Mark Mitchell and Dr. Steven Kardos chat in the Norma Pfriem Healing Garden at Park Avenue Medical Center.
On the right “tract”
Today, Mark Mitchell, 71, of Bridgeport, is happy, smiling and appreciative.
A year ago, life was quite different. Mark was experiencing prostate symptoms, which led to an appointment with urologist Matthew Wosnitzer, MD, of Northeast Medical Group Urology. Dr. Wosnitzer performed a prostate exam and ran a prostate-specific antigen (PSA) blood test, which measures the protein produced by cells of the prostate, a walnut-sized gland that sits under a man’s bladder and next to the rectum. An elevated PSA can reveal a malignant disease such as prostate cancer or a benign, or noncancerous, condition such as an enlarged prostate, known as benign prostatic hyperplasia (BPH).
Mark’s PSA level came back high, so in August of 2016, Dr. Wosnitzer biopsied his prostate. The results uncovered high-risk prostate cancer.
Prostate cancer is the second most common cancer in American men, other than skin cancer, according to the American Cancer Society. About one in seven men will be diagnosed with prostate cancer during his lifetime.
“Prostate cancer is usually asymptomatic. Symptoms like urinating more frequently, having to go more oft en, not being able to hold your urine and getting up at night can be a sign of an enlarging prostate, but are not specifically related to prostate cancer,” said Preston Sprenkle, MD, Yale Medicine urologist. “But these symptoms are good reasons to see your urologist or primary care physician to get a PSA test and prostate exam.”
Treatment, recovery and remission
After Mark’s cancer was discovered, Dr. Wosnitzer referred Mark to a partner in his practice, urologist Steven Kardos, MD. Treatment options vary because of the grade of the tumor, measured by the Gleason score, and the stage of the cancer.
The Gleason score, as defined by the American Cancer Society, is the grade that pathologists give prostate cancers using a scale from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope.
“Mark can see me in the same building where he can meet with our radiation oncologists, which provides great continuity of care,” said Dr. Kardos. “We sat down and talked about the treatment plans and options, from surgery to radiation, and he decided on surgery.”
Mark underwent a prostatectomy, or the surgical removal of the prostate, six weeks later at Bridgeport Hospital, using the da Vinci® minimally invasive robot-assisted surgery system. “The surgical techniques we use have really revolutionized the care for prostate cancer patients,” said Dr. Kardos.
“We perform the procedures robotically and have great visualization. We are able to provide the highest level of care and have better outcomes for our patients.”
Mark was pleased with the robotic procedure and his Bridgeport Hospital experience. “I went into surgery smiling. The staff was fantastic,” said Mark. “The next thing you know, I was waking up from surgery and, after a day or two, was headed home.”
Mark does exercises to help with urinary problems after his surgery, but other than that, he is cancer-free. Dr. Kardos’s office closely monitors Mark’s PSA, which has been undetectable since his surgery. Mark jumped back into caring for his 13 grandchildren along with his wife Carolyn. He is thankful for the care he received from Dr. Kardos and Bridgeport Hospital. “Even though Dr. Kardos is a Philadelphia Eagles fan, I like him anyway,” laughed Mark, an avid New York Giants fan. “I am very grateful.”
Benign urologic issues
Not all prostate or urinary issues lead to a cancer diagnosis. According to Jeffrey Small, MD, attending physician at Bridgeport Hospital and urologist with Adult and Pediatric Urologists & Vasectomy Center of Fairfield County, there are non-cancer-related processes that can affect men as they age. Among them are BPH (enlargement of the prostate) and low testosterone or Low T. Some men may experience decreased sexual desire, low energy, weight gain, decreased erectile ability and loss of muscle mass, which can be caused by Low T.
Similarly, as men age, they may notice decreased strength of their urine flow, increased frequency of urination both day and night as well as feelings of not emptying their bladder completely. This variety of symptoms can be due to BPH and treatment will depend on the severity of symptoms.
“Treatment can include careful monitoring of fluid intake and behavioral modification, medical therapy, minimally invasive procedures and surgical therapy,” said Dr. Small.
“When we look at Low T, we need to determine what the root cause is,” said Jeremy Kaufman, MD, Bridgeport Hospital-affiliated urologist at Urological Associates of Bridgeport. “There can be primary and secondary causes. In the most simplistic way, testosterone is produced at night, when we sleep, so even sleep issues like apnea can cause low testosterone.”
Low T can be caused by underlying diseases such as diabetes, obesity, sleep disturbances like sleep apnea, or opioid use. Low T isn’t an age issue; it can affect men in their 20s and up.
“These benign conditions can be bothersome, but treatment can be straightforward, simple, effective and well tolerated,” said Dr. Kaufman. “I saw a patient earlier today and he wanted to know, ‘Is anything wrong with me?’ We ran three or four simple tests here in the office and within five minutes, I was able to tell him, ‘No, you are fine.’”
For those men struggling wiTherectile dysfunction issues caused by any type of pelvic surgery, or radiation therapy to the pelvis, penile rehabilitation may be an option. Daniel*, 55, of Bridgeport, used this treatment after his prostatectomy.
“For men, pelvic surgery, whether for prostate cancer or other problems, can damage the nerves or arteries or cause inflammation in the pelvis,” said Dr. Wosnitzer. “However, there are treatments to help with these issues should they occur.”
Daniel was concerned about having an active sex life after his prostate removal. For him and many other men, treatment meant starting an oral medication, Cialis, immediately after prostate removal surgery.
“A key component of post-surgery care is to improve and possibly maintain baseline function,” explained Dr. Wosnitzer. “Rehabilitation studies have shown that patients benefit from a consistent daily medication regimen for at least one year after their surgery. These patients are closely monitored by my office to ensure the treatment is working properly.”
Daniel also uses injection therapy to treat his post-surgery erectile dysfunction. His PSA remains undetectable in blood tests. Daniel is in remission.
“I felt so comfortable talking to Dr. Wosnitzer the first time I met him,” said Daniel. “I was concerned with how things would work after my surgery, but he told me, ‘We can take care of this,’ and he has. He always put me at ease.”
“When it comes to your healthcare, a lot of these topics are very personal and intimate issues,” said Dr. Kardos. “It can be challenging for patients to reveal their symptoms, but it is important for men to understand that treatment options are available.”
Bridgeport Hospital offers free PSA screenings at the hospital and/or Park Avenue Medical Center locations, usually during September, National Prostate Cancer Awareness Month. Educational lectures are typically offered during November in celebration of “Movember,” a month when men “change the face of men’s health” by growing a mustache in solidarity with men around the world to raise awareness of men’s healThissues such as testicular cancer, depression/anxiety, substance dependence and improving overall fitness. Visit bridgeporthospital.org/events for more information.
“These men’s health issues can be overlooked,” said Dr. Wosnitzer. “Up to 80 percent of men do not visit a doctor until they are convinced by their spouse or partner.”
Both Mark and Daniel agree that the best course of action is to make an appointment with your physician.
“If you have concerns, just get checked by your doctor. Medicine is very advanced now. If they find something early, like cancer, it could save your life. It is not the end of the world,” said Daniel.
For more information on urology or Smilow Cancer Hospital services through Bridgeport Hospital, please visit bridgeporthospital.org.
Artemis biopsy device
If a patient’s prostate biopsy comes back negative, but his PSA keeps rising, he may be an ideal candidate for a magnetic resonance imaging (MRI)/ultrasound fusion prostate biopsy tool called the Artemis device. “The prostate is the only solid organ where we have poor imaging of inside the organ. With the combination of the MRI and ultrasound, we are better able to identify lesions within the prostate to biopsy,” said Dr. Sprenkle. The Artemis tool is available at Yale New Haven and Greenwich Hospitals, which, like Bridgeport Hospital, are members of Yale New Haven Health.