faster. Prostate cancer, kidney cancer, testicular cancer, and bladder cancer are the main types of illness I'm dealing with. I also deal with other types of surgery, such as those for robotic calculi, but mainly treat patients with cancers.

What are the causes of urological cancers?

Prof. Dr. Saadettin Eskicorapci: There are two aspects: what is scientifically proven and what we do not know. But we can assume. Everyone knows the main causes of cancer - and I always tell this to my patients - that this is primarily about smoking. Cigarette consumption leads to lung cancer, but also to bladder cancer. Smoking is also a risk factor for kidney cancer, along with hypertension and obesity. For prostate cancer, we do not know how it occurs. We have some clues, but we do not know for sure. We do not even know about the testicular cancers that cause them because they appear at young age at 20, 30 years old. We suspect there are some genetic abnormalities. Also, the hereditary factor also counts: for example, if a man's mother had breast cancer, then he has a higher risk of prostate cancer. This occurs in carriers of BRCA changes, but other risk factors are involved. These people should follow the doctor-recommended check-up programs. If there are relatives in the family with testicular, prostate, renal or bladder cancer, then those people have to go to a doctor because they have an increased risk of cancer.

What are the check-up programs that can highlight the early lesions?

Prof. Dr. Saadettin Eskicorapci: At this time, we follow the guidelines we have in the US and in Europe, so the programs include tomographies, magnetic resonance, PET scans, biopsy. But we also have genomic markers that I’m currently studying with Harvard University. Also, in ACIBADEM, we have certain genomic tests available to patients in our check-up programs. And these tests of genomic markers are constantly developing and may indicate the risk of disease. But only the biopsy can tell us for sure whether it is a tumor or not. For example, the PSA test has a sensitivity of less than 70 percent, and elevated values do not accurately indicate a cancer: it may be an infection or other health problem. Until this hour, there is no specific tumor marker one hundred percent fail free. That's why we appeal to imaging and biopsy methods to diagnose a tumor accurately. We appeal to PSA, prostate genomic markers, magnetic resonance for the kidneys, we use alphapetoprotein for testicular tumors. In other words, we appeal to markers, correlate them with other tests, and provide the patient with a risk response and then evaluate whether or not there is a need for biopsy. The future is represented by genomic tests and genomic treatments. And these will apply in many areas of medicine.

What is their role at present in establishing treatments?

Prof. Dr. Saadettin Eskicorapci: At this time, these investigations are still in their beginnings, there are some tests on the market and we use them to select patients for active monitoring and to select patients for biopsy. Sometimes, we can not tell whether or not there is a significant tumor. To select significant tumors in the prostate, we appeal to these tests. In bladder cancers, we use these tests to establish therapies, which may be surgery, chemotherapy or other treatments. And in the future, we will use them more and more.

How are uro-oncologic cancers currently treated?

Prof. Dr. Saadettin Eskicorapci: 80% of kidney cancers are recommended for surgery. In most cases of prostate cancer, in 60-70 percent of patients, the solution is surgery, and these patients no longer need other therapies. In cases of bladder cancer, if detected on time, in 60-70 percent of cases, only surgery is needed. In testicular cancers, patients will also need chemotherapy, but in some cases, testicular seminoma, patients will not do other therapies than surgery.

What type of urological tumors do you use the Da Vinci robot?

Prof. Dr. Saadettin Eskicorapci: We apply robotic surgery to all urological cancers. Cases of bladder and testicular cancer with abdominal lymph nodes are difficult, but I can operate them. But most of all I operate prostate and kidney cancers. Regarding the kidneys, in most cases, we can save them, this is also the purpose of interventions, of what I do. The most difficult cases come to me, we have a good team, we can solve the difficult problems and save the kidneys, even if oncologically they have to be removed. 10 years ago, we have been extirpating kidneys in most of the cases, but today, thanks to technology, we can save them. After surgery, the operated kidney can work almost as well as normal. We remove the tumors with 5 mm safety margins, and the kidney's chance to be functional is nearly 99 percent.

What are the differences between classical surgery and robotic surgery?

Prof. Dr. Saadettin Eskicorapci: I grew up with open surgery for 13 years, I did open surgery. Then I went to laparoscopy, and 7 years ago, I went to robotic surgery. Surgical methods are the same, I practically do the same thing for 22 years. But the technology is different. I'm a happy surgeon because it's easy to do surgery with robots. I have no problems, I do not have back pain after a laborious intervention. It is known that oncological operations are difficult. And patients are happy because the healing process is faster. Patients are recovering quickly, which is a very good thing. After open interventions, pain may take several days. With robotic interventions, pain is attenuated, recovery is faster, incisions are smaller, which is very important. In the case of open surgery, there are many large incisions that remain visible after years of surgery. And the patient will always remember cancer, in the shower, when he's dressing. In the case of robotic surgery, almost nothing can be seen.

What targeted therapies currently exist for urological cancers?

Prof. Dr. Saadettin Eskicorapci: For renal cancers, there is no chemotherapy, it does not work for kidney tumors. Instead, targeted therapies are used. But the most successful treatment is surgery. But in the case of renal metastases, we use targeted therapies. We have more and more therapeutic options for kidney disease and we are extremely pleased that life expectancy is increasing due to these. And for the treatment of bladder and prostate cancers, there are new therapies.

How important is the team approach to urological cancers?

Prof. Dr. Saadettin Eskicorapci: We have a good team at Atakent ACIBADEM University Hospital, and teamwork is the most important approach for oncology patients. In my academic speeches, I always emphasize the team importance. We have a uro-oncology team, consisting of a surgeon, an oncologist, a radiotherapist, a radiologist, nuclear medicine specialists, an anatomopathologist, a geneticist, a specialist in internal medicine, a psychologist, and nurses. We see together each Tuesday, we discuss the cases, especially the difficult ones. We have a very good team in the operating room, all interventions are based on teamwork, all cases are approached within the team.

How important is technology in surgery follow-up programs?

Prof. Dr. Saadettin Eskicorapci: I have been working in the field of uro-oncology for 22 years, and at the beginning I did not have access to methods like PET-CT scans, magnetic resonance-type. But we had to adapt to the conditions at the time. Now, we have many technologies, tumor markers, but the physician's experience is enormously important in the prcoess. She must know how to interpret the results of the tests and investigations correctly. PET scans can not do miracles, the specificity is 80 percent, the sensitivity is 90 percent, the same with the magnetic resonance and the PSA test. So, they have to be interpreted correctly and explained to the patient. Whenever something new occurs in the field, we adapt, we integrate the novelties into medical practice, but the doctor's experience is the key.

How important is the anatomopathologist's experience in the uro-oncological team?

Prof. Dr. Saadettin Eskicorapci: The importance of this specialist is crucial, and my colleague examines all the tumors at microscope. For the accuracy of the results, clinicians need to know how to interpret the result. This depends on choosing the best treatment to ensure a normal life for patients after surgery. My students teach them the concept of uro-oncology: if I were just a surgeon, I would be just a good technician. And if I didn’t work in a team with an anatomopathologist, for example, there would be a risk of removing the prostate gland without reason, with the possibility that the patient had no cancer at all.

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