Dr. Arnon Krongrad: Prostate Cancer
By Mimi Elliott
The 700 Club
FLORIDA'S SUPER DOCTOR
Dr. Arnon Krongrad was chosen as Florida's “Super Doctor” 2007, a designation given by peer physicians to fellow doctors who are best in their field. He's recognized for his pioneering efforts to detect and treat prostate cancer.
Dr. Krongrad has authored hundreds of articles and medical papers on prostate cancer during his years in this field. His work has been published in some of the most prestigious medical journals.
Dr. Krongrad is a pioneering urologist and co-developer of the laparoscopic radical prostatectomy, a minimally invasive prostate surgery. In 1999, he was the first surgeon to offer this procedure in the United States. This technique is associated with less pain, less bleeding and a quicker recovery period. Relying on modern technology, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment and a departure from what historically required the application of relatively primitive surgical techniques.
By 1999, Dr. Krongrad established The Krongrad Institute, a private program devoted exclusively to laparoscopic prostate surgery.
One in six men will be diagnosed with prostate cancer and many more will be diagnosed with prostatitis, a chronic infection that makes for painful inflammation of the prostate. In its earliest stages, the risk for prostate cancer may be suspected solely on the basis of levels of a protein called prostate specific antigen (PSA), which can be measured using a blood test. However, not all tumors produce enough PSA to become detectable.
Regardless of PSA test results, some prostate cancers can be detected early with a physical examination in which the doctor examines the prostate with a finger inserted into the rectum. This is called a digital rectal exam (DRE). There is increasingly good evidence that early detection, combined with treatment for appropriately selected patients, is associated with lower risk of death from prostate cancer.
Laparoscopic radical prostatectomy is not a new prostate cancer treatment. Rather, laparoscopic radical prostatectomy is a modern means of performing prostate cancer surgery, the oldest treatment for prostate cancer. The older radical prostatectomy involves the complete surgical excision of the prostate, seminal vesicles, tips of the sperm ducts, and, depending on oncological considerations, surrounding fat, nerves, pelvic lymph nodes, and blood vessels.
While both procedures require the entire removal of the prostate, laparoscopic radical prostatectomy and open radical prostatectomy differ in how they gain physical access to the deep pelvis. In contrast to open radical prostatectomy, the laparoscopic radical prostatectomy does not require an abdominal incision and relies instead on tiny entry sites, most of which are no longer than five millimeters.
Once removed by laparoscopic radical prostatectomy, prostates are examined by a pathologist. The inspection of the prostate is a more elaborate evaluation of the state of the prostate cancer than with the pre-surgical prostate biopsy. In the post-operative inspection, the pathologist looks for prostate cancer spread and then assigns the prostate cancer stage. He also assigns prostate cancer grade. In many cases, the post-operative pathology report sheds light where pre-operatively there was none. Because the pathologist has more prostate tissue at his disposal after surgery, he has much better samples from which to determine the grade; Gleason Score is the most common prostate cancer grading system. With the prostate fully in hand, the pathologist can better inspect cancer extension than from a core biopsy. He can better determine if the cancer has gone through the capsule or gotten into the adjacent seminal vesicles. If submitted, he can also examine the pelvic lymph nodes for signs of prostate cancer spread.
Less bleeding means a more stable patient in surgery. It means less need for transfusion and less risk of transfusion complications, such as allergic reactions and transfusion associated infections. It means less post-operative anemia, which means less fatigue. Less anemia also means less chance of serious cardiovascular complications. For many reasons, it is good to have little bleeding.
With laparoscopic prostate surgery in our hands, the typical blood loss is less than 100 milliliters. In contrast, open prostate cancer surgery is typically associated with a blood loss approaching one liter. Reductions in blood loss may reduce the chance of transfusion, intra-operative blood pressure fluctuations, and risks of post-operative complications such as heart attack.
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