Urology Update

UU Summer 2016 6-pager_Layout 1 8/31/16 11:16 AM Page 1

Active Surveillance: Prostate Cancer Awareness Month and Treatment Decision Making and Adherence Among Men’s Health Day Low Risk Prostate Cancer Patients Urology Update On Friday, September 23rd, hosted by role of exercise and diet in disease pre- daVinci surgical robot, used by our sur- Active surveillance (AS) is an option years without clinical evidence of can- formation about follow-up care, AS Dr. Ash Tewari, Chair, the Department vention and survival will be provided geons to perform prostate, kidney and The Milton and Carroll Petrie Department of Urology for men whose prostate cancer is con- cer progression. management plan, and delays in fol- of Urology will hold its annual Prostate by medical professionals, supplement - bladder cancer surgery. sidered low risk. Active surveillance Given these statistics, and hoping to low-up surveillance appointments con - Cancer Awareness and Men’s Health ed with printed materials. Free prostate A highlight of the event will be our Prostate Cancer Awareness Month Issue | September 2016 means that instead of treatment such better enhance patients’ treatment deci- tributed to anxiety levels. Financial event in the Guggenheim Pavilion Atri - cancer risk consultations will be avail- 2nd Annual Push-Up for Prostate Can- as surgery or radiation, these patients sions and adherence to active surveil- and life insurance barriers to AS um at Mount Sinai Hospital from 10 am able from 10 am–1:15 pm. For men who cer Challenge at 1:15 pm. Faculty, staff, will be monitored on a regular basis lance follow-up tests, Mount Sinai has emerged as significant concerns about to 2:30 pm. are appropriate candidates and wish to students and visitors will be invited to Mount Sinai First to Test Gold Nanoparticle Treatment for signs of more aggressive disease. undertaken the first study to examine an patients’ ability to stay on an AS proto- Information about prostate cancer, be screened, PSA blood tests will be of- test their athletic ability. Last Septem- Monitoring comprises PSA blood test- intervention to enhance adherence to col in the future despite their willing- men’s health, urological disease and the fered. Guests can also “test drive” the ber, a total of 3,576 push-ups were for Prostate Cancer ing and a digital rectal exam (DRE) active surveillance. Led by Dr. Nihal Mo- ness to continue AS. performed by over 60 participants. No Prostate Cancer specialists at Mount Sinai have treated Fast forward to earlier this year, when he met Dr. Art every few months (the same tests that hamed, the study (phase one) inter- These findings provide evidence for one surpassed Dr. Dennis Charney, their first patient in an exciting new clinical trial with the Rastinehad, Director of Focal Therapy and Interventional are performed for screening), and viewed low risk prostate cancer patients the existence of unmet informational Dean of the Icahn School of Medicine objective of minimizing side effects frequently experienced Urologic Oncology and learned he could undergo a biopsy biopsies at time intervals determined on active surveillance at the Mount Sinai and supportive care needs of low-risk at the Mount Sinai Health System, after radical prostatectomy using a combination of an by the physician. Health System between January and prostate cancer patients making deci- who won the Challenge with a total of or radiation ther apy for MRI of the prostate and a At Mount Sinai, Dr. Ash Tewari has May of 2016, and explored: sions about AS and the barriers and fa- 106 push-ups. prostate cancer while still new approach pioneered one of the largest active surveillance 1) barriers and facilitators of treat- cilitators of patients’ decisions, espe- completely eliminating a here at Mount Sinai. This patient cohorts in the country. Pa- ment decision making regarding active cially adherence to AS. Patient and Prostate Cancer Awareness Month and cancerous tumor. time, the biopsy result was tients under Active Surveillance gen- surveillance provider factors that influence adher- Men’s Health Day Martin Feeney, 70, was di- less favorable. Martin was erally have a PSA blood test and DRE 2) patient and physician factors that ence to AS protocol include patient ed- Friday, September 23rd agnosed with low grade, low found to have a clinically sig- every 3 months, an MRI yearly and influence adherence to the AS protocol ucation about follow-up care require - 10 AM–2:30 PM volume prostate cancer four nificant Gleason 3+4 cancer. biopsy every 3 years. Active surveil- 3) unmet informational and sup- ment, patient tolerance of anxiety and Guggenheim Pavilion Atrium years ago. That was distress- He was faced with a decision lance is sometimes referred to as portive care needs distress, and the value of and desire to Mount Sinai Hospital ing for him, but as scary was of which treatment (surgery “watchful waiting” or “expectant man - The results were enlightening. The maintain sexual function. 1468 Madison Avenue his developing sepsis (a po- vs. radiation) to choose to agement”, but active surveillance is majority of patients followed the physi- Dr. Mohamed believes educational tentially life threatening com - treat his prostate cancer. the favored term for this approach, cian’s recommendation (90%) and few and psychosocial interventions are plication of infection), a re sult Fortunately for Martin, Dr. because it is a proactive, rather than patients searched the internet for ad- needed to enhance AS treatment deci- Dr. Art Rastinehad, Martin Feeney (patient) Department of Urology Offers of the biopsy he underwent and Mrs. JoAnne Feeney Rastinehad is leading the na- a passive regimen. ditional information about active sur- sion making in both patients and their Convenient Locations following his diagnosis. Once tional team investigating a new The decision to follow an active surveillance (30%). Factors that influ enced partners and is developing such pro- recovered, Martin was advised he could follow an active sur- procedure based on nanotechnology that can treat prostate le- Mount Sinai Hospital veillance protocol is a highly personal patients’ decisions to opt for AS in- grams that she will be evaluating later veillance program to monitor his cancer, but he was nervous sions found on biopsy locally instead of removing or radiating 5 East 98th Street one. Some men, aware of the potential cluded trust in the physician’s expert- this year. In the meantime, “physi cians about the regimen of biopsies required for this treatment the entire prostate. This option can give men more confidence 212-241-4812 side effects of curative treatment (i.e., ise, good intentions, and skills in de - could benefit from patient-provider plan. That concern resulted in his delaying his next biopsy for that their cancer will be successfully removed without worry- sexual and urinary side effects) are tecting cancer progression in a timely training to enhance their communica- Did You Know? Mount Sinai Midtown Center over a year. Continued on page 4 elated to have this option. But others manner; and avoidance of sexual and tion skills,” she says. “Our study indi- Dr. Ash Tewari/Men’s Health are uncomfortable with the idea that urinary deterioration associated with cates that patients will accept an AS What are the signs and symptoms of prostate cancer? 625 Madison Avenue cancer, no matter how low risk, is re- other treatment options. Participants recommendation if they trust the 212-241-9955 Prostate cancer is considered a “blind ferred to as an enlarged prostate. siding in their body. In fact, approxi- expressed no desire to discontinue AS physician’s good intentions and skills Mount Sinai Beth Israel Hospital Insights from Dr. Ash Tewari, Chair more updates inside: killer” because there are no symptoms Painful urination may indicate a uri- mately 90% of patients eligible for or regret of decision to opt for AS. Par- in detecting cancer progression in a 10 Union Square of prostate cancer in its early stages. nary tract infection. Blood in the urine active surveillance opt for curative ticipants, however, reported anxiety timely manner but the challenge is By the time symptoms appear, cancer should always be checked out in a 212-844-8900 The controversy over when and who to Faculty Introductions treatment and 25–50% of patients on associated with having cancer that in- keeping them on the protocol, so un- is considered advanced. The symptoms timely manner as it can be a symptom Mount Sinai West screen for prostate cancer continues to active surveillance discontinue the ac- creased around time of clinical testing derstanding their fears and concerns is include difficulty urinating, pain while of bladder cancer. But it can also indi- 425 West 59th Street confuse men and their loved ones. In Immunotherapy tive surveillance protocol within 2–5 of cancer progression. Lack of full in- paramount.” n 212-523-7756 2012, The United States Preventive urinating, blood in the urine, and pain cate a kidney infection or kidney stone Active Surveillance or stiffness in the back, hips, upper or in some cases, is just a result of Mount Sinai St. Luke’s Hospital Services Task Force came out against 1111 Amsterdam Avenue screening for prostate cancer for all thighs, or pelvis. strenuous exercise. Pain in the hips Prostate Cancer Awareness Day Men should keep in mind that some and back can be the result of strenuous 212-523-4000 men, claiming that doing so results in overdiagnosis and overtreatment. of these symptoms are signs of other exercise as well. Because there are no Mount Sinai Brooklyn Did You Know? conditions, some more serious than early symptoms, the best defense is 300 Cadman Plaza West The Amer ican Urological Association Dr. Nihal Mohamed discusses Active Surveillance others. For example, difficulty urinat- knowing your risk and speaking with 929-210-6170 disagreed, but responded by revising with a patient. She hopes conversations that their guidelines, recommending screen - address a patient’s fears and concerns will ing can be a sign of benign prostatic your physician about getting a baseline Mount Sinai Queens ing men at risk at 40 and encouraging improve adherence. hyperplasia (BPH), which is also re- PSA (along with a DRE) in your 40s. n 27-15 30th Avenue men from 55–70 to engage in shared 718-808-7375 decision making: speaking with their

The medical information in this newsletter is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes or as a substitute for professional doctors about their personal risk for diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition. The Mount Sinai Health System expressly disclaims responsibility and shall have no liability for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this newsletter. The Mount prostate cancer and the benefits of Sinai Health System and Department of Urology do not endorse specifically any test, treatment, or procedure mentioned in this publication. CONTACT US if you have a comment about an article or screening. Most recently, a study out would like us to cover a particular topic. We welcome your feedback. And, if you would like to be removed from our mailing list, please contact Kathy Gilbert, Director of Marketing at Dr. Ash Tewari [email protected]. Continued on page 4 5 6 UU Summer 2016 6-pager_Layout 1 8/31/16 11:17 AM Page 2

The Faculty of the Department of Urology Insights from Dr. Ash Tewari Gold Nanoparticle Treatment Immunotherapy: Fighting High Risk Cancer with Continued from page 1 Continued from page 1 Urology Associates is comprised of board-certified and fellowship-trained physicians who are consistently recognized by their peers and their patients as the best in their fields. Personalized Defense Systems of Northwestern University reported ing about side effects that can impact an increase of metastatic pros tate can- quality of life. Prostate cancer is the second leading cause of cancer death in men. The Immunomodulators in combination with other treatments cer (cancer not confined to the pros - In May, Martin was the first man to Dr. Ketan K. Badani Dr. Aaron Grotas Dr. Jay A. Motola Dr. John Sfakianos American Cancer Society predicts there will be an estimated 180,890 new Immunotherapy can be used with traditional types of cancer treatment, in- tate gland) of 72 percent in the ten undergo gold nanoparticles directed Urologic Oncology, General Urology Cryosurgery, General Urologic Oncology, cases of prostate cancer and 26,120 deaths in 2016. There is not yet a reliable cluding surgery, hormone therapy, chemotherapy, radiation and ablative years between 2003 and 2013, raising focal laser ablation (removal) of his le- Robotic Surgery Mount Sinai Beth Israel Urology Prostate Health, Robotic method to predict the course of the disease or to distinguish between indolent therapy. We will focus on studies that will evaluate the success of im- the question whether a trend of fewer sion. Gold nanoparticles, also known as Mount Sinai Hospital Hospital Mount Sinai West Surgery from aggressive types. Radical prostatectomy (removal of the prostate) is a munotherapy with several of these treatment options. men screened might be contributing AuroShell® particles, are infused into Mount Sinai West Mount Sinai Hospital standard treatment approach for clinically localized prostate cancer and to this rise or whether the disease has the blood of the patient where they set- Mount Sinai Queens while it is curative in a large proportion of patients, approximately 25% of Immunotherapy of early and clinically localized agressive cancers just become more aggressive. More tle into prostate lesions. These particles patients will ultimately develop disease recurrence (metastases). Treatment There are several immunotherapeutic agents in clinical trials at this point studies need to be conducted to an- absorb laser light and create heat, dif- of metastatic disease is a major clinical challenge as recurrent metastatic tu- in time but their focus is on advanced disease and treatment alternatives for swer this question def ini tive ly, but in ferentiating the lesions from nerve tis- Dr. Natan Bar-Chama Dr. Mantu Gupta Dr. Harris M. Nagler Dr. Sovrin Shah mors eventually develop resistance to androgen deprivation (hormone ther- high risk prostate cancer patients. There exists a need for new strategies to either scenario, early detection makes sue or blood vessels, allowing for highly apy) and radiation and/or chemotherapy. This is why researchers, including reset a patient’s immune response so that it is able to prevent tumor spread sense. Erectile Dysfunction, Kidney Stones, Strictures, Sexual Health, Infertility Female Pelvic Medicine, targeted ablation. our team at Mount Sinai, are seeking ways to attack high risk cancer before and/or resistance to treatment. Male Infertility, Andrology Upper Tract TCC Mount Sinai Beth Israel Reconstructive Surgery We believe that all men should be Follow up imaging of Mr. Feeney’s the metastatic stage. Based upon response to immunotherapeutic agents to date, we believe we Mount Sinai Hospital Mount Sinai West, Hospital, Mount Sinai Mount Sinai Beth Israel screened by the time they are 50 (men prostate showed no sign of cancer. He Immunotherapy is treatment that uses a patient’s own immune system can elicit similar responses in patients with localized, aggressive disease and Mount Sinai Midtown Mount Sinai Midtown Midtown Center Hospital, Mount Sinai at highest risk around 40), or at a min- is doing well at this point in time and Center Center Midtown Center to fight disease. Immunotherapy treatment has garnered significant in- oligometastasis (cancer that has spread beyond its primary site, but is limited imum, be speaking to their doctors has experienced no side effects. He terest as a promising option for increasing survival for several cancers. to 5 or fewer spots, typically confined to one organ) in addition to metastasis. about the screening process. The PSA and Dr. Rastinehad are both elated. Indeed, the first immunotherapeutic agent approved by the FDA for any The benefits of this focus are profound: eliminating the need for invasive treat- blood test is not a perfect tool. But, “This new treatment may allow men cancer was for prostate cancer: in 2010, the FDA approved Sepuleucel-T, ment such as surgery or the side effects of radiation or chemotherapy and in along with a DRE (digital rectal exam), to avoid side effects yet still obtain Dr. Norman Coleburn Dr. Grace Hyun Dr. Craig F. Nobert Dr. Doron Stember Erectile Dysfunction, a vaccine that was shown to elicit a response against the prostatic acid all cases, preserving of quality of life (i.e., urinary and sexual function). screening with the PSA is the best de- excellent outcomes,” Dr. Rastinehad Prostate Cancer, BPH Pediatric Urology Urologic Oncology, Infertility, Andrology phosphatase (PAP) antigen, which is expressed in most prostate cancers. fense we have to diagnose a cancer that says. “Mount Sinai is the first hospital Mount Sinai St. Luke’s Mount Sinai Hospital Robotic Surgery, Kidney Mount Sinai Beth Israel Mount Sinai researchers were among the scientists responsible for its de- Impact of immunotherapy in racial disparity of cancer is forecast to account for 26,120 deaths in the world to have brought this to Hospital Mount Sinai Beth Israel Stones, Prostate Health Hospital, Mount Sinai velopment and approval. Persons of African American descent are the group most at risk for aggres- this year. The PSA test gives us a num- patients; we could not be more Hospital Mount Sinai West Midtown Center The Uro-Immuno-Oncology Program at Mount Sinai is dedicated to cut- sive prostate cancer. Our research will explore immunotherapy in African ber that can be tracked over time, and thrilled.” n ting edge research in comparative immunotherapy and the development of American patients in the hope of decreasing the disease burden. does allow us to best predict cancers novel immunotherapy strategies for genitourinary cancers. We have multiple that are likely to be aggressive. The PSA Prostate Cancer Risk Factors areas of focus: Our overarching goal is to develop new immunotherapy agents, personalized to has resulted in many fewer advanced Dr. Caner Dinlenc Dr. Jeffrey A. Stock Dr. Steven Kaplan Dr. Michael A. Palese a patient’s own tumor, and with increased ability to educate a patient’s immune sys- cases of prostate cancer at the time of • Race – African Americans are Urologic Oncology, Pediatric Urology, Robotic Benign Prostate Disease, Robotic Surgery, Development of novel immunomodulatory agents for genitourinary tem to eliminate cancer. We believe that when these immunotherapy agents are ad- diagnosis. Kidney Stones, Robotic Surgery 1.6 times more likely to be diag- Men’s Health Urologic Oncology, cancers ministered alone or in combination with existing treatments a potent immunologic Like a Bengal tiger, prostate cancer Surgery Mount Sinai Hospital nosed with prostate cancer than Mount Sinai Midtown Kidney Stones, Prostate Our goal is to develop immunotherapy agents with the ability to either ac- and tumor-specific effect will be generated and that one or more of these agents will can be gentle or vicious. Metastatic Mount Sinai Beth Israel Caucasians and twice as likely to Center Health celerate tumor elimination or prolong the stage when there is “crosstalk” or succeed as first-line treatment for clinically localized aggressive disease. We are ex- prostate cancer is not curable and late Hospital die from prostate cancer. Mount Sinai Beth Israel communications between a tumor and the immune system to keep the bal- cited that precision immunotherapy has long-term clinical benefits and potential stage disease is marked by intense Hospital, Mount Sinai Hospital, • Family History – Family history ance that prevents tumor growth. to dramatically improve prostate cancer outcomes. n pain, fatigue, weakness and a highly is a key risk factor for prostate Mount Sinai Midtown Center impaired, very poor quality of life. But Dr. Michael J. Droller Dr. Hugh J. Lavery Dr. Ash Tewari cancer. Having one affected first Dr. Courtney K. Phillips when prostate cancer is detected Urologic Oncology Elmhurst Hospital Center Prostate Cancer, early, nearly 100% of men are cured. degree relative (father, brother) Mount Sinai Hospital and Queens Hospital Urologic Oncology, Prostate Health, has high risk, and the risk jumps Kidney Stones, Prostate And in the hands of an experienced Center Robotic Surgery, Urologic if they were diagnosed younger Health surgeon, and with the precision that Urologic Oncology, Robotic Oncology, Men’s Health robotic prostate surgery affords (mag- than 65 or if two or more first de- Surgery Mount Sinai Hospital Program Drs. Shalini Singh, Sujit Nair and Nina Bhardwaj (left to right) are nification of the operative field and gree relatives were diagnosed at Mount Sinai Hospital working to develop effective immunotherapy agents, personalized less blood loss than open surgery), any age. Second degree relatives Mount Sinai Midtown Center to a patient’s own tumor, and with increased ability to educate a Dr. Erik Goluboff Dr. Reza Mehrazin treatment side effects are minimal (e.g., uncle) count, too. Urologic Oncology Urologic Oncology, Dr. Art Rastinehad patient’s immune system to eliminate cancer. They believe that and can usually be resolved in a rea- precision immunotherapy has the potential to dramatically • Age – Prostate Cancer is not Mount Sinai Beth Israel Robotic Surgery Focal Therapy and improve cancer outcomes. sonable timeframe. usually seen in men under 40, but Hospital, Mount Sinai Mount Sinai Hospital Interventional Urologic This September, we hope you will is diagnosed increasingly with Brooklyn Mount Sinai Beth Israel Oncology, Urologic start this new season and mark Please visit us at Hospital Oncology each passing decade. www.mountsinai.org/urology Prostate Cancer Awareness Month by Mount Sinai Hospital talking to your physician about your • Diet – The effect of diet on Mount Sinai Beth Israel Hospital You will find full profiles of our risk, getting screened if appropriate, prostate cancer diagnosis has few Mount Sinai Midtown Center Dr. Neil Grafstein Dr. Nihal Mohamed faculty, conditions we treat, and encouraging family and friends to clear-cut answers. It appears that Post-prostatectomy Oncologic Behavioral advancements in treatments, do the same. men who eat a lot of red meat and Incontinence, Science information on clinical trials, news high-fat dairy products have a Reconstructive Urology, Mount Sinai Hospital articles, a newsletter archive To your health, slightly increased chance of get- Female Pelvic Medicine, and more. ting prostate cancer. Urethral Stricture, BPH Ash Tewari Mount Sinai Hospital, Mount Sinai 2 Midtown Center 3 4 UU Summer 2016 6-pager_Layout 1 8/31/16 11:17 AM Page 2