Textbook of
Robotic Urologic
Surgery.



Release Date:
January, 2007

Michael Esposito,
Vincent Lanteri
&
Jeffrey Stock

06/17/07 - Posted from the Daily Record newsroom

Band of brothers battling prostate cancer together

Florham Pk. siblings all were diagnosed with disease in 2005

BY VIDYA PADMANABHAN
DAILY RECORD
FLORHAM PARK -- The Danishek brothers always have been close.

They are close in age -- Jim and Jerry, 60, are identical twins, and Bruce is only two years older. They grew up in Florham Park, all still live in the borough, and they run a business, Florham Park Liquors, together. They lost both parents by the time they were teenagers, which brought them even closer.

Two years ago, the degree to which their lives intertwined became scarily apparent.

All three men were diagnosed with prostate cancer in 2005.

"That was pretty uncommon," said Dr. Vincent Lanteri, who treated two of the brothers. Prostate cancer tends to run in families, but he had never come across any other set of three family members who had been diagnosed with it at about the same time, he said.

After the initial shock, the Danishek brothers were thrust into the difficult task of considering various treatment options and trying to choose the right one. The fact that their father had died young of cancer also was in the back of their minds.

By the end of the year, all three brothers had emerged from the scare shaken, but cancer-free.

Not all men diagnosed with the disease are as fortunate. According to the Prostate Cancer Foundation, a new case is diagnosed every 2.5 minutes in the United States, and a man dies from prostate cancer every 19 minutes.

Fortunately, about 90 percent of all prostate cancer cases are detected in the localized and regional stages. Consequently, the cure rate for prostate cancer is very high, the Prostate Cancer Foundation says.

Still, the statistics are alarming. Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men, the foundation says. It estimates that more than 2 million American men currently are living with prostate cancer.

In the case of the Danishek brothers, Jerry was diagnosed first, and the diagnosis was unexpected.

All lean men with bright blue eyes, the Danishek brothers bustled about their large store, which their father had started in 1956, and took turns minding the cash register on a recent afternoon as they recalled the tumultuous events of 2005.

Jerry had been feeling fine when a routine physical exam in April 2005 revealed worrying levels of the protein PSA, which when found in the blood at high levels could indicate prostate cancer, he recalled as he propped his foot on a crate of wine bottles.

A PSA count of 4 or less is considered normal, according to the Prostate Cancer Foundation. Jerry had a count of 5.5.

His urologist did a biopsy, which came back positive. His wife, Ann, who knew doctors at the Johns Hopkins Hospital in Baltimore, persuaded him to go there. After getting a second opinion, the diagnosis was the same.

While they were worried about their brother, Jim and Bruce also began to think about their own health.

"When Jerry got diagnosed first, it really put him back on his heels," Bruce said. "For us, it was just a matter of when."

Jim's doctor told him that, as Jerry's "genetic clone," he should get tested. So he did. And Jim's biopsy confirmed his doctor's fears.

"When Jimmy tested positive, my wife started to get nervous and twitchy," Bruce said.

So he got tested, and scored a PSA of 2. That should not have indicated a problem and the doctors weren't worried, but they did a biopsy nonetheless, as most doctors will do any time a PSA is greater than 1. The biopsy turned out to show that not only did Bruce also have prostate cancer, but that it was likely to spread more quickly than Jim's.

"I was concerned," Bruce said. "But a couple of doctors assured me that it was curable if you catch it early."

The doctors tried to take the edge off the fear, but the thought of two acquaintances who had died of prostate cancer weighed on him. The men had not wanted to undergo prostatectomy, or prostate gland removal, which was the course of treatment recommended for all three brothers, Bruce said.

"I guess men have a fear of this type of surgery," he said.

Jerry's doctor at Johns Hopkins had recommended that he have a conventional prostatectomy. Doctors performed the surgery on Jerry in June 2005.

"He lost a lot of blood -- he looked pretty weak," Jim said. He added that Jerry had to wear a catheter for two weeks and had to wait for his incision to heal.

"After that, there was no question what I was going to do," Jim said.

Jim and Bruce had been debating the merits of traditional and robotic surgery and decided to try the robotic method.

Although it had been approved by the federal Food and Drug Administration four years earlier, robotic surgery still was a relatively revolutionary procedure in mid-2005, said Dr. Michael Esposito of the New Jersey Center for Prostate Cancer and Urology in Hackensack. The procedure was non-invasive, required patients to wear catheters for shorter periods, had a lower impact on continence and sexual function and allowed them to leave the hospital after just a day, he said.

For doctors, the control and precision offered by robotic surgery was unparalleled, Esposito said.

"It's like the difference between chopsticks and eating with fingers," he said.

Bruce had the robotic surgery in August; Jim had it two months later. They spent less time in the hospital and had a quicker recovery period than Jerry.

All three brothers continue to have frequent follow-up tests, and their PSA counts have remained under control, they said.

"The key is early diagnosis," Jim said. "You have a very good chance of beating it if you do something right away."

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