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Thursday, November 14, 2019

September is Prostate Cancer Awareness Month and there is good news to share about the latest in the detection and treatment of prostate cancer.

Prostate Cancer Screening

The American Urological Association recommends screening for men between the ages of 55 and 70 who have a life expectancy of 10 years or more. I recommend that men begin discussing screening with their physician by age 50 and have regular prostate cancer screening until age 70 or 75, depending on their overall health. If a man has a first-degree relative, i.e., a father or brother, who had prostate cancer, then screening should begin 10 years before the age at which that person was diagnosed.

Men should discuss prostate cancer screening with their primary care physician for guidance in their decision-making, based on their health, history and values.

BRCA and Prostate Cancer

Men with an inherited BRCA (BRCA1 or BRCA2) gene mutation are at higher risk for prostate cancer. If a man has a family member with a BRCA gene mutation, he should be tested for it, too. Because men with a BRCA gene mutation are at significantly increased risk for prostate cancer, as well as earlier onset and more aggressive forms of the disease, they need more aggressive screening, starting at an earlier age.

Elevated PSA levels

A common concern of patients is an elevated prostate-specific antigen (PSA) level, which is measured by a blood test. But an elevated PSA does not necessarily mean cancer. PSA levels can be high for a variety of reasons, such as infection, inflammation and injury. Generally, however, an elevated PSA level does warrant further investigation.

MRI/Ultrasound Fusion Biopsy

In addition to traditional prostate cancer biopsies, at Englewood Health we offer the latest MRI/ultrasound fusion biopsy technology. With MRI/ultrasound fusion, an MRI of the prostate is used as additional visual guidance during real-time transrectal ultrasound-guided biopsy.

Imagine a blueberry muffin. One blueberry in the muffin is big, and the others are small. With a traditional prostate biopsy, we take 12 random samples of prostate tissue. That’s like trying to hit the blueberries with a needle, without being able to see them. With the MRI overlay images, we can target any suspicious areas, in addition to the 12 samples. This allows for greater accuracy and enhances our ability to provide an accurate diagnosis, evaluate risk and create a personalized treatment plan, if necessary.

Active Surveillance

Active surveillance, or close monitoring for signs of disease progression, began about six years ago. Prior to that, the standard of care was to treat all diagnosed prostate cancer. Now, most men whose pathology reveals a low-risk, slow-growing tumor are followed with active surveillance. Patients with higher-risk tumors are treated with surgery or radiation therapy.

Robotic Surgery for Prostate Cancer

Numerous studies have found that robotic surgery results in less blood loss, shorter length of stay and faster recovery.

We also perform robotic kidney nephrectomies (kidney removal) and partial kidney nephrectomies (partial kidney removal) for kidney cancer. Robotic surgery can preserve more kidney function (for patients having partial kidney removal) and result in shorter length of stay and faster recovery.

The magnified view provided by the robotic technology allows the urological oncology surgeon to perform these procedures more precisely and in less time than with open surgery.

Genetic Testing of Tumors

The development of genetic testing over the past few years is an important advantage for patients with prostate cancer. At Englewood Health, all prostate tumor biopsies receive genetic testing, which can indicate the likelihood of disease progression. After prostate cancer surgery, we also perform tumor testing to predict the likelihood of cancer recurrence.

Personalized Care for a Range of

Urologic Conditions

At Englewood Health, our urologic oncology team provides personalized care in the way we would want our own family members to be treated. Throughout my day, I see a diverse range of patients and medical conditions. I might treat a young man in his 20s with testicular cancer in the morning and then diagnose and treat older men with prostate or bladder issues in the afternoon. In urology, many cancers and other diseases can be cured. It’s gratifying to be able to resolve these conditions for patients.

By Gerald Portman, MD


Gerald Portman, MD is a urologist at Englewood Health, part of the team at The Lefcourt Family Cancer Treatment and Wellness Center and a member of the Englewood Health Physician Network. In addition to English, Dr. Portman is fluent in Russian. Dr. Portman recently joined Englewood Health from Yale New Haven Health, where he was an assistant professor of urology. A specialist in minimally invasive surgery, he did his robotic surgery fellowship training at Hackensack University Medical Center.