Covering the Bases: Multidisciplinary Prostate Cancer Care

The Cancer Institute’s arsenal includes brachytherapy, which uses “seeds” about the size of grains of rice that emit radiation at the site of the tumor. (PHOTO CREDIT) Theragenics Corporation

A prostate cancer diagnosis can unleash a confusing dilemma for patients: how to decide which of the many available treatment options makes the most sense.

To help these men improve their outcomes by guiding them through their treatment, the North Shore-LIJ Cancer Institute offers an innovative clinical model for prostate cancer care.

The program provides the only truly multidisciplinary approach to prostate cancer treatment in the New York metropolitan area. Patients benefit from the team approach, meeting with multiple health care specialists during the same visit in one setting. These prostate cancer experts create individualized treatment options, which they review with the patient and his loved ones in order to choose the best plan of action.

“There’s a certain sense of vulnerability that goes along with the fear of being diagnosed with prostate cancer,” said Louis Potters, MD, chair of radiation medicine. He added that this sense of vulnerability may influence men's treatment choices based on physician bias — whether from a urologist who performs the surgery or a radiation oncologist who does the radiation treatment. “So we established a multidisciplinary consultative service for prostate cancer patients to obtain a second opinion simultaneously.”

Customized Care

This approach leads to better patient care, outcomes and satisfaction, said Manish Vira, MD, director of the urologic oncology fellowship at the North Shore-LIJ’s Smith Institute for Urology. He added, “It’s about coming up with the right solution for that particular patient, not a one-size-fits-all solution.”

With urologists fellowship-trained in minimally invasive oncology, the Cancer Institute is at the forefront of laparoscopic and robotic surgery. Furthermore, it offers the latest in image-guided targeting, including stereotactic radiosurgery and prostate brachytherapy. For men with advanced prostate cancer, Cancer Institute medical oncologists, including Thomas Bradley, MD, are in the lead of chemotherapeutic treatment, including molecular targeted therapy, immunotherapy and multiple clinical trials.

Every patient benefits from the perspective of multiple specialists who deliberate the particulars of the case to recommend individualized treatment. Radiation medicine practitioners, urologists, pathologists and radiologists convene weekly to examine imaging scans and discuss pathology and other considerations, Dr. Vira said. “We review each patient’s history and discuss the best treatment options, including participating in clinical trials.” The results are highly coordinated care with a consensus among clinicians.

Such a consensus among specialists can be reassuring. Because the disease often develops very slowly, some men require only physician monitoring of their prostate cancer without ever needing treatment. “For some patients, the hardest thing to do is nothing,” said Louis Kavoussi, MD, chair of urology for the North Shore-LIJ Health System. “But when they hear from multiple doctors, ‘Yes, it’s OK to not do anything,’ it helps their comfort level with that decision. We approach our patients not only to provide a cure but also to minimize secondary issues: quality-of-life issues and value-based outcomes.”

Dr. Kavoussi added, “As a team, we provide the mechanism for patients to get the complete perspective about treatment. That could explain why North Shore-LIJ cares for more surgical urologic cancer cases than any place in the metropolitan area.”

Surgery and radiation treatments provide “extremely high cure rates” for prostate cancer, said Lee Richstone, MD, chief of urology at North Shore University Hospital and vice chair of urology. He added that post-treatment “urinary control is extremely good. We continue to improve upon functional outcomes by fostering an environment of ongoing individual learning and sharing that knowledge to keep the whole group on the cutting edge.”

William Merkle, a prostate patient under the care of Dr. Vira and Brett Cox, MD, chief of brachytherapy for the North Shore-LIJ Health System, is undergoing radiation therapy for nine weeks this summer. For three years, he has been monitored via active surveillance. “All the people I’ve dealt with, from the people who sign you in to the nurses and doctors, have been great,” he said. “I have the utmost confidence in them.”

The Winning Team: Find multidisciplinary treatment for prostate cancer at the North Shore-LIJ Center for Advanced Medicine in Lake Success. Call 855-858-8550 to make an appointment.


Stages and Treatment

The stage of prostate cancer — how far it has developed — generally dictates its treatment.

Meaningless disease. Active surveillance may be appropriate for this group, whose disease is indolent, low grade and unlikely to progress in the short term. Over time, the disease either declares itself as “meaningful” and a physician will recommend treatment, or it will stage as indolent, without the need for treatment. About 40 percent of North Shore-LIJ prostate cancer patients choose to start with active surveillance — a higher rate than at most clinics.

Meaningful disease. These men have prostate cancer that, if left untreated, is likely to progress. Treatment is recommended. Most men can select either surgical removal of the prostate or one of several radiation therapies.

High risk/advanced disease. At this point in disease development, a comprehensive, multimodality option that allows multiple treatments for the patient may be necessary.


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