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Men of all ages with very low-risk prostate cancer — localized cancer that presents with a low-volume Gleason score of 6 or less and a PSA level lower than 10 ng/mL — may also benefit from active surveillance. 2 The potentia l dow nside of active surveillance is that patients live with the knowledge that they have cancer, which ca n be a nxiety-provoking. To better individualize therapy and pinpoint men with high-risk, aggressive disease who are in need of treatment, South Nassau Communities Hospital o•ers specialized prognostic testing. "With genomic testing, we can reassure men that their disease does not seem to be acting aggressively at the cellular level," Dr. Herman says. "On the other hand, genomic testing has also helped identify men with low-grade disease who needed treatment to prevent cancer progression." A MULTIDISCIPLINARY APPROACH South Nassau Communities Hospital o•ers a wide variety of treatment options for men with prostate cancer, including active surveillance, open and robot-assisted radical prostatectomy, cryosurgery, brachy- therapy — the placement of radioactive seeds or pellets within the prostate — exter- nal beam radiation therapy, and targeted high-dose radiation using Novalis Tx Radiosurgery. Each modality has specific risks and benefits. As with prostate cancer screening, men should participate in shared decision-making with their physicians to determine which treatment o•ers the best possible curative and functional outcome. The team of physicians who treat men at South Nassau Communities Hospital's Center for Prostate Health includes urolo- gists, urologic oncologists and radiation oncologists. The ability to speak with physicians who have expertise in multiple specialties can make the decision easier for patients. THE EVOLUTION OF SURGICAL PROSTATE CANCER MANAGEMENT W hen Sta n ley M . R ing, M D, FACS, Director of the Urolog y Program, and Daniel S. McCally, MD, FACS, Assistant Director of the Urology Program, joined the South Nassau Communities Hospital team nearly 40 years ago, open radical prostatectomy was the gold-standard surgical treatment for localized prostate cancer. In the early 1990s, the advent of laparoscopic surgery presented the possibility of minimally invasive pros- tatectomy. However, the equipment 's 2-D visualization and rigid instrumenta- tion limit surgeons' ability to perform complex dissection and suturing. Many surgeons opted to continue performing open operations. The development of robot-a ssisted p r o s t a t e c t o m y using the da Vinci Su rg ica l Syst em ha s ushered i n a new era of surg i- cal care. T h e d a V i n c i Su rg ica l Syst em can be used during a variety of urologic surgeries, and as physicians' expertise with the technolog y has grown, so too have its indications for use. At South Nassau Communities Hospital, physi- cians use the da Vinci Surgical System to treat benign and malignant urologic diseases, including prostate and kidney cancers, benign prostatic hyperplasia, and urinary stone disease. Arguably its Dr. Herman's hand movements are precisely mirrored by the robotic arms of the da Vinci Si Surgical System. Prostate biopsy images " South Nassau Communities Hospital is extremely supportive in providing the technological updates necessary to care for patients in this community. Our up-to-date surgical and radiation departments ensure physicians don't have to refer their patients 30 to 50 minutes away from home to receive complex care." DANIEL S. MCCALLY, MD, FACS, ASSISTANT DIRECTOR OF THE UROLOGY PROGRAM AT SOUTH NASSAU COMMUNITIES HOSPITAL 0 9 M D N E W S .C O M /// M D N E W S L O N G I S L A N D ■ 2 016