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Dr. Jonathan Hwang 簡介:
                                               
Dr. Jonathan J. Hwang is a nationally recognized expert in using robotic surgery technique, which involves tiny incisions in the body
through which small robotic arms enter to manipulate and excise the prostate gland with utmost precision and delicacy – a sharp contrast
to the open surgery of yesterday. This significantly lessens blood loss and pain leading to a faster recovery without any of the major
complications of open surgery.
He has performed over four hundred robotic prostatectomy cases with excellent results using the da Vinci surgical system, manufactured
by Intuitive Surgical. He has also established robotic surgery programs at two major medical centers and has taught and proctored dozens
of other surgeons on how to use this new operative modality. He is one of the few urologic surgeons in the United States who has trained in
open, laparoscopic, and robotic techniques with a formal fellowship in urologic oncology (cancer specialty). He uses the newest da Vinci
model S module at Washington Hospital Center to perform robotic surgery.
Dr. Jonathan Hwang's Contact Info
2021 K St., NW, Suite 420, Washington, DC, 202 877-9460
jonathan.j.hwang@medstar.net
Prostate cancer:
Prostate cancer ranks as the number one cancer risk for American man over 50. Prostate cancer is a disease in which malignant (cancer)
cells form in the tissues of the prostate. The prostate is a grand in the male reproductive system located just below the bladder and in front
of the rectum. It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate
gland produces fluid that makes up part of the semen. Tests that examine the prostate and blood have been successfully used to detect and
diagnose prostate cancer. Available treatments include watchful waiting, surgery, radiation treatment and hormone therapy. Treatment options
are dependent on various prognostic factors including age, stage, cell type (histological) grade, and year of diagnosis.
 
One of the most effective treatments is the surgical removal of cancerous cells. The advent of robotic technology into the operating room
has breathed new life into the age-old field of surgery. This is especially true for prostate cancer surgery, which has jumped quantum leaps
in the past several years with robotic assistance – the newest form of minimally invasive surgery.
 
Summary of Dr Hwang 's Presentation
                     - Summarized by Edward Wan

What is the prostate gland and its function

The prostate is a gland in the male reproduction system located just below the bladder and in front of the rectum. It is about the size of a walnut and         surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that makes up part of the semen. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH).

What are the Symptoms of Prostate Cancers

      ·        Weak or interrupted flow of urine.
      ·        Frequent urination (especially at night).
      ·        Trouble urinating.
      ·        Pain or burning during urination.
      ·        Blood in the urine or semen.
      ·        A pain in the back, hips, or pelvis that doesn't go away.
      ·        Painful ejaculation

 Tests and procedures to diagnose prostate cancers

·        Digital rectal exam (DRE): An exam of the rectum.
·        Prostate-specific antigen (PSA) test: A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
·        Trans-rectal ultrasound: A procedure in which an ultrasound probe is inserted into the rectum to check the prostate.

 

Potential Causes and Prognosis of Prostate Cancers
·        High protein diets- high protein diets potentially cause high risk
·        Antioxidants such as tomato juice, Vitamin D etc. might be beneficial to prevent prostate cancers
·        Other supplements such as Vitamin E and Selenium have not proved to be effective to prevent prostate cancers
·        Age and health conditions are critical factors– less risk for men with age less than 50 and higher risk for men with age greater than 65 
·        Race is a factor - African Americans tend to have twice as much risk than the White Americans. Asian Americans have the lowest risk but with high intensity prostate cancer potential
·        Heretic definitely is a factor – men with high risk if one’s relative (like brother) over age 50 has prostate cancers
·        Prognosis depends on the Gleason score and the level of PSA – the level of Gleason score and PSA are directly proportional to the age groups

Available Prostate Cancers Treatments

Watchful waiting -watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is usually used in older men (over age 70) with other medical problems and early- stage disease.

Radiation therapy- radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Impotence and urinary problems may occur in men treated with radiation therapy.

 

Hormone therapy- hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones (androgens) can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.  

 

Surgery Options - One of the most effective treatments is the surgical removal of cancerous cells. Patients in good health are usually offered surgery as treatment for prostate cancer. Two types of radical prostatectomy. In a retropubic prostatectomy, the prostate is removed through an incision in the wall of the abdomen. In a perineal prostatectomy, the prostate is removed through an incision in the area between the scrotum and the anus. The most common surgical options consists of the following:

 

Open Surgery- in the old days, open surgery was the only available means to remove prostate and the success of operation was largely dependent on surgeon’s skill and knowledge. Since prostate gland and its associated nerve systems are deeply imbedded inside the abdomen, sometimes the surgeon’s hands are too large to maneuver to reach to the prostate gland.
 
Robotic Surgery – the advent of robotic surgery for prostatectomy in the US since 2003 has breathed new life into the age-old field of surgery. This is especially true for prostate cancer surgery, which has jumped quantum leaps (i.e. over 30,000 total surgeries performed in the US) in the past several years with robotic assistance – the newest form of minimally invasive surgery. The robotic surgery technique, which involves tiny incisions in the body through which small robotic arms enter to manipulate and excise the prostate gland with utmost precision and delicacy – a sharp contrast to the open surgery of yesterday. The robotic surgery basically eliminates the uncertainties associated with the surgeon’s hands. This also significantly lessens blood loss and pain leading to a faster recovery without any of the major complications of open surgery.

Dr Hwang has performed over seven hundred robotic prostatectomy cases with excellent results using the da Vinci surgical system, manufactured by Intuitive Surgical. Dr. Hwang commented that in order for a surgeon to be proficient in the robotic prostatectomy, the surgeon needs to perform close to 200 operations. He predicted that robotic prostatectomy would continue to grow and could replace the old-fashioned open surgery of prostactectomy in the future. The initial investment for the robotic equipments would be high compared to conventional surgical systems, but the life-cycle costs for the robotic surgery could be attractive when considering the entire surgical procedures and the overall shorter patient recovery time.

Cryo-Surgery- cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy. Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with cryosurgery.

 

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