Prostate and Urologic Cancers

Our radiologists specialize in the imaging of disorders of the abdomen, pelvis, and genitalia. They are leading experts in magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), and fluoroscopy and are committed to delivering the highest quality diagnostic imaging in a patient-focused, evidence-based care environment to all our patients. Our radiologists utilize clinical expertise along with the latest advances in technology, including MR-US fusion for prostate imaging as well as positron emission tomography (PET) scans and advanced nuclear medicine scans. In addition, Blue Light™ Cystoscopy, an advanced endoscopic technology, is employed to improve bladder cancer detection and reduce risk of cancer recurrence. Our board-certified doctors are national and international leaders in the diagnostic imaging of genitourinary cancers, and they are dedicated to maintaining the highest standards of care in patient safety, quality, and satisfaction.

Learn more about interventional radiology

Our team is composed of surgeons with extensive clinical experience and fellowship training in urologic oncology. Each urologist is committed to achieving optimal cancer outcomes through advanced surgical techniques and emphasizes organ preservation and safeguarding of sexual and urinary function whenever possible.

The surgical approach is customized and carefully considered for each patient, whether endoscopic, robotic, or traditional open surgery. The urology team is committed to surgical innovation and offers cutting-edge technology for cancer diagnosis, including the pioneering use of a M RI-ultrasound fusion prostate biopsy. In addition, cystoscopy, an advanced endoscopic technology, is used to improve bladder cancer detection and reduce risk of cancer recurrence. MRI-ultrasound fusion prostate biopsy. In addition, Blue Light™ Cystoscopy, an advanced endoscopic technology, is used to improve bladder cancer detection and reduce risk of cancer recurrence.

Surgeons perform a radical prostatectomy to remove the prostate and some surrounding tissue when the cancer has not spread to other parts of the body. The goal is to eliminate the cancer while preserving normal urinary and sexual functions as much as possible. At Smilow Cancer Hospital, a robotic surgical system offers men with prostate cancer better outcomes with fewer side effects. Another option called cryotherapy uses sub-zero temperatures to destroy cancer cells in the prostate. Through the use of advanced techniques, including minimally invasive and robotic surgery, such as nerve-sparing robotic prostatectomy, our urologists are able to optimize both cancer care and surgical recovery.

Cryoablation (tumor freezing) may be a good option for some patients with prostate or kidney tumors. Focal therapy is also available for appropriate patients with prostate cancer, as it can treat the cancer without the use of radiation or surgery, preserving the prostate and urinary and sexual function. Similarly, for some patients with cancers of the ureter or upper urinary tract, a laser can be used to treat the tumor and preserve kidney function.

For each of our patients, our urologists provide a high-quality experience and focus on safety and quality of care after surgery. Most patients are candidates for our Enhanced Recovery After Surgery (ERAS) protocol, which reduces length of stay and complications while optimizing our patients’ complete recovery.

Our kidney surgeons have experience with targeted systemic therapy administration and multidisciplinary care, allowing an excellent relationship with our medical oncology team including participation with integrated surgical/systemic therapy clinical trials.

Single-port radical prostatectomy (SP-RARP), is another treatment option we offer for patients with prostate cancer. Not readily available at most hospitals, this minimally invasive robotic-assisted procedure uses a single incision, leading to less pain and faster recovery compared to traditional multiple-port approaches.

Learn about answers to commonly asked single-port robotic prostatectomies questions

Chemotherapy is often recommended before surgical removal of a urologic tumor to prevent the disease from returning or to delay its return. Chemotherapy is also prescribed to treat patients with advanced or metastatic diseases. Our medical oncology team provides experience and knowledge of innovative treatment options and investigational therapies. Yale Cancer Center is a major national research center for the development of novel therapies and provides our patients with access to the newest options available through clinical trials. Our team continues to search for combination therapies and targeted therapies to improve future outcomes. For some patients, there are treatment approaches that can help avoid the toxicities of conventional chemotherapy, and new immunotherapies are also becoming available for patients with recurring diseases. Our goal is to help patients live the longest possible time with the best quality of life.

Radiation oncologists are an essential component of our multidisciplinary urology team and are vital contributors to the care of our patients. Our radiation oncologists are at the forefront of treating urologic cancers. They continually evaluate new radiation technologies and conduct research to ensure that our patients receive the most cutting-edge treatment available, including volumetric modulated arc therapy for prostate cancer, bladder-sparing treatment of muscle-invasive bladder cancer, and use of an injection that can protect other organs from the effects of radiation. Our radiation oncologists participate in our urologic oncology tumor boards, where each patient’s images are reviewed and discussed, and help to ensure the best treatment plan is made.

Learn more about radiation oncology

The genitourinary pathology team has extensive expertise in tissue-based diagnosis of diseases of the kidney, bladder, prostate, and testis. Our genitourinary pathologists are national and international leaders in diagnostic classification of genitourinary malignancies, as exemplified by editorship of the World Health Organization book of genitourinary tumors, which is the worldwide standard. Uniformity of diagnostic approaches and terminology is assured by close and regular interactions, including regular genitourinary pathology consensus conferences and diagnostic sessions at a dedicated multi-headed microscope, in addition to weekly tumor board conferences. In this highly specialized area, our pathology team utilizes state-of-the-art techniques and approaches to provide diagnostic and prognostic pathology reports that are critical for the care of patients.

Often, prostate cancer does not require treatment. In the vast majority of patients, low-risk prostate cancer can safely be monitored, with some patients receiving treatment in the future. This allows patients to delay or avoid entirely the potential risks of treatment, while achieving excellent cancer outcomes. Men who are older, have other medical issues, or do not want to experience potential side effects from treatment may take this approach.

People with advanced prostate cancer may require hormone therapy, sometimes in combination with radiation, surgery and chemotherapy. Hormone therapy may benefit patients whose prostate cancer has spread or has recurred after treatment. These treatments usually reduce the levels of the hormone testosterone, which stimulates the growth of prostate cancer cells.

Risk factors are traits that may put people at greater risk of developing prostate cancer.

• Age: Although prostate cancer can strike at any time, the risk of developing the disease increases with age. Men over 65 represent two-thirds of all cases.
• Race: For reasons unknown, African Americans are twice as likely as Caucasians to develop prostate cancer. Asians and American Indians have the lowest incidence.
• Family History: A family history of prostate cancer can raise a person’s risk. This is especially true if the disease has hit several relatives or developed before age 60. Some men could benefit from genetic counseling to assess their risk for cancer.
• Nutrition: Studies suggest a diet rich in vegetables may reduce the risk of developing prostate cancer, while a high-fat diet may increase the odds of contracting the disease.

• Enlarged prostate (This could be a benign condition called prostatic hyperplasia, also referred to as BPH)
• Problems urinating
• Blood in the urine
• Frequent pain in the lower back, hips or other bones

PSA Blood Test

A simple test to detect the presence of prostate-specific antigen (PSA) in the blood can screen the prostate gland for cancer. PSA is a protein produced in the prostate. Patients with an elevated PSA may be at higher risk of having prostate cancer. Often, a more detailed evaluation including prostate MRI may be helpful. Some patients benefit from prostate biopsy. Tissue extracted during a biopsy provides more information to make an accurate diagnosis.

A physician may recommend a core needle biopsy for men with an elevated PSA level and abnormal digital rectal exam. During a biopsy, the physician inserts a narrow needle into the prostate to remove tissue samples for a pathologist to examine. If cancer cells are found, further tests are done to determine the extent and aggressiveness of the disease.

Pathologists determine the aggressiveness of prostate cancer using the Gleason grading system. This estimates the cancer’s potential to grow and spread. Cells with a low Gleason grade pose less of a threat. Tumors with a high Gleason grade (7 or above) are more likely to grow and spread beyond the prostate.

Various imaging tests are used to determine the stage or extent of the prostate tumor and whether cancer cells have spread to nearby tissues or other parts of the body. These tests may include:

• Artemis
• Bone scans
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)
• Ultrasound