I see about 300 men with prostate cancer each year. Many of them have low-risk disease and are candidates for active surveillance, meaning that no immediate treatment is necessary. In this approach, we monitor the tumor closely for signs that it might be growing or becoming more aggressive and hold off on treatment. For those men with more high-risk cancer that requires treatment, I primarily perform robotic-assisted radical prostatectomy.
At MSK, our treatment recommendations are based on personal risk. Not all men have the same risk — one size does not fit all. Many prostate cancers are of such low risk that treatment would only result in possible side effects, without improving patients’ life expectancy. Such cancers are best managed with active surveillance. Other men will benefit from either surgery or radiation therapy.
While most men are candidates for robotic surgery, some may still do better with traditional open surgery, a procedure I also perform. An area of special interest to me is men with high-risk prostate cancer who might not have been considered candidates for traditional open surgery. This includes men who have previously been treated with radiation therapy but whose cancer has returned.
My clinical research focuses on improving outcomes following surgery for prostate cancer. This includes controlling the cancer and restoring normal urinary and sexual function. Together with my colleagues in medical oncology and radiation oncology, we tailor therapy as accurately as possible to each individual’s cancer to control or cure it while minimizing treatment-related side effects.
We’re also starting to investigate the role of local treatment — surgery or radiation — in selected men with low-volume metastatic prostate cancer, meaning that their cancer has spread to a limited number of other sites in the body. Such men have traditionally been treated only with hormonal therapy. We are now investigating using a therapy in which men receive systemic treatment, such as chemotherapy, plus local treatment. The goal is to prolong survival and, ultimately, cure the cancer.
In addition, certain carefully selected men may be candidates for focal therapy, in which just the area of the prostate with the cancer is treated rather than the entire gland. This approach reduces the risk of treatment side effects while still eradicating the cancer.
During the course of my career I’ve given more than 180 invited presentations at meetings and symposia in the United States and around the world. I have also published 300 peer-reviewed studies in prestigious national and international journals.
As a doctor, my focus is on the whole person, not just his disease. I want my patients to be alive, but also to be able to live full and enjoyable lives.
