Be physicians, not just technicians

Dr. Slawin has dedicated his career to the improvement in care for men with prostate cancer and has been involved from the inception with many of the technological innovations that we now take for granted as standard of care.  Dr. Slawin’s focus on this disease has led him to be an early adopter of technologies that he feels will make a difference for his patients.  For example, Dr. Slawin, identified the potential value of percent free PSA in the early 1990’s and was one of only six investigators who performed the pivotal trial leading to FDA approval of percent free PSA in 1998.  In 2001, he discovered novel molecular forms of free PSA in his laboratory, that could differentiate men who have prostate cancer from those with BPH, and is now one of eight investigators worldwide conducting a pivotal trial of one of these forms, -2 pro PSA, to improve our ability to screen men for prostate cancer.  He was the first urologist in Houston to perform laser prostatectomy in 1994, to perform the TUNA procedure for BPH in Houston, and was one of only a handful of urologists in the nation who experimented with radiofrequency ablation of prostate cancer as well.  Throughout these periods, Dr. Slawin always maintained his focus on the disease, not the technology, which has proven to come and go as advancements in science and engineering have given us new and better tools to fight this disease.Important information:
 Learning Curve Accrues More Slowly for Laparoscopic Prostatectomy
Article from Lancet Oncology April, 2009

In 2000, after traveling to Paris, France, to observe surgeons performing laparoscopic prostatectomy in patients with prostate cancer, Dr. Slawin recognized the value of such an approach to the surgical removal of the cancerous prostate cancer in minimizing the side effects of prostatectomy, but it was not until 2001, after training on the da Vinci Robotic Surgical System in Galveston, TX for several months, did he perform the first Robotic Prostatectomy in Houston, TX, after having performed over 1000 open radical retropubic prostatectomies, which gave him valuable insight into how to apply this new technology to improve outcomes for patients while maintaining the high rates of cancer control achieved by open radical retropubic prostatectomy.

Dr. Slawin’s experience with robotic prostatectomy now numbers over 750 cases, and an analysis of outcomes clearly shows that cancer control rates have been maintained at high levels, with reduction of postoperative pain, and improvements in the time to recovery of both continence and potency.  After robotic prostatectomy, which can be performed without the requirement for epidural anesthesia, patients are walking and eating on the evening of the day of surgery, and are routinely discharged the next morning, after breakfast. The urinary catheter is removed after one week, and many patients return to work shortly thereafter.

After performing thousands of radical prostatectomies, either open or robotically, Dr. Slawin is now able to routinely achieve excellent long-term results with respect to cancer control, potency and continence recovery.  It is clear now from several studies published in the best medical journals that successful outcomes after prostate cancer surgery are directly related to the skill of the surgeon, including the specific techniques utilized and the volume of cases performed yearly by that surgeon. There is nothing magical about robotic prostatectomy, and our data suggests that these principals still hold valid. Prostate cancer surgeons who have demonstrated excellent cancer control and quality of life outcomes in their patients can use the da Vinci robot system to translate these excellent results into their patients operated using this minimally invasive technology. This is likely because each individual case requires the surgeon to make hundreds of decisions throughout the case about how close his dissection can get to the prostate without accidentally leaving microscopic bits of cancer behind.  Thus each case reflects the delicate balance between achieving high potency rates after surgery that are maximized when the surgeon meticulously “hugs” the prostate as he carefully peals away the erectile nerves from the prostate and the caution of staying far enough away to avoid leaving cancer behind.  Thus, the da Vinci system will not automatically improve the outcomes of less experienced surgeons who have not yet gained the breadth of experience treating men with prostate cancer over decades.  Prostate cancer patients undergoing surgery cannot be viewed as an assembly line of identical cases awaiting a standardized, identical approach, for every case.  Thus, it is always prudent for any patient to explore the experience and specific outcomes achieved by his specific surgeon.