New tests and tools are enabling Jupiter Medical Center urologists and urologic oncologists to detect and remove genitourinary—genital and urinary—cancers faster, with more precision and better outcomes.
“We’re dedicated to offering the latest and greatest devices,” says Dr. Patrick Tenbrink, medical director at the JMC Barb and Joe Charles Center for Urology, specializing in urology and urologic cancers.
With next-generation instruments, doctors can identify, isolate, and remove cancer cells sooner via minimally invasive treatments, with less damage to surrounding tissues, fewer side effects, and shorter hospital stays and recovery. Largely unavailable even five years ago, the state-of-the-art tools also can lower the risk of cancer recurrence, erectile dysfunction, incontinence, and the loss of an entire organ, such as the bladder, prostate, or kidney.
“We’re always looking for what’s coming to offer patients the best technology—and better patient outcomes,” says Dr. Adam Nolte, minimally invasive urologic surgeon at Jupiter Medical Center Physician Group. “The best equipment enables surgeons to provide the best care.”
Catching prostate cancer has gone far beyond the standard and widely used prostate-specific antigen (PSA) blood test.
Prostate MRIs use 3 Tesla (3T) magnetic resonance imaging with double the resolution of standard MRIs. The higher-field machines create far more detailed visuals of the body’s soft tissues.
Screening and detecting prostate cancer has significantly advanced in recent years. While PSA testing remains essential to the diagnostic process, JMC urologic radiologists and surgeons now also add imaging, genetic assessments, and other biomarker blood tests. These help assess a patient’s risk of aggressive disease so oncologists can provide a personalized and optimal treatment plan, Nolte explains.
A new technique revolutionizes biopsies. Fusion biopsies start with patients having an MRI that can highlight cancerous cells. Then an ultrasound probe is inserted into the prostate. The MRI image is superimposed on the ultrasound image, enabling physicians to insert biopsy needles precisely in suspicious areas, reducing the risk of false negatives. “Such targeted biopsies increase the successful diagnostic rate of biopsies,” Nolte says.
With early detection, men can be cured before the onset of metastatic disease, which may spare the need for systemic treatments such as androgen deprivation therapy (ADT). That process blocks male hormone receptors throughout the body to starve aggressive or metastatic cancer. Though ADT can prolong survival, it also may cause undesirable side effects such as a decreased sex drive, erectile dysfunction, weight gain, fatigue, and loss of bone and muscle mass. “If cancer is detected early,” Nolte says, “doctors can prevent the need for such treatments in the future.”
Intuitive’s da Vinci 5 robotic system—approved by the Food and Drug Administration (FDA) in March 2024—earns its name because it’s an engineering feat leading medicine into the future.
The da Vinci has robotic arms that can move in more directions than a surgeon’s hands, and a console screen magnifies the view and in 3D.
Only a few hospitals nationwide offer the advanced capabilities of the da Vinci 5, used for partial or full removal of the prostate due to cancer. Even fewer hospitals have experts such as Nolte, who also specializes in robotic partial kidney removals. “If tumors are small and in a favorable location, we can remove them and spare the kidney,” he says. The more renal parenchyma that is preserved, the better it can succeed in its daily filtration of waste, which can potentially prevent the need for dialysis in the future.
“The robot allows for fine dissection and a magnified field,” Nolte says. “When you’re removing tumors, you’re trying to get into tissue between the tumor and the kidney itself, to spare as much of it as possible while having a negative margin on the tumor. The robot allows more precision, decreasing pain, bleeding and hospital stays.”
Also used for enlarged prostates, the da Vinci provides far better outcomes, Nolte says. Replacing standard surgery’s major incisions, it enables everything to be done through very small incisions, so post-op pain and recovery are improved.
The da Vinci 5 also gives surgeons tactile feedback on inflation pressure in the abdomen, “whereas the prior generation had purely visual feedback,” Nolte says. FDA-approved in 2001, each iteration of the da Vinci robotic console has improved on its predecessor.
As before, the surgeon sits at a console and controls the robot’s arms and instruments with highly precise movements. But now, for the first time, surgeons can sense the force they’re exerting while operating robotically. “If you’re suturing and dissecting tissue, you need an idea of the tension and amount of force you’re using,” Nolte says. “Previously we relied on watching console screens to see how much a tissue or suture was pulling.”
Tenbrink notes “tactile feedback allows surgeons to get all the cancer while sparing trauma to nerves that are a big part of safeguarding erections. Surgeons have the same sensation as if operating with their hands but with fewer complications.”
This also cuts the risk of incontinence after a prostatectomy, he says.
Nolte says the new da Vinci system also is ergonomic. “It’s more comfortable for physicians to use, so they can be more focused on the surgery itself.”
The earliest da Vinci surgery was performed in 2005. In the two decades since, creator Intuitive Surgical, Inc. has provided the multi-armed robotic console to medical TV shows, including “Private Practice” and “Grey’s Anatomy.”
After an MRI-guided fusion biopsy targets cancerous cells with precision, surgeons can remove tumors without removing surrounding tissue using focal ablation or NanoKnife treatment, says Tenbrink.
The NanoKnife is a minimally invasive procedure using electrical pulses to destroy prostate cancer cells. It’s a type of irreversible electroporation (IRE) focal therapy, already used for pancreatic and biliary cancer at JMC.
During this procedure, thin needles are inserted into the prostate under ultrasound or MRI guidance. Electrical pulses are delivered to the needles, creating nano-sized pores in the membranes of the cancer cells. “You use low amounts of electricity to kill the cancer cells, because with minimal electricity you have minimal issues with ejaculation or incontinence concerns,” Tenbrink says.
The procedure disrupts cancer cells’ ability to function and causes them to die. Following the minimally invasive outpatient procedure, the treated area is left to heal naturally.
A forceful water jet can eradicate excess tissue of noncancerous but enlarged prostates—also known as benign prostatic hyperplasia.
The surgeon uses ultrasound imaging and a robotically guided camera to direct the cold stream precisely where needed to destroy and remove excess tissue without harm to the urinary tract and surrounding vessels and nerves.
It replaces transurethral resection of the prostate, which involves inserting a tube through the urethra and into the prostate where unneeded tissue is removed via electrocautery.
Aquablation uses no cuts and no heat. Once surgical swelling goes down, erections can return, and urination no longer is a problem.
Developed in 2017, aquablation for large but benign prostates joins the robotic procedures that are transforming today’s treatments.
Bladder tumors have become easier to spot and biopsy via blue light cystoscopy. Urologists inject an imaging dye called Cysview an hour before threading a thin, flexible tube through the urethra (urinary tract) to the bladder, Tenbrink says. The dye converted into a photoactive solution causes cancer cells to glow bold pink under UV light, while healthy tissue is blue. This makes it easier for surgeons to biopsy cells.
Nolte is excited about JMC’s consistent drive to deliver the best devices urologic surgeons need—and as soon as they’re available. “We hope to continue bringing in new and innovative technologies as we grow the program,” he says.