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Our philosophy on prostate cancer care: sophisticated planning, teamwork and technology

By Eugene Lee, MD, urologic oncologist

lee-eugene-BWP000HHOne-size-fits-all may suffice when selecting a hat or scarf, but nothing could be further from accurate when designing a care plan to effectively combat prostate cancer. At The University of Kansas Hospital, we assess every patient like the individual he is. We are committed to patient-centered care using the leading innovations in treatment and technology.

The American Cancer Society estimates that 238,590 new cases of prostate cancer were diagnosed in 2013, and about 29,720 men will die of the disease this year. Though prostate cancer is second only to lung cancer as the leading cause of cancer death in American men, treatment opportunities abound, as evidenced by the more than 2.5 million men once diagnosed with prostate cancer who are still living today.

We believe this accomplishment is in part attributable to those who take a unique approach to caring for unique patients, as we do. In potentially complex cancer care, no two cases are identical. Risk factors are unique from patient to patient, as are patient interests in balancing cancer control measures against current and future quality-of-life goals.

We embrace and practice a multimodal approach toward care planning, including chemotherapy, radiation, hormone deprivation therapy and surgery as needed. Our multispecialty board convenes regularly to discuss our steadily growing experience in prostate cancer treatment. Discussions occur at the individual patient level and help ensure our professionals consistently collaborate to share knowledge and create aggressive, tailored treatment plans to attack cancer from all possible angles. We constantly review a tremendous body of literature to study outcomes and leverage the findings – advances in basic science, clinical research and clinical trials – to review and revise our approach in keeping with evidence.

It is an environment of cooperation and continuous improvement with all evaluation and changes implemented to make a direct positive impact on patient care.

To screen or not to screen?

In 2012, the U.S. Preventive Services Task Force recommended against use of the previously routine PSA (prostate-specific antigen) screen to detect prostate cancer in asymptomatic men. Yet the American Urological Association today maintains its belief that proactive screening saves lives.

How can physicians process the controversy among reputable organizations for the benefit of their patients’ good health? It may not be possible to neatly resolve the debate, but these clarifying points can help physicians determine whether and when to recommend the PSA screen. 

Current industry dissent is specific to asymptomatic, low-risk men. This does not apply to men with any symptoms consistent with greater potential for prostate cancer or with high-risk factors.

Organizations that recommend PSA screening suggest that the decision to screen should be an informed decision made by individual patients based upon communication with their doctor detailing the test’s potential harms and benefits.

Recent research sought to answer the specific question, “Do routine PSAs in asymptomatic men reduce deaths from prostate cancer?” Several recent clinical studies (PLCO; ERSP1) estimated the following for every 1,000 men ages 55-69 who are screened every 1-4 years for a decade: 0-1 deaths from prostate cancer would be avoided; 100-120 men would have a false-positive test result that would lead to a biopsy; about 1/3 of men receiving the biopsy would experience moderately bothersome symptoms from the biopsy; and 110 men would be diagnosed with prostate cancer, 50 of whom would experience a significant side effect of treatment, such as erectile dysfunction or urinary incontinence. Thus, the PSA screen has shown the potential to offer benefits as well as inconveniences or harms and should be utilized thoughtfully rather than universally.

With these findings in mind, the AUA agrees that screening as a routine measure is not recommended for all men. However, it is still believed that early detection, including PSA screening, plays a crucial role in reducing prostate cancer mortality. As PSA screening can result in harms, such as overdiagnosis and overtreatment, it must become a more targeted measure promoted for those most likely to benefit from the test.

Urologists at The University of Kansas Hospital align with the AUA and respect its guidelines, created by the leading experts leveraging research and experience unique to our field. We counsel that men ages 55-69 who are in good health and have a life expectancy of 10-15 or more years should have the opportunity to make an informed decision to be tested and should come to that decision with a knowledgeable and thoughtful physician.

Armed with current information and with the guidance of qualified medical professionals in tune with a patient’s unique attributes, men should understand the beneficial role PSA screening can still play.

Sources

  • forbes.com/sites/stevensalzberg/2013/11/11/great-news-for-guys-no-more-invasive-prostate-exams/
  • cancer.gov/cancertopics/factsheet/Detection/PSA


The right resources

Prostate cancer care journeys are unique to the individuals facing them. They may, for example, include the use of magnetic resonance imaging. This technology can be helpful for patients undergoing active surveillance to ensure appropriate patient selection. It can also play a role in preradiation and presurgical planning to ensure adequate margins of therapy. From a surgical perspective, MRI can assist care providers in identifying areas of potential capsular penetration as well as possible seminal vesicle invasion. This allows clinicians to plan for the necessary margins of resection to adequately combat the cancer.

When the road to prostate cancer recovery does incorporate surgery, community physicians can direct their patients to the hospital with great confidence. For many reasons, our program is a leader in relentlessly pursuing – and attaining – the best possible outcome for every patient who enters our doors.

First, our program offers our patients access to five urologic surgeons who are fellowship-trained urologic oncologists. All can effectively utilize the robotic technologies that are today’s gold standard in prostate cancer surgery instruments. Our facility has several state-of-the-art da Vinci Surgical Systems at the ready for patient treatment. The prevalence of the industry’s best technologies combined with the most highly trained healthcare professionals offering deep proficiency in using them ensures that our surgical patients receive leading-edge, expedient treatment.

Second, the robotic technologies we use in the majority of our surgical cases help pave the way not only for swift recoveries, but for the fullest ongoing quality of life post-procedure. This minimally invasive surgical technique allows optical magnifying scopes to be inserted through very small incisions.

Patients undergoing such treatment experience greatly reduced blood loss as compared to traditional open surgeries and are generally able to resume normal activity more rapidly.

From the surgeon’s perspective, robotic surgery enables greater visualization – an enhanced, high-definition, three-dimensional view – of the operative field. This promotes unprecedented precision and control, critical to the effort to preserve nerve bundles, such as those that control continence and sexual function. This has a direct impact on the big picture view we emphasize: Many men unsurprisingly value ongoing quality of life as much as they do cancer control, while some value it even more highly. Armed with the latest in sophisticated, minimally invasive robotic surgical tools, our urologic oncology team can simultaneously deliver equal attention to both ideals.

Next, we recognize that cancer care is a journey, not a single event. We ensure our patients experience care and service excellence that extends from beginning to end of the complete care process. From the hospital’s administrators to our surgical technicians and nursing staff, we all share the same goal: to provide devoted attention and superior commitment to maximize the patient’s comfort and strive toward the optimal outcome. The complete team of healthcare professionals is dedicated to creating the best possible experience for our patients from start to finish.

Finally, as an academic medical center, our organization offers a dimension of observation and care above and beyond that which nonteaching facilities provide. The residents in training offer patients an advantage while in pursuit of their educations, serving as extra sets of eyes and ears taking part in delivering the patient’s care plan. Our residents represent additional healthcare team members dedicated to tending to patients’ day-to-day needs. The model is second to none.

When to recommend  an evaluation

While proactive PSA screenings are often the catalyst in a prostate cancer diagnosis, these signs also warrant careful scrutiny.

Symptoms

  • Frequent urination or the inability to urinate
  • Difficulty in starting or holding back urine flows

Risk factors

  • Family history of the disease
  • Age between 55 and 69 years
  • Ethnicity, with prostate cancer most prevalent in African-American men

When to refer: understanding  the signs

Prostate cancer is one of the most common cancers diagnosed in men in the United States. It is often discovered via a routine PSA (prostate-specific antigen) screening, which measures the level of PSA protein in the blood. The higher the PSA level, the more likely the man being tested has prostate cancer (though prostate cancer is not the sole explanation for high PSA levels).

Symptoms that may suggest investigation of a possible diagnosis of prostate cancer can also include frequent urination, inability to urinate and difficulty starting or holding back urine flows. Any man determined to have high PSA levels or experiencing any of these symptoms should consult a urologist.

In addition, physicians should assess their male patients for risk factors as they relate to the potential for prostate cancer. Men who have a family history of the disease, are between 55 and 69 years of age, and are African-American may face a greater occurrence of prostate cancer. Physicians should also consider the patient’s overall state of health and life expectancy.

The global picture of a patient’s health very much plays into the suspicion of the presence of prostate cancer, and it is important for physicians to consider each case thoughtfully, as not all patients will be treated in the same manner. In low-risk cases, ongoing observation may be the proper course of action, while higher-risk cases may warrant more aggressive intervention. Any concern or symptom as described above should drive toward an in-depth evaluation.

In addition to complete risk assessments, our team offers the latest options for risk monitoring and prevention therapies at our Burns & McDonnell High-Risk Prostate Cancer Prevention Program.

An optimistic outlook

From first concern through treatment, the thoughtful approach begun by a general practitioner or urologist will be continued by staff at our hospital. Once a patient arrives, we will determine the most appropriate individual care plan. Not all patients require surgery. Some are better served with hormone treatment or radiation. Our multidisciplinary team of medical oncologists, radiation oncologists and surgeons together promote a multimodal approach to care. This is our commitment to your patients, and our pledge in pursuit of optimal health.

Dr. Lee completed his residency training at the University of Kansas followed by a urologic oncology fellowship at the University of Texas, MD Anderson Cancer Center. His clinical focus spans bladder, kidney, penile, prostate and testicular cancers.

To consult with a member of our urologic oncology team, call
913-588-5862 or toll free
877-588-5862. Or visit kumed.com/consult.