MDNews - Long Island

The Latest Treatments for Benign Genitourinary Disease STANLEY M. RING, MD, FACS, Director of the Urology Program, and Daniel S. McCally, MD, FACS, Assistant Director of the Urology Program, provide the full-spectrum of up-to- date services for general urology complaints, including benign prostatic hyperplasia, erectile dysfunction, urinary tract infections, urinary and kidney stones, and traumatic injuries. Treating urinary stones traditionally involved open surgery; however, physicians now use endourologic therapies or extracorporeal shock wave lithotripsy, which uses sound waves delivered via ultrasound to destroy simple kidney and upper urinary tract stones less than 3 centimeters in size. Endourologic therapies may also be used to remove or destroy stones in the bladder, kidney or ureter. Erectile dysfunction, which was viewed as a psychological disorder before researchers uncovered the responsible histological changes in erectile tissue, may be treated medically with drugs such as vardenafil, tadalafil and sildenafil. Benign prostatic hyperplasia — a disorder previously treated by resection of the prostate — can also be managed medically in many cases, with drugs including alpha-blockers, 5-alpha reductase inhibitors and tadalafil. If medication fails, minimally invasive treatments, such as photoselective vaporization of the prostate, present other attractive options to open surgery. Drs. Ring and McCally also closely collaborate with interventional radiology colleagues to treat traumatic kidney injuries. Interventional radiology techniques, including selective angiography and placement of coils in the artery, can diagnose and treat concerns such as internal bleeding. "Because of these advancements in urinary stone, enlarged prostate and kidney injury treatment, we very rarely need to perform open procedures on patients with benign disease," Dr. McCally says. "However, our team maintains the skillsets necessary to perform open and robotic urologic surgery when needed." participate in shared decision-making about prostate cancer screening. The association advises against screening in men between the ages of 40 and 54 who have an average risk of prostate cancer. However, it states that men between ages 55 and 69, men younger than age 55 who are of African-American descent or who have a family history of the disease, and men over the age of 70‡who are in excellent health should be counseled about the risks and benefits of screening so they can make an informed decision. In recent years, the advent of follow-up tests that have a greater specificity for clinically significant disease, such as the 4Kscore Test and the Prostate Health Index (PHI), have enhanced methods for following up on men with elevated PSA. Indicated for men who have an elevated PSA level, the 4Kscore Test evaluates four specific kallikrein biomarkers to determine the percent likelihood of aggressive disease with a Gleason score of 7 or higher. 1 The PHI is indicated for men with PSA levels between 4 and 10 ng/mL and combines results from total PSA, free PSA and [-2] proPSA tests to predict malignancy. Both tests empower patients to make educated decisions alongside their physicians about the need for prostate biopsy, according to Dr. Herman. ADVANCEMENTS IN PROSTATE CANCER BIOPSY Prostate biopsy traditiona l ly ha s involved ta k ing up to 12 random samples of tissue from the prostate using transrectal ultrasound (TRUS) guidance. However, this technique can miss a significant number of cancers, according to Dr. Herman. In conjunction with the traditional biopsy technique, South Nassau Communities Hospital o•ers MRI/TRUS-fusion biopsy, which combines MRI and sonography to provide a virtua l roadmap to prostate lesions. A 2015 study published in JAMA: The Journal of the American Medical Association found that, when compared with random biopsy, MRI/TRUS-fusion biopsy identified 30 percent more high-risk cancers and appears to better di•erentiate among low-, intermediate- and high-risk disease. "The information provided by the MRI allows us to biopsy tissue from areas of the prostate that are more likely to have disease," Dr. Herman says. "Accurate biopsy facilitates a better understanding of where the disease is within the prostate and what type of disease is present. This informs treatment decisions because it allows physicians to better determine if the patient has aggressive or nonaggressive disease." IDENTIFYING PATIENTS IN NEED OF TREATMENT Another drawback to prostate cancer screening is the possibility that screening and subsequent biopsy find nonaggressive disease. In cases of slow-growing disease, the treatment risks, which Dr. Herman and Edward Mullen, MD, Director of the Radiation Oncology Program, discuss prostate treatment planning for the Novalis Tx Radiosurgery System. 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 0 7

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