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 sur- veillance (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.