Laser may reduce prostate surgery’s sexual side effects

One of the challenges of prostate cancer surgery is removing the cancer-affected gland without side effects. The procedure is estimated to cause long-term sexual dysfunction in half of men.

Now, new published research by urologic surgeons at Columbia University Medical Center/NewYork-Presbyterian Hospital presents evidence that a new laser technology used with robotic prostate cancer surgery may reduce the risk of damaging the crucial nerves necessary for erections and urinary continence.

Published in the July online issue of the Journal of Endourology, the pilot study is the first to evaluate the CO₂ laser for prostate cancer. The research was also presented recently at the American Urological Association annual meeting in San Francisco.

"The precision of movement available through robotic surgery is already helping reduce the risk of sexual side effects, and the early evidence is that CO₂ lasers will help us be even more accurate – especially when preserving the sensitive nerve areas necessary for sexual function and urinary continence," says Dr Ketan Badani, director of robotic urologic surgery at Columbia University Medical Center/NewYork-Presbyterian Hospital and assistant professor of urology at Columbia University College of Physicians and Surgeons.

CO₂ lasers are widely used to treat cancer in the head and neck. A new, flexible, fibre-based delivery system is now making the treatment approach possible with robotic prostate cancer surgery.

In the procedure, Dr Badani uses the robotic instrumentation to remove the patient’s prostate. This process is aided by the laser, which is used to dissect the plane between the nerves and the prostate, freeing the nerves and preserving them.

"Traditionally, we cut, clip or cauterise the tissue around the prostate nerves. However, these techniques can cause irreversible damage due to traction or heat injury," explains Dr Badani. "The CO₂ laser may reduce this risk because it is low-heat and doesn’t require much manipulation of the nerves."

The new study describes the use of the laser in 10 cases. It reports that the technology is easy to manipulate and very accurate. Patients experienced a return of urinary continence better than the norm, something the researchers found "extremely encouraging". Future research will determine if the technology can improve outcomes with regard to the ability of men to sustain an erection, and its long-term ability to prevent cancer recurrence.

The laser technology, known as BeamPath, was provided by OmniGuide of Cambridge, Mass. OmniGuide BeamPath CO₂ laser fibres are cleared for use by the FDA across a variety of open, endoscopic and laparoscopic soft-tissue cutting applications, including urology.

The paper’s first author is Dr Philippa J. Cheetham, postdoctoral fellow at Columbia University Medical Center. Co-authors include Dr Jaime M. Landman, associate professor of urology at Columbia University College of Physicians and Surgeons and a urologist at NewYork-Presbyterian/Columbia; Matthew D. Truesdale, a medical student at Columbia University College of Physicians and Surgeons; and Daniel J. Lee, postdoctoral fellow at Columbia University Medical Center.

According to the American Cancer Society, prostate cancer is the second most common type of cancer found in American men, and the second leading cause of cancer death in men. In 2009, it is estimated that there were 192,280 new cases of prostate cancer and 27,360 deaths from prostate cancer in the United States alone.

(Source: Columbia University Medical Center: Journal of Endourology)