PHILADELPHIA INTERNATIONAL MEDICINE® NEWS BUREAU
Contact: Leonard N. Karp
lkarp@philadelphiamedicine.com
215-735-3989
May 27, 2005

For immediate release:

In this month's issue:

1. Fox Chase Cancer Center Study Finds Prostate Cancer in 25 Percent of High-Risk Men with “Normal” PSA Levels
2. Jefferson Vascular Surgeons Go on Web to Demonstrate Less Invasive Treatment than Vein Stripping for Varicose Veins
3. PENN Researchers Use Completely Robotic Surgery to Dramatically Reduce Physical Trauma for Head and Neck Cancer Patients

Editors note: Research by Philadelphia International Medicine physicians may lead to new ways to treat some of our most challenging diseases. Below are some examples from our hospitals.

Fox Chase Cancer Center Study Finds Prostate Cancer in 25 Percent of High-Risk Men with “Normal” PSA Levels 

Philadelphia – Men at high risk of developing prostate cancer should undergo aggressive screening for the disease. That is the recommendation following a Fox Chase Cancer Center study of 520 men at high-risk of developing prostate cancer in which 25 percent were diagnosed with the disease despite having a low PSA. The findings were presented at the American Society of Clinical Oncology 41st Annual Meeting.

“This study demonstrates that we can find cancer earlier in high-risk men if we use more aggressive screening criteria,” said Andre Konski, MD, clinical director of the Prostate Cancer Risk Assessment Program at Fox Chase and lead investigator of the study. “Men at high risk of prostate cancer are more likely to develop the disease at a younger age. Catching the cancer early before it has spread is critical to curative treatment.”

The report detailed the results of a study involving the first 520 men enrolled in Fox Chase’s Prostate Cancer Risk Assessment Program between 1996 and 2004 (200 Caucasians, 315 African-Americans and five others). African-American men and men with a family history of prostate cancer who are between the ages of 35 and 69 are eligible to enroll in the Prostate Cancer Risk Assessment Program. Caucasian men testing positive for the BRAC1 gene are also eligible.

“Our study criteria dictated that men with an abnormal digital rectal exam and a PSA level between 2 and 4 would receive a biopsy,” explained Dr. Konski. “While an abnormal digital rectal exam could trigger a physician’s concern about the possible presence of cancer, the low PSA level would not usually raise suspicions. A PSA level between 2 and 4 would not warrant a biopsy according to traditional screening guidelines.”

Of the 520 men, a total of 75 men (44 African-American and 31 Caucasian) underwent 101 biopsies. The median age at biopsy was 56 (37 to 73). The median PSA at biopsy was 3.5 (0.4-53.6 ng/ml).

“We found prostate cancers in 45 percent of these men,” said Dr. Konski. “Twenty-six percent of these men had a Gleason score of seven or higher, indicating aggressive cancers. What’s more surprising is that 25 percent of the men who were diagnosed had a PSA of 2.5 or lower.” This PSA level falls below the new guidelines adopted last year by the National Comprehensive Cancer Network and the American Urological Association, suggesting biopsy when PSA levels exceed 2.5.

The Fox Chase study did not evaluate if earlier diagnosis of these men increased overall survival.

The Prostate Cancer Risk Assessment Program offers education, risk assessment, screening and an opportunity to participate in innovative prostate cancer research to men who are at an increased risk of the disease because of their family history or their race. This unique program is designed for men aged 35 to 69 who have increased risk of prostate cancer because of family history — a father, brother, or son with prostate cancer — or because they are African American, with or without a family history of prostate cancer.

Dr. Konski’s Fox Chase co-authors include radiation oncologist Steven J. Feigenberg, MD, assistant clinical director for the Prostate Cancer Risk Assessment Program; research nurse Amy Bower, RN, MSN, OCN.; data manager Susan Raysor; research biostatistician Debra Eisenberg; urologic surgical oncologist Robert G. Uzzo, M.D.; urologic surgical oncology chief Richard E. Greenberg, MD; radiation oncologist Eric M. Horwitz, MD; radiation oncology chairman Alan Pollack, MD, PhD; retired radiation oncology chairman Gerald E. Hanks, MD; and Prostate Cancer Risk Assessment Program director Deborah Watkins Bruner, PhD., along with pathologist Ila Mirchandani, MD, of Temple University’s Jeanes Hospital.

Jefferson Vascular Surgeons Go on Web to Demonstrate Less Invasive Treatment than Vein Stripping for Varicose Veins

Typically, painful and unattractive varicose veins are dealt with by removing the vein, better known as vein stripping. Stripping is a lengthy procedure often performed under general anesthesia and requires a surgeon to make incisions in the groin and below the knee and remove the vein with a long, surgical instrument extending inside the leg to the knee. The resulting postoperative convalescence can last two to four weeks and entail a significant amount of bruising, bleeding and postoperative pain.

But vascular surgeons at Thomas Jefferson University Hospital are offering patients a minimally invasive, less painful and shorter procedure for treating this problem and will demonstrate it on the Internet in a Webcast from Jefferson University Hospital.

The Webcast is scheduled for 4:30 p.m., Wednesday, June 22. For information on viewing the Webcast, please contact Lucia Rosenberg, director, Philadelphia International Medicine Institute of Education, lrosenberg@philadelphiamedicine.com , or 215-735-3269.

The procedure will be performed by R. Anthony Carabasi, III, MD, professor of Surgery, and director, Division of Vascular Surgery, Jefferson Medical College of Thomas Jefferson University.

Called the Closure system, the procedure uses radiofrequency energy to close the saphenous vein, a large vein that runs from the ankle to the groin. Problems with valves in this vein often contribute to the development of varicose veins.

“Unlike vein stripping, the Closure procedure is less invasive, requires no general anesthesia, takes approximately 45 minutes and allows most patients to leave the doctor’s office within two to three hours,” said Dr. Carabasi.

With the Closure system, instead of stripping the vein, the surgeon makes a single, small needle-size incision near the knee and inserts a slender catheter into the saphenous vein that delivers bipolar radiofrequency energy directly into the vein wall, explained Dr. Carabasi.

The catheter is then positioned near the groin, energized with a radiofrequency generator and slowly withdrawn, sealing the vein shut. The passage of heat through the vein wall as the catheter is withdrawn causes resistive heating, shrinking the vessel. The catheter’s flexible electrodes then cause the vessel to collapse around the catheter, thereby closing the vein and eliminating the backward flow of blood called venous reflux. Reflux contributes to the development of varicose veins when incompetent leg vein valves let blood flow down toward the feet instead of up to the heart.

“Studies have shown that patients receiving the Closure procedure exhibit less pain and bruising and return to normal activity and work significantly faster than those receiving vein stripping,” Dr. Carabasi noted.

Varicose veins may ache, and feet and ankles may swell toward day’s end, especially in hot weather. They can get sore and inflamed, causing redness of the skin around them. In some cases, patients may develop venous ulcerations.

Research indicates that more than two million workdays are lost annually in the United States and $1.4 billion is spent each year on this common medical condition.

A leading cause of this unattractive medical condition is “incompetent” valves in the large saphenous vein running from groin to ankle in each leg. When those valves deteriorate, blood flows backward instead of surging toward the heart. This places increasing amounts of pressure on vein walls, which stretches them, builds up fluid in the legs and causes other veins to deteriorate.

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases.

The Webcast is approved for AMA PRA Category 1 credit. Jefferson Medical College of Thomas Jefferson University, as a member of the Consortium for Academic Continuing Medical Education, is accredited by the ACCME to provide continuing medical education for physicians.

PENN Researchers Use Completely Robotic Surgery to Dramatically Reduce Physical Trauma for Head and Neck Cancer Patients

For patients with cancer of the mouth and throat, surgery is a frequent course of treatment, often leading to speech and swallowing dysfunction and external scarring. Researchers from the University of Pennsylvania School of Medicine’s Department of Otorhinolaryngology/Head and Neck Surgery, have completed two studies – the most comprehensive and largest to date – that demonstrate the effective use of the daVinci Surgical Robotic System to perform Trans-Oral Robotic Surgery (TORS) which greatly reduces surgical trauma for patients. Their initial findings, presented Monday, May 16th at 11:45 a.m., at the combined annual meetings of otorhinolaryngology (ear, nose and throat) experts – the Triologic Society, May 13th through16th, in Boca Raton, Florida.

PENN physicians anticipate that the application of the daVinci System to treat mouth and throat cancers will allow for complete tumor removal while helping to preserve voice and swallowing function. “The daVinci Robot has been FDA-approved and successfully integrated into cardiac and urologic surgery. Patients are reaping the benefits with decreased bleeding, less pain, and are able to return to work sooner,” said otorhinolaryngologist Neil G. Hockstein, MD, who served as lead investigator for both studies. “I saw the potential to apply the attributes of surgical robotics to the treatment of head and neck cancer and we’ve successfully devised novel approaches to introduce the robotic arms through the mouth into the throat and voice box.”

For head and neck tumors, treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure. Conventional cancer surgery can consist of an almost ear-to-ear incision across the throat or splitting the jaw in half. This can result in speech and swallowing deficits for patients. “The research we’ve done to date suggests that TORS has great potential to improve the way we treat head and neck cancer patients,” said Bert O’Malley, Jr., MD, Chair of PENN’s Department of Otorhinolaryngology/Head and Neck Surgery. “We believe this technology will have a dramatic impact on the ability to completely remove tumors while preserving speech, swallowing, and other key quality of life issues.”

In the first study, researchers used the daVinci Robot and “operated” on a mannequin. They found that, by applying simple instruments and retractors commonly used for tonsillectomy, the robotically controlled camera and instruments could be inserted through the mouth into the throat and voice box. The surgeons were able to manipulate different elements in the voice box with a high degree of dexterity that would be tremendously difficult using conventional instruments. They were also able to suture and tie knots deep in the mannequin’s throat with relative ease – a task exceptionally challenging without the aid of robotic technology.
In the second study, the surgeons performed a variety of surgical procedures on a human cadaver. They concluded that robotic surgery may shorten operating time and allow for minimally invasive treatment of more cancer patients.

The self-contained daVinci robotic system has three main components: a mechanical robot with three multi-jointed arms; a computer command center several feet from the patient, where the doctor sits, and a 3-D computer monitor similar to a “viewfinder” that affords a magnified view of the surgical site inside the patient. Equipped with a special, double-telescopic endoscope, the viewfinder allows surgeons to see the surgical site more closely than human vision allows, and to work at a smaller scale of detail than conventional surgery permits. Unlike other endoscopic systems now in use, which afford reverse-image views that require counter-intuitive movements by surgeons (whereby the surgeon must move his hand to the left in order to move the mechanical device to the right), the daVinci technology affords surgeons the direct, “intuitive” control they exercise in traditional open surgical procedures, seamlessly translating their natural hand, wrist and finger movements at the console into corresponding micro-movements of laparoscopic surgical instruments inside the patient’s body.

Additionally, the robot is computer controlled to eliminate any tremors and allow for steady, precise movements. “When operating with the daVinci System, the optics and fluidity of instrument movement are just amazing,” adds Dr. Hockstein. “It has the potential to add great precision to our surgical treatment of a variety of diseases of the head and neck.

Philadelphia International Medicine is an organization that provides medical and patient support services to international patients. It also provides continuing medical education and health care training and education to international physicians, administrators and other practitioners. As the international department of several Philadelphia-area hospitals, international patients gain access to physicians and hospitals rated among the best in the world through one telephone call to PIM. You can reach PIM by calling 1-215-735-3575; fax, 1-215-790-1267; or e-mail, physicians@philadelphiamedicine.com . You can find out more about PIM through its Website at www.philadelphiamedicine.com .