by Alice Daniel

Dr. Sanford Siegel, 59, CEO of Chesapeake Urology Associates (CUA) in Baltimore, isn’t a runner. But when fellow urologist and marathoner Dr. Sean Van Zijl suggested that CUA sponsor a race to benefit prostate cancer research, Siegel enthusiastically supported the idea. “I wrote a proposal,” says Van Zijl, “and Dr. Siegel just ran with it.”

In 2007, Siegel founded the Great Prostate Cancer Challenge (GPCC), a 5K run that raised $135,000 to support prostate cancer research and provide free cancer screenings and education to people in need. Since then, the event has raised more than half a million dollars, and this year, urology practices in 11 other cities, including Nashville, Tenn., and Richmond, Va., will sponsor GPCC races.

“Our vision is to do for men’s health and prostate cancer what organizations like Susan G. Komen have done for women’s health,” Siegel says, referring to the organization behind the Race for the Cure events that have raised millions of dollars for breast cancer research.

Some of the money raised by the Baltimore GPCC funds education and outreach, especially in the black community, where the incidence rate for prostate cancer is about 60 percent higher than that of other ethnic groups.

To better reach that community, Siegel and CUA have partnered with Zero—the Project to End Prostate Cancer, to provide free screenings at black churches in Baltimore. Zero provides the mobile medical clinics and CUA provides the staff.

“We try to offer man-friendly health care where they can feel comfortable talking about an uncomfortable subject,” says Skip Lockwood, CEO of Zero. Even the mobile units have a masculine touch, with leather seats and big-screen TVs.

The free screenings include a blood test and a physical exam of the prostate. Because some of the patients haven’t seen a doctor in years, the exam itself often offers insight into the patient’s general health, Lockwood says. For example, a patient might not have prostate cancer but he might have an enlarged prostate. Or a conversation about diet and exercise might lead the doctor to suggest a diabetes test.

The Rev. Hoffman Brown III, pastor of Wayland Baptist Church in Baltimore and a prostate cancer survivor, says about 300 community and church members came to the last prostate cancer screening at Wayland.

“Chesapeake Urology and Dr. Siegel are just extraordinary in terms of their reaching out to the African-American community,” Brown says. “They have a real concern and gift for helping those who would probably not take this matter so seriously to be more conscious about it.”

CUA also follows up on its patients and returns to the same churches every year to offer the free screenings. “It’s a way of building trust in the community,” Siegel says. If someone needs but can’t afford treatment for prostate cancer, “we will treat them for free if we can’t find sources to provide funds for treatment,” he adds.

Siegel says that his work sponsoring the race and screenings is part of a bigger picture, one that, ideally, will continue long after he steps down from CUA. “I feel that what I do every day is a job, but what CUA does in the community is our legacy.”

by Michael Adkins

Editor’s note: Please refer to “Understanding Prostate Cancer” on page 7 for explanations of many of the clinical terms used in this article.

Prostate cancer treatments have come a long way in a relatively short period of time – in part because of improvements in screening practices, which has led to more patients being diagnosed at early stages of the disease. This means treatment regimens can be started earlier, which means these treatments are more likely to yield positive outcomes for patients.

Deciding which course of action is the right one is a choice each patient should make with his physician. Some of the most promising options offered by the experts at Chesapeake Urology Associates are profiled on the following pages, in order to help patients make the most well-informed decisions possible for their care.

Watchful Waiting
According to the American Urological Association’s Guideline for the Management of Clinically Localized Prostate Cancer, watchful waiting involves monitoring the disease and watching for progression. Dr. Marc H. Siegelbaum, FACS, partner at Chesapeake Urology Associates and chief of urology at St. Joseph Medical Center, says this is an approach often chosen by older men. “If the patient is 75 years old or older, has less than 10 years to live, or has a small amount of prostate cancer, with a PSA less than 10, watchful waiting might be a viable option,” he explains. “We would continue to check PSA levels and schedule a digital rectal exam every six months. Periodic repeat biopsy may be in order.”

Watchful waiting is not always the best option, however, especially in young patients. “Anybody younger than 75 with prostate cancer should have some form of cancer treatment,” Dr. Siegelbaum urges. “These men are usually young enough (life expectancy of at least 10 years) and healthy enough so that they would live long enough to have morbidity and mortality from their prostate cancer. Treatment would prevent these dire consequences. Those who have the best potential for curing their cancer have low-volume disease, have a low Gleason score — 7 or less — and a PSA of 10 or less. We think of these as ‘curable’ cancers, or cancer that can benefit from treatment.”

Robotic Prostatectomy
Prostatectomy, or the surgical removal of the prostate, is most often used for cancer that is in its early stages and has not spread beyond the prostate. The traditional technique for doing this was open surgery through an incision in the lower abdomen. Approximately five years ago, Chesapeake Urology Associates began offering robotic prostatectomy, with the attending surgeon controlling a robotic surgical system for improved precision and magnification (please see the article “Limitless Possibilities” in the previous issue of Chesapeake Urologist for more information).

The da Vinci system, so named because of renowned scientist Leonardo da Vinci’s conception of the first robot and his contributions to understanding human anatomy, uses a laparoscopic approach involving several small punctures, rather than a single large incision. The urologic surgeon sits at a console and controls the robot’s arms during the surgery.

The main benefits of this surgical method are less pain and faster recovery, Dr. Siegelbaum says. “Patients can get out of bed and start walking and performing breathing exercises almost immediately,” he adds. “In fact, most patients are discharged within 24 hours.” Dr. Siegelbaum also notes that the robot’s precision allows for cleaner, more accurate surgeries with considerably less blood loss than the traditional approach. Approximately 70 percent of radical prostatectomies in this country are now done robotically.

IG-IMRT
Another form of intervention for prostate cancer treatment is IG-IMRT, or image-guided-intensity modulated radiation therapy. IG-IMRT is a form of radiation therapy used to target cancer cells. “We insert gold markers in the prostate,” explains Dr. Richard S. Hudes, radiation oncologist with Chesapeake Urology Associates. “These markers are used as guides for targeting the radiation.” The gold shows up on X-rays, allowing for a clearer picture of the target area. This allows a more precise delivery of the radiation to the prostate than the techniques that were used 10 years ago.

Once the markers are in place, the cancer can be targeted with radiation. “It works like a gun, if you will,” Dr. Hudes says. “The IMRT system sculpts the dose to the shape of the target and delivers the intensity needed. One portion of the tumor may need a higher dose than another, and the computer software we use allows us to maintain that level of control.” If given as a standalone treatment, IG-IMRT is given five days each week for 35 to 40 treatments. For more aggressive tumors, IG-IMRT therapy is used for a five-week period and is then followed by brachytherapy.

Brachytherapy
Brachytherapy involves the implantation of radioactive “seeds” in cancerous areas of the prostate. According to Dr. Hudes, the patient is placed under anesthesia, and the physician, using special needles, implants 40 to 100 rice-sized pieces of radioactive material in the prostate. The seeds’ radioactivity is designed to shrink the cancerous growth. The seeds are radioactive for six to 12 months, depending on the isotope used. After the procedure, the seeds remain permanently in the prostate. The procedure is almost painless, and the patient can return to his normal activity within a few days of the implantation.

Chemotherapy
Chemotherapy has been a staple of cancer care for many years — but there were no demonstrably effective chemotherapy options for prostate cancer until recently, according to Dr. Adam R. Metwalli, urologic oncologist with Chesapeake Urology Associates. “About five years ago, a clinical trial demonstrated the effectiveness of docetaxel at prolonging survival and treating bone pain from prostate cancer that has spread,” Dr. Metwalli explains. Docetaxel is well tolerated by the patient and usually does not lead to cases of nausea and hair loss, as are common in chemotherapy for other types of cancer.

Hormonal Therapy
Unlike most other forms of cancer, prostate cancer responds to the presence of the male hormone testosterone. Testosterone is required for prostate cancer cells to grow and spread. Therefore, depriving the body of testosterone can help prevent the growth and spread of prostate cancer, although the cancer often becomes resistant to deprivation techniques after one to three years of use.

Orchiectomy — or the removal of the testicles, where most of the body’s testosterone is made — causes a dramatic decrease in hormone levels. However, many men are reluctant to undergo this procedure, so injections to block the release of the hormone that stimulates the testicle to make testosterone, as well as other drugs called antiandrogens, which block the action of testosterone on the prostate cancer cells, are often used instead.

One of the long-term complications of androgen deprivation is the possibility of developing osteoporosis. Dr. Metwalli and other specialists in hormonal therapy are stepping up efforts to protect patients’ bones while treating their prostate cancer. “All patients on androgen therapy should be taking calcium supplements,” he says. “Also, if a patient’s bone density is confirmed to be low, biphosphonates are used to force calcium back into the bones, making them stronger.”

Erectile Dysfunction Treatment
With many types of active prostate cancer treatment methods, the risk is present for erectile dysfunction, or ED — the inability of a man to obtain or maintain an erection long enough to have sex. Many of the effective treatments can cause nerve damage in the area surrounding the prostate, which can lead to ED.

However, prostate cancer patients can work to prevent ED with the help of Dr. David M. Fenig, urologist at Chesapeake Urology Associates. Dr. Fenig administers a comprehensive treatment program designed to increase nerve stimulation, increase oxygen flow in the area and lower the risk of scarring.

Dr. Fenig’s approach involves the use of multiple treatment options, including mechanical devices, medications and, if necessary, injections to stimulate nerves without the need for surgery. In addition, Dr. Fenig begins working with patients before and during their prostate cancer treatments, which often leads to improved outcomes. “Often, no one treatment is enough,” Dr. Fenig says. “With the clinical expertise and training I have, I can give men the additional information and reassurance they need. By offering this program, Chesapeake Urology Associates is on the cutting edge of urology care.”

Clinical Trials
When today’s treatments aren’t enough, many patients turn to clinical trials for a chance at tomorrow’s options. Clinical trials are usually thought of as being performed at major university research centers, but Chesapeake Urology Associates operates a distinguished research division — Chesapeake Urology Research Associates, or CURA —led by Dr. Ronald F. Tutrone Jr., FACS, Chesapeake Urology Associates’ research director. Dr. Tutrone and his staff have conducted numerous trials for new prostate cancer treatment options at CURA (please see the article “Clinical Trials Offer Most Advanced Care” in the previous issue of Chesapeake Urologist for more information).

The tested materials are at the cutting edge of prostate cancer treatment, Dr. Tutrone points out. “Some of these products may not be available to the public for five years or more after the trials,” he says. “Trial participants get them now. When other treatment options have failed, a clinical trial may be a good option.”

For more information about CURA’s current clinical trials, please see the sidebar on page 17.

Chesapeake Urology Associates – Your Partners in Prostate Cancer Care
No matter which treatment method or methods you and your doctor decide are right for you, Chesapeake Urology Associates and its world-class specialists are there to provide the expert care you need to get through this difficult time. For more information, or to schedule an appointment with a member of the team, call 877-422-8237, or visit www.chesapeakeurology.com.

CUA is now offering a comprehensive health and wellness program specifically designed to address metabolic issues. While not a “diet,” this lifestyle system integrates low-glycemic eating, exercise and behavior modification into a flexible, step-by-step program that helps participants build healthy habits. The key difference between this system and other weight-management programs is that it offers a more comprehensive, holistic approach to diet and lifestyle changes. It emphasizes losing fat rather than just pounds, thus creating the optimal body composition. Fat loss is achieved by balancing a person’s blood sugar through low-glycemic impact eating. The glycemic index, or GI, ranks carbohydrate-rich foods according to their effect on blood glucose levels. Foods with a high glycemic index, like simple carbohydrates, white sugar, white bread and sugary soft drinks, are converted to glucose very quickly in the body. This fast conversion causes a release of insulin. Subjecting the body to high-GI foods over a period of time leads to a condition called insulin resistance and eventually to type II diabetes. In addition, consumption of high-GI foods tends to increase hunger and triggers a series of hormonal and metabolic changes that can then lead to overeating and eventually weight gain and obesity.

Clinical studies support this program’s effectiveness. The average weight loss per participant was found to be 14 pounds. It is even more impressive that participants lost an average of 4 percent body fat and four inches from their waist circumference.

Our program covers topics such as low-glycemic impact eating to optimize fat loss, detoxification, good fats versus bad fats, inflammation and oxidation as the root causes of disease, the importance of adequate sleep, regular exercise to support lean muscle mass, stress reduction and proper supplementation. We teach participants to focus on a diet that is rich in antioxidants, low in proinflammatory and carcinogenic substances, and low in simple sugars. This diet is combined with a regular exercise plan. These lifestyle changes can make an important difference in improving the overall health of every prostate cancer thriver.

To learn more about CUA’s Your Health and Wellness program, call the Prostate Center at 443-738-9393.

For more information, please visit the Prostate Cancer Foundation at http://www.pcf.org/site/c.leJRIROrepH/b.5814065/k.FB26/Nutrition__Wellness.htm.

To screen or not to screen is one of the hottest questions in men’s health these days.

For urologists at Chesapeake Urology, there is no doubt that the American Urologic Association has the right approach, which is to advocate that men begin PSA testing at age 40, provided there are no other health concerns that indicate the man has less than a 10-yearlife expectancy. This way, their doctors have a baseline to help monitor their prostate cancer risk in the future.

“If all men have regular PSA testing according to the AUA guidelines, we could virtually eliminate discovering prostate cancer when it is at an advanced stage and no longer curable,” says Dr. Bruce Berger, a CUA urolo-gist. “The lifetime incidence of prostatecancer for a man is 16 percent, which means that a lot of men are at risk for developing prostate cancer.”

In the 1980s, before PSA testing became standard, two-thirds of the men newly diagnosed with prostate cancer had an advanced cancer that was not curable. According to Dr. Berger, “PSA testing has revolutionized prostate cancer diagnosis and treatment.” Since 1990, there has been a 35 percent decrease in prostate cancer deaths. Between 1994 and 2004, the mortality rate from prostate cancer has decreased by four percent annually, even though the population is aging and more men are at risk for developing prostate cancer.

The PSA, which stands for prostate-specific antigen, is a blood test that measures a protein produced by cells in the prostate. “As the PSA goes up, the risk of prostate cancer increases,” Dr. Berger says. PSA screening can help detect prostate cancer five to 10 years earlier than it might be detected by physical exam. Early detection can lead to finding prostate cancer when it is confined to the prostate and more likely to be cured.

There is no specific PSA level that indicates cancer. Therefore, it is important for the doctor to monitor the rate of change of a man’s PSA from year to year. Many older men have higher PSA levels because their prostates have enlarged due to benign prostate hyperplasia (BPH). However, too rapid a change indicates an increased risk for prostate cancer.

“Screening gives us knowledge,” Dr. Berger explains. “Rescreening intervals are based on an individual’s baseline PSA and the patient’s age. The decision to proceed to a prostate biopsy should be based not only on the total PSA levels but also on multiple other factors.”

These factors include PSA properties, such as free PSA, PSA velocity and PSA density; rectal examination; the patient’s age and co-morbidities; prior biopsy history; family history; ethnicity; diet and lifestyle. African-American men and men with a family history of prostate cancer have an increased risk for the development of prostate cancer. “Cancer risk does correlate with an increased PSA level, but there is no PSA value below which a man may be assured that he does not have biopsy-detectable prostate cancer. We cannot give guidance concerning the best way to treat a man’s prostate cancer if we don’t know the cancer exists,” Dr. Berger says.

CUA’s urologists are very concerned about whether men are being discouraged from getting timely screening. There have been reports that the PSA is inaccurate or not reliable. This is not true. Recently, the American Cancer Society issued new guidelines on prostate cancer screening. Many urologists are not in full agreement with some of their recommendations.

“We concur that informed consent should be an integral part of a man’s decision to have PSA testing. We don’t agree that the first testing should occur after age 50 and that the decision to then do a biopsy be tied to a specific PSA level,” Dr. Berger says. “We feel that there is no single PSA standard that can be applied to all men. Education combined with PSA testing is the best way to find prostate cancer when it is still curable.”

There is a real controversy concerning PSA and biopsy evidence of early prostate cancer. As we use changes in PSA as one indicator for doing a biopsy, there is concern that we may find more low-grade cancers that are small in volume and that will not grow rapidly enough to threaten a patient’s life span. Therefore, there is the potential for overtreating cancers that may not ever cause a clinical problem. Some of these early cancers can be closely followed and do not need immediate treatment. Others can progress to more aggressive cancers. Unfortunately, our tools for distinguishing the incidental cancer from the significant cancer are not yet as accurate as we would like them to be.

“Currently, the only way to cure prostate cancer is to find it early. The PSA guides us. Early prostate cancer has no symptoms. By the time there are symptoms, the disease has advanced and is more difficult to treat and impossible to cure with our present treatment modalities,” Dr. Berger concludes.

Before the PSA test became standard, there were 40,000 prostate cancer deaths annually in the U.S. Now, that statistic has dropped to 26,000 annual deaths. “We want that downward trend to continue,” Dr. Berger emphasizes.

For more information on prostate cancer screenings, or to make an appointment, please call 877-422-8237.

by Deanna Strange

Consistently, prostate cancer ranks in the top three most common forms of cancer diagnosed for men each year. Knowing that an abundance of men are experiencing the same feelings is not enough to ease the pain of learning of a diagnosis. Cancer is life-changing, no matter how severe its form and stage. Finding reassurance can often be difficult, and sometimes what it takes is talking to someone who has been there or is experiencing the same things.

Chesapeake Urology has designed its Prostate Center with men and what they encounter throughout prostate cancer treatment in mind. Dr. Richard Hudes, one of four radiation oncologists at the center, affirms, “From the moment they walk in, they feel comfortable and that this center is suited to them.”

Beginning with the waiting area, the decor is geared toward men older than 50. For those guests who arrive early to an appointment, they enjoy a hotel-concierge feel, with hardwood floors, a fireplace, a cyber cafe and seating that is more like a lounge than a waiting area. “There are mainly well people in the waiting area who are coming for treatments,” Dr. Hudes points out. “In a typical cancer center, a man getting radiation treatment might be waiting next to someone who is having chemotherapy and losing hair.”

The Prostate Center specializes in radiation treatments; specifically, it offers image-guided – intensity modulated radiation therapy (IG-IMRT) – a state-of-the-art new treatment that is painless and minimizes damage to surrounding tissue through its precision (see the article “Innovative Treatments for Prostate Cancer” on page 14 for more information). Jeff Zemencik, director of the Prostate Center, elaborates, “We are the only center dedicated to prostate cancer in Maryland. A more general center would treat three or four prostate cancer cases a day, but we treat about 40 cases a day.”

With prostate cancer treatment being the focus of the center, patients are more comfortable in their setting and with fellow patients. “There’s camaraderie. The men feel more at ease with each other,” Zemencik states. Dr. Hudes adds, “The man who comes for treatment at 8:15 a.m. is going to know the guy who comes at 8:30 a.m., so they form a strong bond.”

Coming to terms with prostate cancer and undergoing treatments can create a feeling of isolation from family and friends. Forming relationships with other survivors, the radiation oncologist and other staff members is essential to keeping patients from feeling alone throughout the process. “We want the patient to feel he has a high-tech and high-touch treatment,” Dr. Hudes says. “We have follow-ups for years after the treatment is complete, and part of that is our annual Survivor Day. It’s heartening to have these men come back and be able to meet men who are going through treatments. It brings a sense of community.” The center also provides support meetings called Man to Man, where survivors and patients can meet in private and talk about issues and concerns (see related article on page 20).

Chesapeake takes a number of safety precautions to ensure the best radiation treatment available. One of the main quality-assurance features is an on-site PhD physicist and a dosimetrist. “This makes sure the patient is receiving the correct amount of radiation they should be,” Zemencik states. Another method of safety is keeping a photo identification of patients, allowing the therapist to visually confirm that the right patient is receiving the correct treatment every day. In addition, a fiducial-based treatment localization is used.

Through this process, gold markers are implanted at the site of radiation treatment during the planning CT scan. The markers may move depending on how full the bladder or rectum is, so it is important to track the markers instead of the site the prostate was in previously. “Every day before treatment, we take images to make sure we are aligning the beam with where the prostate is at that moment,” Zemencik continues.

The Prostate Center also benefits from a consistent staff – having the same group together for three years. “It’s important that patients have consistency and that staff members get to know the patient and what they are treating,” he adds. Staff members also stay connected to each other by reading one another’s patient cases and following patients through Chesapeake’s electronic medical records (EMR) system.

What the patients may not be as cognizant of is what physicians and staff members do to work closely as a team. “We give patients more efficient care because we are linked through electronic medical records,” Zemencik offers. “This allows the radiation oncologist to more easily communicate with the urologist. It allows for instant communications, and it greatly reduces the chance of error.”

Dr. Hudes compares EMR to the convenience and prevalence of text messaging. “The radiation oncologist is always sending notes back to the urologist, so there is always a dialogue about the patient,” he says. “Behind the scenes is important as well. It may not be apparent to the patient that I’ve spoken to his urologist already, so I will tell him. It offers peace of mind if he knows everyone is on the same page.”

Zemencik sees some great possibilities for expanding the scope of care for patients. “Once treatment is over, patients still want to feel like they are in control and actively doing something to help them feel better,” he notes. “We are starting programs for survivorship and wellness to address those needs.”

The success of the Prostate Center relies heavily on the staff members and their interactions with patients. “People often think of a large group like Chesapeake as an institution, but it really is the people here,” Dr. Hudes summarizes. “I think it’s the level of quality and the personal attention that make the impression.”

For more information about the Prostate Center, please visit www.chesapeakeurology.com/prostatecenter.aspx, or call 443-738-9393.

by Michael Adkins

More than 186,000 American men are diagnosed with prostate cancer each year, according to es-timates from the National Cancer Institute, and some 26,000 men die from the disease each year. Prostate cancer is the second most common type of cancer among men in the United States, with only skin cancer being more prevalent.

With so many men facing this disease each year, it’s important for patients to know the facts about prostate cancer so they can make the choices that are best for them, their families and their specific situations. Fortunately, patients in this region have a strong ally in Chesapeake Urology Associates to help them deal with prostate cancer.

What Is the Prostate?
The prostate itself is a gland that is part of the male reproductive system. A healthy prostate is roughly the size of a walnut, and it helps produce seminal fluid – the fluid in which sperm are carried out of the body as part of semen. In addition, the prostate encircles the urethra – the tube that carries urine away from the bladder.

Benign Versus Malignant Prostate Growths
As men age, their risks for developing problems with the prostate increase. Growths of prostate cells are relatively common in men over the age of 50. Many of these growths are classified as benign, or non-cancerous (see the Fall 2009 issue of Chesapeake Urologist for more information on BPH, a specific type of benign prostate growth).

Malignant, or cancerous, growths are much more serious. Prostate cancer, if left untreated, can spread to other parts of the body and can be fatal. Thus, finding prostate cancer early and treating it before it has a chance to spread is crucial.

Risk Factors
One way physicians can determine who is most in danger for prostate cancer is by examining common risk factors for the disease. These risk factors include:

• Age: The diagnosis of prostate cancer is rare in men younger than 40.
• Family history: Men whose fathers, grandfathers, brothers, sons or other closely related family members have had prostate cancer are at an increased risk themselves.
• Race: African-American men are at a 60 percent increased risk for prostate cancer as compared to Caucasian or Hispanic men, and the disease is rarer among Asian-American and American Indian men.

Symptoms
According to Dr. Bruce W. Berger, urologist at Chesapeake Urology Associates, men in early stages of prostate cancer may not have any symptoms at first. “It could be 10 years or more before symptoms are noticeable,” he explains.

Some symptoms of prostate cancer may include:

• Difficulty urinating and/or difficulty starting and stopping urine flow
• Needing to urinate frequently, especially during the night
• Weak urine flow
• Pain or burning during urination
• Blood in the urine or semen
• Back pain, especially in the lower back, the hips or the thighs

Experiencing these symptoms is not usually the best way to determine the presence of prostate cancer, Dr. Berger notes. “These are usually late-occurring symptoms,” he says. “When symptoms start, the cancer is generally not curable. It needs to be found and cured before symptoms develop.”

Screening Process
The American Urological Society recommends that men over the age of 40 who have at least a 10-year life expectancy should be screened annually for prostate cancer. The two main components of prostate cancer screenings performed by the physicians at Chesapeake Urology Associates are the digital rectal exam and the prostate-specific antigen, or PSA, screening.

A digital rectal exam involves the physician placing a gloved, lubricated finger into the rectum and feeling the prostate through the rectal wall. This allows the physician to feel the prostate for lumps, nodules and other abnormalities.

A PSA screening is a blood test that can detect high levels of PSA, a protein produced by the prostate. PSA is normally present in relatively small quantities in the blood, and elevated levels of PSA are often an early indication of prostate cancer, as well as other disorders of the prostate. However, an elevated PSA does not always indicate cancer, just as a normal PSA means there is no cancer.

If either of these tests yields an abnormal result, the physician will often order a biopsy. At this time, a biopsy is the only way to diagnose prostate cancer. “The entire biopsy usually takes about 15 minutes or less,” Dr. Berger says. “The patient is placed on his side, and an ultrasound probe is inserted in the rectum to let us see the prostate. We use a local anesthetic, and the procedure has minimal discomfort.” The physician uses needles to take samples – called cores – from different areas of the prostate. Biopsies have an 85 percent chance of detecting cancer if it is present in the patient, according to Dr. Berger.

The cores are sent to a pathologist, who determines if there is cancer present in the samples. If there is cancer present, the pathologist scores the cancer based on the Gleason score. The pathologist looks at the patterns of cells in the cancerous tissue and scores the two most common patterns on a scale of 1 to 5, with 5 being the most abnormal cellular state. These scores are then added together to get the cancer’s Gleason score, which can range from 2 to 10.

“We usually see a Gleason score of about 6, or moderate prostate cancer,” Dr. Berger explains. “Any prostate cancer with a 4 as either the first or second score is an aggressive form, and total Gleason scores of 8, 9 or 10 are highly aggressive. The more cores that are positive for cancer, the more serious the cancer is.”

The cancer is also assigned a stage, based on how advanced the disease is in the patient. According to the National Cancer Institute, the stages are denoted as follows:

• T1: The earliest state is divided into three types: T1a, T1b and T1c.
• T1a is when prostate cancer is found during a surgery performed on the prostate for an unrelated condition. It is microscopic and found in less than 5 percent of the prostate tissue.
• T1b is found similarly to T1a, but the cancer is more extensive, involving more than 5 percent of the tissue.
• T1c is the most frequently found prostate cancer. It is detected by a prostate biopsy, which was done because of information provided by PSA testing.
• T2: A more advanced state, but the cancer is still entirely within the prostate. T2 cancer can be felt during a digital rectal exam.
• T3: The cancer has begun to spread locally beyond the prostate but has not reached the lymph nodes.
• T4: The cancer has spread and may have reached the bladder, the rectum or other nearby areas of the body, including the lymph nodes and/or the bones.

Treatment Options
If cancer is found after a biopsy, the patient has options he can discuss with the professionals at Chesapeake Urology Associates, including watchful waiting, removal of the prostate, implantation of radioactive seeds, external radiation, cryosurgery to freeze the prostate, and hormonal therapy (see “Innovative Treatments for Prostate Cancer” article on page 14). These treatments are designed to kill the cancer cells and/or shrink and cure tumors.

Successful treatment of prostate cancer is a relatively recent development – 25 years ago, the disease was mostly incurable because of the lack of diagnostic tests and viable treatment approaches. “When I first started practicing, 70 percent of prostate cancer patients were in advanced stages of the disease,” Dr. Berger recalls. “Now, less than 20 percent to 25 percent of our patients are in an advanced stage.”

The combination of modern technology and cutting-edge therapeutic techniques at Chesapeake Urology Associates means physicians have a better chance than ever to help patients successfully treat and manage prostate cancer. “If we can catch it before it has a chance to spread and while the grade and amount of cancer are low, the chance for curing prostate cancer is greater than 90 percent,” Dr. Berger points out. “We’re able to find it earlier and treat it more successfully than ever before.”

For more information on prostate cancer, or to make an appointment, please call 877-422-8237 or visit www.chesapeakeurology.com.

Loi Tran immigrated to the U.S. with his family when he was 11 years old. He did not speak any English and as a result, he struggled in middle school. Loi recalls adapting to the environment quickly and graduating from high school in the top ten percentile of his class.

With only one parent supporting his entire family, including their grandmother, Loi’s financial resources are limited. His father works hard to support two children in college, but it is not enough.

Loi Tran is enrolled in the Bachelor of Science Degree Nursing program at the University of Maryland Baltimore. Upon completion, he will pursue a Master Nursing Degree through a Certified Registered Nurse Anesthetist program. This will require two years working in an Intensive Care Unit in a hospital. Although Loi has a long road ahead of him, he is motivated by how far he has already come from his home country of Vietnam.

In addition to excelling academically, Loi gives back to his community through extracurricular clubs. Among those efforts, Loi volunteers with the Friends of Patapsco Valley River where he participates in stream clean-ups and planting trees to improve the environment.

“A scholarship will play an essential role in ensuring my success,” writes Loi. CSB was proud to award Loi, a truly well-rounded second-year recipient, with the Chesapeake Urology Associates Scholarship last year.

WASHINGTON, May 26 /PRNewswire-USNewswire/ — Dr. Sanford “Sandy” Siegel of Baltimore, MD and Mrs. Sherry S. Galloway of Albuquerque, NM are new members of ZERO’s Board of Directors.

Dr. Siegel is the President and CEO of Chesapeake Urology Associates, the largest urology practice in Maryland and the Mid-Atlantic Region with 16 urology centers, the Prostate Center, the Incontinence Center and 14 surgical centers throughout the greater Baltimore, Maryland area. He initiated the Chesapeake Urology Scholarship Program and was a leader in establishing the Chesapeake Urology Scholar through the American Urological Association Foundation.

In 2007, Dr. Siegel led the formation of the “Great Prostate Cancer Challenge” (GPCC) to raise money and awareness for prostate cancer research. GPCC 5K races, in partnership with ZERO’s DASH FOR DAD race series, represent the premier men’s health race event in the U.S. which is coming to 12 cities this year and engaging more than 6,000 runners and 10,000 volunteers, spectators and supporters.

Dr. Siegel graduated from the University of Maryland School of Medicine and received specialty training at Temple University Hospital in Philadelphia. He has practiced urology in the Baltimore area for more than 20 years and is certified by the American Board of Urology.

Mrs. Galloway is a Registered Nurse. She received an A.A. in registered nursing and a B.A. in psychology. She worked as an emergency room nurse for almost 30 years and then attended Esalen Institute in Big Sur, CA, where she studied massage therapy. She later relocated to Albuquerque where she taught medical massage at the New Mexico Academy of Healing Arts in Santa Fe.

Currently, Mrs. Galloway works as a Registered Nurse and also teaches at the Central New Mexico City College system which has five campuses. Her work involves informing the student population about various diseases, particularly cancer, and teaching awareness.

Mrs. Galloway directly experienced the impact of prostate cancer as her husband is a prostate cancer survivor. Her only son, 36-year-old Jeremy, died from prostate cancer in 2007 after an 18-month struggle. She became involved with ZERO during the period of her son’s illness when she would contact the organization for information and support. She joined ZERO’s Founders Club, attended ZERO’s annual Summit to End Prostate Cancer in Washington, DC, and testified before a U.S. House of Representatives subcommittee in support of prostate cancer research. She plans to write a book about her son’s story to raise public awareness of prostate cancer and the need for increased research to find a cure.

SOURCE ZERO – The Project to End Prostate Cancer

Imagine that your daughter is about to receive her college diploma when the feeling of urgency strikes. You squirm uncomfortably in your seat, torn between two concerns: you don’t want to go to the restroom and miss her big moment, but you fear the accident that will likely occur if you stay seated. As the pressure increases, you’re forced to dash to the bathroom just as the announcer calls her name. Another special moment is tarnished by urinary incontinence.

Urinary incontinence affects the lives of millions of people, regardless of age or gender. “Anyone can develop it”, notes Andrew Shapiro, MD, Director of the Chesapeake Urology Center for Continence and Pelvic Floor Disorders. Women tend to develop it more often than men do. However, men who have undergone prostate surgery, sustained spinal cord injuries, neurological injuries or strokes are at high risk as well. Urinary incontinence has three primary forms, stress, urge and overflow incontinence. These differ in symptoms, causes, as well as the type of person who suffers from these issues.

Stress incontinence frequently affects women, especially after childbirth. In addition, men who have undergone prostate surgery are also at risk. Stress incontinence is leakage caused by coughing, sneezing or any activity that puts stress on the abdominal muscles. Stress incontinence typically occurs during the daytime but in people with severe leakage, it may occur both day and night. The problem is normally worse when the bladder is full or partially full.

Urge incontinence is a common problem that affects both men and women. It becomes increasingly common as people age. Men and women with neurologic issues, such as Diabetes, Multiple Sclerosis, Parkinsons or major back issues, are far more likely to have this issue. People with urge incontinence experience a sudden and strong desire to urinate. This desire cannot be postponed and often leads to incontinence episodes. People with this condition will also go more frequently and may wake up at night to urinate. Urge incontinence can be triggered by several factors, including dietary irritants, urinary tract infections and nervous system damage. Sometimes, especially in elderly patients, this condition can lead to falls and even admission to a nursing home.

Although women tend to experience incontinence more frequently than men, overflow incontinence is predominantly a male condition. “As the male ages and his prostate enlarges, it can block his bladder. This in turn makes it difficult to empty the bladder. When men’s bladders no longer have the strength to empty well, they begin to leave large amounts of urine behind after they urinate. This can lead to “overflow” incontinence. Sufferers frequently complain of an inability to void, despite a constant feeling of the need to empty the bladder, and often experience urine leakage.

Incontinence can be diagnosed by talking to the man or woman suffering these symptoms. Normally, a good history, physical examination and a urinalysis will give us the necessary information to diagnose the problem and begin treatment. For people who have more complicated histories, have had prior pelvic surgery or who have failed conservative treatment, we rely upon office testing to give us more specifics.

Dr. Shapiro relies on two primary examinations to diagnose the specific type of urinary incontinence, a urodynamic test and a cystoscopy. The urodynamic test bears many similarities to an EKG and assesses bladder function. The test is done in the office and allows us to determine why people are having problems with their bladder. The second diagnostic measure is a cystoscopy, in which a tiny camera is inserted into the urethra to look inside the bladder and examine the lining for any blockages or abnormalities that may explain the symptoms.

The treatment options for urinary incontinence vary widely based on the patient’s needs and the form of incontinence that affects them. “In general, doctors like to begin with the most conservative treatment and move to procedures only when necessary,” Dr. Shapiro explains. For patients suffering from stress incontinence, the first line of treatment is pelvic floor physical therapy.

“Pelvic floor muscle exercises help increase muscle tone and the overall strength of the pelvic floor muscles,” Dr. Shapiro notes. Physical therapy is a non-invasive treatment that can be quite effective but does require time and patience as the improvement typically occurs over the course of months.

Women with stress incontinence may also benefit from an outpatient suburethral sling procedure, in which a physician places a piece of permanent mesh beneath the urethra to help re-support the weakened urethra. This procedure is minimally invasive and takes less than a half-hour to complete. It is an outpatient procedure with excellent success rates.

For women who desire an office based procedure or who are poor candidates for a sling, injectable therapy can be used. We can inject an agent which helps to seal the weakened urethra. This therapy is less invasive and can be safely done in the office. While it is not as permanent as a sling, it can be effective for the right candidate.

Men with stress incontinence can also be treated with injectables or slings. Male stress incontinence is far less common and is almost always related to a prostate procedure. For men with more severe leakage, an artificial sphincter may be necessary.

Urge incontinence is associated with bladder irritability and spasticity. Oral medications (pills) are often effective in reducing these symptoms. There are multiple options available and not one pill works for everyone. For men and women who do not get adequate improvement from medication, we have several other minimally invasive options. Interstim is a very effective procedure for men and women who have failed medications and dietary changes. Interstim is an implant which is like a bladder pacemaker. Thru a simple office test, we can tell whether or not you are a candidate for this therapy. This test is easy to perform with minimal risk and after 1 week we will know whether or not this therapy is suite for you, Dr. Shapiro explains. Another potential option would be injecting medication directly into your bladder.

Overflow incontinence is most frequently due to an enlarged prostate. For many men, this can be fixed with an outpatient laser procedure to open up the obstruction. This is done thru a camera inserted into the urethra. It is typically performed as an outpatient with you sedated. The improvement is generally seen immediately and the procedure is generally safe.

Although urinary incontinence is a frustrating and embarrassing condition, many times it can be treated easily and successfully. “Women who have stress urinary incontinence have a greater than 90 percent chance of having a significant improvement or cure with sling surgery. Patients who have urge incontinence may see significant improvement from medication or minimally invasive surgery. Sadly, this very treatable condition is often either too embarrassing or people are unaware that it is treatable and they do not seek help. Dr. Shapiro recommends several outside resources to individuals struggling with urinary incontinence, including:

• The National Association for Continence (www.nafc.org)
• The American Urological Association (www.auanet.org)

Incontinence is a widespread condition that touches millions of lives, but some simple steps can be taken to reduce your chances of developing bladder control problems. There are ways to avoid or improve your control problems at home. We know that caffeine can worsen bladder symptoms. Therefore, minimizing or avoiding coffee, tea, soda and alcohol can improve your urgency. Losing weight is also very helpful in reducing your risk of developing incontinence, according to recent studies exploring the effects of weight on urinary incontinence. In addition, Kegel exercises can help improve or prevent stress incontinence. These exercises are often difficult to teach yourselves and a trained physical therapist can be very helpful for those patients who are unsure. Toning your pelvic floor, eating a healthy diet, exercising and maintaining a healthy weight can all be important factors in preventing or improving incontinence — which means that your special moments will no longer be interrupted!!

For more information or for an interview with Dr. Shapiro, please call CUA PR at 443-738-8107.

As long as humans have been experimenting with technology, there have been skeptic observers of it. The dawn of the Industrial Revolution, which set the stage for today’s technologies, witnessed a group known as the Luddites, who were responsible for the destruction of machines in their pursuit to prevent the advancements of technology and what they considered the inevitable end to the need for human workers. Innovations have continued to emerge throughout the years, ranging from personal computers to cellular phones to robotics. The latter has posed many philosophical debates concerning how far robotics can go and what they mean to the future of mankind. Essentially, can robots be constructed that render human beings unnecessary? While that debate may continue indefinitely, it cannot be denied that robotics can and do make life simpler and, in some cases, can improve human talent and ability, specifically in medicine.

Cancer results in 13 percent of all deaths in the United States annually, which makes it a major focus for research and new treatment options, including robot-assisted surgery. Prostate cancer, as one of the most common cancers among men, receives a considerable amount of attention from clinical trials and leads the movement for minimally invasive robot-assisted laparoscopic radical prostatectomies.

Treatment of Prostate Cancer
Prostate cancer is a disease that will affect one in six men in their lifetimes; however, with proper screening, most cases will be diagnosed early on. No requirement exists for prostate cancer screenings, but the American Urological Association suggests annual screenings for prostate cancer should be offered to asymptomatic men 40 years of age or older, and earlier for men with an elevated risk – for instance, if they are African-American or have a family history of prostate cancer.

Prostate cancer is not limited to one method of treatment. “There is a lot of consultation, and treatment depends largely on the patient’s preference,” states Dr. Benjamin H. Lowentritt with Chesapeake Urology Associates. “There are more treatment options every year. I tell my patients there is no right or wrong answer picking a treatment.” The variety of care largely depends on the stage of the disease and the comfort and beliefs of the patient. The least-invasive treatment is “active surveillance,” which assumes a localized cancer will advance so slowly as to not affect the patient during his life. However, if cancer spreads, another form of treatment may need to be considered.

Cryotherapy, the freezing and killing of cancer cells with liquid nitrogen, generally has good results with early-stage prostate cancer and can be repeated if necessary. It serves as an effective alternative for men who cannot have surgery or radiation therapy. However, a common complaint is impotence.

For a more widespread cancer or as an alternative to surgery, radiation therapy kills cancer cells either through high-energy X-rays or radioactive seeds. The risk of radiation is long-term damage to the nerves involved in sexual function. Radiation therapy, while causing little pain to the patient, can be somewhat intrusive, with sessions lasting as long as 10 weeks, from 10 to 30 minutes a day.

More than 90 percent of men with prostate cancer are candidates for some form of radical prostatectomy – the removal of the prostate and surrounding tissue. The advantages of surgery include reducing nerve damage, monitoring how the cancer spreads and offering a minimally invasive procedure. Several methods are available for radical prostatectomy, beginning with the traditional open surgery to the less invasive laparoscopic surgery to the innovative new robot-assisted laparoscopic da Vinci surgery.

Robot-Assisted Prostatectomy
The da Vinci surgery received its name because Leonardo da Vinci invented the first robot and because of his accuracy of the human body in his work. This state-of-the-art system performs surgery in a similar fashion to traditional laparoscopic prostatectomy. Six 1- to 2-centimeter incisions are made in the abdomen, so the incisions are less painful. Furthermore, there is less blood loss compared to the open technique. The surgeon uses robotic appendages to enter the incisions and remove the cancerous prostate. Although the surgeon’s hands do not physically touch the patient or the tools during the bulk of the procedure, the surgeon is in complete control throughout the procedure, with the robot serving as an extension of the surgeon.

The da Vinci surgery uses 3-D camera imaging to give the surgeon a greater view of the prostate than is possible with traditional laparoscopic surgery. This magnified image allows the surgeon more accuracy and the ability to better distinguish nerves that are vital to sexual function. “It’s essential to be able to see as clearly as possible and to be able to make decisions at that time,” Dr. Lowentritt explains.

Generally, the surgeon is positioned at the controls of the robot a few yards from the patient. From there, the surgeon can make very small gestures to operate the robotic arms and remove the prostate. An interesting design feature that increases the safety of robot-assisted surgery is tremor reduction, which protects the patient from an unintended shaking hand movement that might result in an inadvertent action. This type of technology offers laparoscopic prostatectomy more safety and precision than a surgeon could prior to the use of robotics.

As a minimally invasive surgery, robot-assisted laparoscopic prostatectomies also allow the patient to return to his daily routines at a much quicker pace than some treatments of prostate cancer. Dr. Lowentritt explains, “Radiation therapy can take seven or eight weeks to complete. With this surgery, the patient may be fully recovered in that time.” After the surgery, the patient will spend the night in the hospital while recovering from the anesthesia, but patients typically spend no more than two nights in the hospital.

Patient Concerns
Robot-assisted surgery troubles many patients because they fear the surgery is controlled by a machine. However, the da Vinci system is 100 percent controlled by the surgeon. According to Dr. Lowentritt, the military initially developed robot-assisted surgery so it could allow the surgeon to operate on a patient in the midst of combat from a secure location.

During the robot-assisted surgeries done in Chesapeake Urology, the surgeon is present with the patient, as well as a surgical team. “There is always an assistant at the bedside passing instruments,” Dr. Lowentritt adds. “And there’s never a moment when I can’t step up to the operating table.”

Fear of surgery is another factor that pushes some patients away from robot-assisted or traditional laparoscopic prostatectomy. “Some patients have so much anxiety about surgery that they understandably pursue another treatment,” Dr. Lowentritt points out. “Currently, between 70 and 80 percent of prostatectomies in the United States are done by robotic assistance. It is becoming a fairly common treatment.”

“There is a lot of personal belief surrounding surgery,” Dr. Lowentritt continues. “People want the cancer out. They don’t want to leave it in their bodies.” Surgery ensures a greater opportunity to detect any recurrences or any rogue cancer cells than other forms of treatments do.

As a surgeon, Dr. Lowentritt states that he almost never chooses the open prostatectomy over the robot-assisted prostatectomy. He believes that robot-assisted surgery has made him a better and more precise surgeon, attributing this to his increased visibility and greater dexterity with the robotic arms.

“Within Chesapeake, we offer seven fellowship-trained robotic surgeons, and the number of experienced surgeons in this field is beyond compare to any group that I know of,” he states. “Prostatectomies are becoming less and less invasive, and robotic surgery is here to stay. Only the imagination can limit where it goes.”

Undergoing surgery can be a stressful and frightening time for a patient, and no amount of planning and preparation may relieve that stress. Ambulatory surgery centers do, however, take patients through the surgery with as much comfort as possible. In a typical hospital setting, surgery may be performed by a team that is not specifically trained in the patient’s condition, whereas an ASC can offer a team that specializes in certain operations.

“It allows us to have quality and consistent care,” explains Stacy Zemencik, Director of Nursing with Chesapeake Urology. “We’re prepared for any emergency; all training is in urology so our nurses know just how to handle any situation. Surgery is more personal, and the staff is more friendly.”

The dedication of the staff at Chesapeake’s Summit ASCs is reflected in the recent achievement of accreditation. The Accreditation Association for Ambulatory Health Care (AAAHC) offers one- and three-year accreditations — both are a voluntary process. Accreditation shows to patients the dedication of the ASC’s staff and their willingness to test and prove their worth.

Chesapeake received a three-year accreditation — the highest form of certification available. “When you’re accredited, it shows the value that you have for [patient care],” Zemencik says. “It means you have gone above and beyond. Our patients are getting the best possible treatment.”