Urologic Care: What Makes MSK Stand Out

Doctor in white coat speaks to patient whose back is to camera.

Urology Service Chief James Eastham explains treatment options to a prostate cancer patient.

Earlier this month, the U.S. News & World Report 2016-17 Best Hospitals issue ranked Memorial Sloan Kettering among the top for urology — number five in the nation and number one in the New York City area. This recognition of excellence reflects the dedication and expertise MSK brings to the treatment of people with prostate cancer, bladder cancer, kidney cancer, and testicular cancer, including pioneering many advances that today are the standard of care.

James Eastham, Chief of the Urology Service, explains what is distinctive about care for urologic cancers at MSK.

What makes the care your team offers stand out from other hospitals?

We have experts in every treatment option for all urologic cancers. For prostate cancer — my area of expertise — we offer active surveillance, which involves closely monitoring the disease for changes; robotic or traditional open surgery; all forms of radiation therapysystemic therapies such as hormone therapy, chemotherapy, and immunotherapy; and focal therapies, which involve treating only the cancerous portion of the prostate rather than the entire gland. For those with higher-risk disease, we offer access to clinical trials. Many centers have one option and try to fit every patient into that one box, be it robotic surgery or CyberKnife-type radiation [a form of stereotactic body radiotherapy]. If you have prostate cancer, your situation is unique and requires consideration of a variety of strategies. Having experts whose top priority is doing what is best for the person, rather than simply offering everyone the same option because it’s what’s available, is one of the things that makes MSK a great place to seek treatment.

For bladder cancer, our experts are skilled at using surgical techniques that can limit your side effects and speed your recovery, keeping in mind that preserving or re-creating the bladder is a key consideration. If you need chemotherapy before surgery, we can help you get through that phase of your treatment much more quickly than other cancer centers can because our bladder cancer experts work so closely together. After surgery, our nurses provide expert support in helping those patients whose bladder was removed and who require a stoma.

For kidney cancer, our specialists are practiced in minimally invasive and kidney-sparing surgery. We also have an active program of clinical trials designed to explore new treatment approaches. MSK is also among the nation’s most experienced in treating testicular cancer, caring for nearly 300 men who are diagnosed each year. For young men who are otherwise healthy, the experts in our Male Sexual and Reproductive Medicine Program regularly provide guidance regarding a variety of fertility and sexual health concerns, including how to store sperm prior to treatment

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What research are you most excited about right now?

In prostate cancer, the two research areas that excite me the most are focal therapy and multimodal therapies — which combine several treatment approaches — for patients with advanced disease who typically are treated only with hormonal therapy. In selected men in whom the cancer can be limited to one area of the prostate, focal therapy can destroy that area using heat, cold, electricity, or light energy. The majority of the prostate is left intact. This treats the cancer yet spares most normal tissue — resulting in better quality of life with fewer side effects. It offers an alternative to traditional surgery or radiation.

One of the main reasons we offer multiple options is because one person may value a particular aspect of care or outcomes that differs from those valued by another person.
James A. Eastham Urology Service Chief

We also see great potential in multimodal strategies. Many men with high-risk or metastatic prostate cancer are often treated with only androgen deprivation [hormonal] therapy. We are investigating new approaches that combine systemic therapy [newer hormonal agents], radiation, and surgery, sometimes guided by the genetic makeup of the cancer, to determine if we can improve survival in these men. This is investigational so not all such men are eligible, but this is a potential game changer in the management of advanced disease.

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What are some of the ways your team helps ease patients’ recovery?

Cancer naturally causes a great deal of anxiety, not only about life-and-death issues but also about the side effects of therapy. MSK has experts in psychiatry and psychology who lead the field in helping patients and their loved ones deal with all forms of urologic cancer. We also have specialty clinics devoted to helping men manage adverse effects of treatment, such as sexual dysfunction and urination problems.

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How do quality of life and patient satisfaction factor into your treatment recommendations?

Unfortunately, treatment of cancer does have risks, and patients need to understand these risks clearly. They should be wary of doctors or institutions posting overly optimistic data that are based on misleading factors. One of the main reasons we offer multiple options is because one person may value a particular aspect of care or outcomes that differs from those valued by another person. Listening to patients, understanding their concerns and those of their loved ones, and having a realistic discussion of expectations is critical for patients to be able to make an informed decision.

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Dr is insisting hubby have denosumab. He was diagnosed with stage 4 prostate cancer November 2015. Currently psa is 0.06 and bone density is normal. Takes lupron every 3 months. Also curamed 750 mg 2X and osteosheath 3X day. Very concerned about the side effects

Hi Lois, we recommend that you speak with your husband’s heathcare team if you’re concerned about what medications he’s taking or the side effects. If you’d like to arrange for a consultation with a doctor at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

I was diagnosed in May of 2015 with Kidney cancer. I have Systemic Lupus, from the Lupus I developed embolism disease, I have a IVC filter in my Vena Cava and Take Lovenox shots subcutaneously for the past 7 years. The first surgeon I saw scared me to death, I then decided to have stereotactic Radiosurgery, my first dose was Wednesday last week. I was freezing and cold to the bone when I arrived home and then hot and this continued through the night. A lot of nausea, a lot of pain in the area radiating down my left leg, the side of the kidney cancer. The Dr, who performed it said he has done 40 thousand cases and has never heard this. When I asked if I could have it once a week instead of twice, His response to me was it's a free country do what you want! I'm 62, have had a lot of things go wrong like pulmonary embolism on two different occasions, two strokes, two heart attacks, DVT once. Someone please tell me that what I experienced last week that landed me in bed for 4 days is not in my head. I had dry heaves for three of those days and he says "never heard of it, 40 thousand patients, your the first" At this point I am petrified and don't know what to do, am I doing the right thing, are these side effects normal. I would appreciate any input I can receive. Wednesday this week is supposed to be round two and I don't know if I can, too scared. Please help if you can. Sincerely Theresa Russell

HI Theresa, we’re very sorry to hear that you experienced this. If you’re not happy with the answers your doctor is giving you, we recommend that you speak to another doctor and get a second opinion. If you’d like to arrange for a second opinion at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

I received wonderful care during my stay at mskcc. Dr Sheri Donat and her team saved my life! The nurses at the hospital were amazing. I love going back every year for a clean bill of health.

Dear Linda, we’re so glad to hear you’re doing well. We’ll share your message with Dr. Donat and her team. Thank you for your comment, and best wishes to you.

MSK is the the best place to be if you have ANY kind of cancer. My husband has prostate cancer that spread to the bones. The disease is being controlled with many types of meds that allow him to have a life and lets him be with his loved ones. The urology team is great. We Have confidence in them.

Dear Susan, we’re so glad to hear that you’ve been happy with your husband’s care. Thank you for your kind words!

In October 2014 My husband was diagnosed with Prostate Cancer after a routine checkup that checked his PSA levels. We immediately left the urologist and turned to MSKCC where we met with Dr. Karim Touijer. Upon further examination he was also diagnosed with bladder cancer. I know that had we not found Dr. Touijer the bladder cancer would have gone undiagnosed and my husband may not be here today. He performed both surgeries and we visit him every three months for a checkup. I am eternally grateful for Dr. Touijer and his team at MSKCC.

Dear Fran, we’re so glad to hear that your husband is doing well. We will share your message with Dr. Touijer. Thank you for your comment, and best wishes to you and your husband.

Good blogging! I just want to ask whether you provide services of prostate cancer screening tests. Hoping a prompt response, thanks!

After bladder removal is an internal new urine deposit out of an intestine and colon, connected to a stoma instead of the urethra , feasible for an 84 year old in very good physical condition.

Dear Mauricio, we recommend that you discuss the various options with your surgeon. If you are interested in coming to MSK for a consultation, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

Dear Dr. Eastham,
I was diagnosed prostate cancer just now. The doctor said my prostate need to be removed. I asked questions and he thought I asked too much. After I read your above article, I found hope. Would you please schedule an appointment with me and accept me as your patient? Thank You and Best Regards.
Michael Hu

Dear Michael, we’re very sorry to hear about your diagnosis. If you would like to make an appointment with Dr. Eastham or one of our other prostate cancer experts, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.