From Belleville News-Democrat, December 14, 2004 by Roger Schlueter

When Joe Boeving was diagnosed with prostate cancer last year, his treatment options seemed equally depressing.

The Belleville barber did not want to be laid up two months by conventional surgery, but he wanted no part of beam radiation, either. Still, he figured he was too young for the freezing technique known as cryotherapy and his particular case probably ruled out radioactive seed implants.

Then, something interesting happened. For years, he had heard his wife, Linda, a medical office worker, talk about minimally invasive laparoscopic surgery, now used for everything from gall bladder removal to colon surgery. Wouldn’t it be nice, he mused, if someone were using it for prostate cancer.

The words were hardly out of his mouth before his wife was scouring the Internet. She came up with only two hits, but one of them happened to be Barnes-Jewish Hospital in St. Louis, where in 2001 Dr. Gerald Andriole had become one of a handful of surgeons to pioneer the technique in the United States.

The discovery meant a world of difference for Boeving. Instead of a nasty 6- to 8-inch incision and weeks of slow recovery, he was back cutting hair in 14 days and bowling in a month with only five small nicks on his lower abdomen to show for it.

His catheter was gone in a week and his bladder control was back in six. Most important, he is, by every indication, cancer-free a year after his October 2003 operation.

"It was really a piece of cake," Boeving said. "It really was. I really have no problems. I’d recommend it to anyone who would be a candidate."

In the summer of 2003, Boeving, 58, was stunned to find himself a candidate. Thanks to his wife’s prodding, he had faithfully undergone yearly checkups for more than a decade, and his blood level of prostate-specific antigen (PSA) was still just 3.5, well under the often accepted cancer-alert level of 4.

But his urologist, Dr. Dennis Stanczyk of Belleville, thought a small stone in part of his prostate looked suspicious. As it turned out, the stone was just calcium, but the biopsy from the "healthy" part of his prostate turned out to be 14 percent cancerous.

"Dr. Stanczyk recommended surgery. He said, ''I wouldn’t wait,''" said Boeving, who was already taking medication for a bladder problem.

"So I figured I’m tired of taking these stupid pills anyway, so let’s get rid of the whole thing. And my wife didn’t really appreciate me saying I wasn’t going to do anything. I didn’t want to have to live with her looking at me stupid all the time."

Boeving, however, had heard enough medical war stories to dread what he was in for.

In conventional surgery, doctors cut from just below the navel all the way to the pubic bone. Patients must use a catheter for two or three weeks and are usually out of work for two months. Regaining bladder control can take weeks longer; if the nerves are spared, sexual function can take months or years to return.

Little wonder Boeving chose to go with Andriole, even though Barnes-Jewish was one of just five institutions in the country offering the procedure at the time. (The number is now up to about a dozen.)

"You really can’t quantify it, but, yeah, it’s better," said Andriole of the laparoscopic procedure. "How much better is what I cannot say, and I’m being kind of bluntly honest with you here. I’m not trying to trump this thing up to say, ''Gee, you’ve got to do it this way.''

"But, absolutely, the vast majority of men regain pad-free urinary control within four weeks. And, you can also say that the majority of men regain erections suitable for penetration within six to 12 months. That’s true."

Andriole has had his eye on the procedure ever since watching a French surgeon show it off at an international meeting on prostate surgery about four years ago.

"It looked very interesting, but it wasn’t ready for prime time yet," said Andriole, who heads the division of urologic surgery at Washington University. "But I kind of followed him along. I had him visit me two times here and I visited him another time in France. So it was I got my training to do this."

The surgery is done through an inch-long incision just below the navel and four smaller punctures on the abdomen. Surgeons use the smaller holes to insert their surgical instruments before removing the cancerous prostate, encased in a small, plastic bag, through the larger opening. They view their movements on a TV monitor.

Besides a shorter recovery time, the new procedure also usually means little or no pain for the patient. Hospital stays are generally cut from three or four days to one or two.

Other advantages might surprise you. To help doctors better find their way and work their instruments, the abdomen is puffed up with carbon dioxide. As a side benefit, the pressure of this gas cuts bleeding dramatically during the procedure, virtually eliminating the need for transfusions.

And, while it might seem counterintuitive, using the smaller incisions actually enhances accuracy, Andriole said. Guided by a tiny camera that can magnify objects 12 times, doctors can better avoid damaging the nerves and muscles that affect bladder control and sexual function.

As it turned out, Boeving was a textbook case. He remembers no pain after surgery and was walking around his yard even with his catheter still in. A week later, he was already walking two miles.

"I would just push it to the point where I noticed I felt something," he said. "That’s when I’d go, ''Hmmm, guess I’d better quit.''

The immediate problem was rebuilding his bladder control.

"You’ve got to kind of start over," he said. "There’s a muscle that kind of disappears when the prostate is gone. But there’s another one above it that usually doesn’t get exercised that much. That’s the one that has to take over, so you’ve got to build that one up."

Still, by following his daily Kegel exercise regimen, Boeving was finished with his Depends in a month and stopped using smaller pads a couple of weeks later.

"After that it was all over," he said. "I didn’t have any problem after that. So I was quite fortunate. I didn’t really like those things."

As for men’s other major worry -- the preservation of sexual function -- Boeving gives an answer that would make "Seinfeld’s" George Costanza proud.

"My nerve is starting to work its way up," he said. "(Dr. Andriole) said sometimes it takes almost two years for that nerve to work all the way back up. I see signs of it moving now. I’m not 18 again, but I see signs of it moving."

Even more important, Andriole said, the procedure’s cancer control rate is "unquestionably" as good as the standard procedure. That’s why Andriole suggests that any man who is a candidate for a standard prostatectomy at least investigate the possibility of having the laparoscopic procedure performed.

"If every cancer cell is in the prostate and we take out the prostate and the lymph nodes and there’s no spread anywhere, that guy wakes up a cured man."