On a recent Saturday, I walked through the OC Fairgrounds looking at the
3,500 or so classic cars featured at the 14th annual Cruisin' for a Cure.
The event raised awareness for prostate cancer, and that's where I
ran into Beverly Hills attorney Mark Eskander.
His classic 1957 Continental Mark II displayed a sign in the windshield
saying, “Thank You Dr. Jeff Yoshida.”
Eskander, 63, says he wouldn't be at this car show – or anywhere
for that matter – if it weren't for Yoshida.
“He saved my life,” he told me.
About five years ago, after a routine prostate cancer screening, Eskander's
Los Angeles urologist informed him that his resulting test numbers had
risen from the previous years.
Eskander says his PSA test numbers started at 3.3 and had risen steadily
over the years, 3.6, 3.7, 3.9, until they hit 4.1.
His doctor told him not to worry and wanted to wait a year and re-test him.
Eskander insisted on a biopsy instead.
He was glad he pressed the issue. The biopsy confirmed he had prostate cancer.
Weighing his treatment options with doctors in Los Angeles at the City
of Hope and Cedars-Sinai, Eskander opted for the da Vinci robotic surgery
in 2009 with Yoshida at Hoag Hospital.
The two men became friends after the surgery.
As we talked at the car show, the conversation turned to a recent article
in the Orange County Register that questioned the safety of the da Vinci
surgery, and the UCI doctors who've helped promote the technology.
It said federal regulators were looking into an increase in injury and
death reports involving da Vinci surgeries, which resulted in dozens of
“At least 71 people have died since 2000, according to a recent
study. The reports include severe burns to internal tissue, pierced arteries
and organs, and internal bleeding that is not discovered for days,”
the article stated.
But is the problem with the technology or the operators?
Yoshida, program director of urologic oncology at Hoag Family Cancer Institute,
wouldn't comment on surgeons' training, but does defend the benefits
of da Vinci.
Men facing prostate cancer shouldn't discount this technology, he said.
Practicing since 1996, Yoshida was one of the first surgeons to complete
a fellowship in urologic oncology with an emphasis on robotic surgery
at the City of Hope.
Since 2003, he's performed an estimated 1,700 surgeries using the
da Vinci and said has never had a death or injury as a result of the surgery.
He says the robot has been an asset for prostate cancer treatment since
its introduction in the early 2000's and continues to be improved.
“We are now utilizing the third-generation robot (da Vinci Si),
which has the best optics and ergonomics,” he said.
The procedure called RALP – robot-assisted laparoscopic radical
prostatectomy – has also been improved over the last decade with
better nerve-sparing, so men can still enjoy sex and avoid incontinency,
and reconstructive techniques, he said.
The biggest advantage of the robotic approach is accelerated patient recovery
and fewer complications compared with traditional surgery or what he calls
the “open” approach.
Who are the best candidates for robotic surgery?
“Men who have aggressive forms of prostate cancer who are healthy
and have not had any significant prior abdominal surgery,” he said.
As we stood by Eskander's Mark II, men lined up for free prostate
screening exams at the mobile unit across from us.
Yoshida said early detection is key to surviving prostate cancer, and
stressed the importance of yearly screenings.
“Since we started using the PSA test in the late 1980s, the prostate
cancer mortality rate has decreased over 40 percent,” he said.
But the Register article stated that experts now warn men “not to
have the prostate-specific antigen, or PSA, test, which has been found
to lead to unneeded surgeries.
“Underlying those warnings is the fact that most prostate cancer
grows so slowly that it poses no lethal threat. In 2011, a federal task
force recommended that healthy men no longer take the blood test,” it said.
Yoshida takes exception to this, likening prostate cancer to the many
different varieties of snakes. Some are harmless while others are downright deadly.
Prostate cancer should be viewed similarly, he said.
He warned that prostate cancers are not the same from man to man, and
there is a misconception that the disease is a relatively sluggish cancer
and far from deadly.
“In reality, there is a spectrum of prostate cancers that range
from indolent to very lethal,” he said.
There are obviously differences of opinions when it comes to treating
and diagnosing prostate cancer, as the Register article pointed out.
But Eskander believes he wouldn't be here today if he'd listen
to the so-called experts and not taken matters into his own hands.