09th Oct 2018
“I mean- this is a huge difference!” Robotic surgery pioneer Dr. Mani Menon, Founding Director of the Vattikuti Urology Institute exclaims as he converses with Vattikuti Foundation CEO Dr. Mahendra Bhandari about the latest project he has undertaken: The Menon Precision Prostatectomy, or MPP. Drs. Menon and Bhandari were meeting to discuss future plans to develop the procedure, based on findings from the first patient results. Holding up an orange, which the innovative robotic surgeon uses as a model of a prostate gland, he explains the basis for the MPP:
“This is an orange. Think about it as if this was the prostate gland. An orange has fruit and a peel. Similarly, the prostate has flesh (the glands) and a peel (the capsule). Cancers of the prostate start in the flesh of the prostate, in the orange, if you will, and then will gradually extend out through the ‘peel,’ before they spread outside the prostate.”
Dr. Menon points to the exterior of the fruit: “The nerves that maintain erection, are scattered through the peel of the orange- or the capsule of the prostate. In any given patient, can we find an area of the peel that does not have cancer? And, if we were able to preserve it, would we be able to preserve more nerves, and would that result in better function? And the answer to this is: Yes, yes, and yes!”
Being in the room, one can feel the passion the acclaimed surgeon (there are dozens of awards scattered around his office) has for this ongoing research. Menon has never been one to rest on previous accomplishments- he is driven to make life better for prostate cancer patients, and feels that the best treatment for prostate cancer is to remove it. He tells the Vattikuti Foundation about the data results from his first MPP patients:
“I think it’s encouraging. We’ll need to measure this more carefully; we’d like to start a clinical trial, to see exactly what patients are candidates for this, and collect the data very robustly.”
The word ‘Precision’ in the procedure title refers to the exacting way that some of the ‘peel,’ or capsule of the prostate is left behind by the surgeon- along with a bundle of nerves critical to preserving erections far better than previous prostate procedures could: First, a 3-D biopsy is done, providing the team with the locations of suspected cancer tissue within the prostate gland. Menon explains further the advantage this new diagnostic tool has helped to provide:
“There is a 3-D biopsy machine that was just approved by the FDA about a year ago. We got that machine about 6-months ago, and we have a clinical trial for doing the 3-D biopsy, and seeing if it can allow us to map the cancer better.”
He once again demonstrates with his orange: “We’ve found that we can map the cancer better. In very selected patients, all you’re doing is preserving the peel, or the capsule of the prostate. We are not leaving all of the peel behind. Let’s say that the cancer is on the right side: On the right side we would remove the entire prostate, and on the left side, we would remove the entire prostate, but leave the peel.”
So far, leaving a small part of the prostate behind is yielding big results: “We are leaving behind just 4-to-5 millimeters of thickness, but preserving that- resulted in potency rates of 85-to-95% at one year!” By comparison, removing the entire prostate results in potency rates of 25-to-40% at one year. It is important to note that the 4-5 mm capsule is left behind only if no cancer is found on pre-operative 3-D biopsies. If cancer is found throughout the capsule, the patient receives the highly regarded Vattikuti Institute Prostatectomy.
Dr. Menon cautions us that there is one caveat: “The flip side of this is: ‘OK, you’ve increased potency, but in what percentage of patients are you missing cancer in the peel? How accurate is your biopsy of the peel?’ We don’t know the answer to that. Complete prostate mapping in men who have had total prostatectomy suggest that it will be around 5-to-10%, but it may be as low as 1%, if our 3-D biopsy is precise. This is why patients will have to be followed carefully for several years.”
Good research takes time.
The Vattikuti Foundation will let readers know about further developments with the Menon Precision Prostatectomy as news warrants. For more information, please visit Dr. Menon’s website: http://manimenon.com
Images / video stills: Dave Meinhard-VF