We work in collaboration with oncologists at the Lifespan Cancer Institute and its Genitourinary Multidisciplinary Clinic, with the goal of precisely diagnosing and treating prostate, kidney, and bladder cancers as soon as possible.
Expertise with High-Risk Patients
We have extensive experience caring for high-risk prostate cancer patients. High-risk prostate cancer includes men with a Gleason score of 8-10 or PSA greater than 20. These types of aggressive prostate cancers often require multiple modalities of treatment and a team-based approach to treatment.
We utilize various imaging technologies to give you the best care:
- PET scans
- Prostate MRI scans
- High-resolution CT scans
We use diagnostic tests to help identify prostate, kidney, and bladder cancers:
Fluciclovine PET – This is an advanced diagnostic imaging agent, or radiotracer, that’s used with a positron emission tomography (PET)/computed tomography (CT) scan for men who have had prior treatment for prostate cancer and now have elevated prostate specific antigen (PSA) levels.
PSMA PET – PSMA stands for prostate specific membrane antigen, a protein found on the surface of prostate cancer cells. Positron emission tomography (PET) is a type of medical imaging that detects if prostate cancer has spread anywhere in the body. PSMA PET imaging allows for more precise detection of prostate cancer in the body, for better treatment planning, and targeted care. This exam uses a new imaging agent that is far superior to earlier agents to detect prostate cancer that may have spread to other parts of the body.
Transperineal biopsy - This is the gold standard for diagnosing prostate cancer. A transperineal biopsy is a newer approach for detecting prostate cancer that has benefits for both patient and surgeon, the transperineal prostate biopsy targets the perineum, the area between the testicles and anus. It has decreased risk for infection compared to the more traditional prostate biopsy, is a more comfortable procedure for the patient, and is appropriate for men who have an elevated PSA or are at increased risk for prostate cancer.
Fusion MRI - one of the newest and most advanced technologies available to diagnose and monitor prostate cancer is the MRI/Ultrasound Fusion-Guided Prostate Biopsy. MRI images of the prostate are fused or blended with real-time ultrasound images using special computer software known as computer-aided detection (CAD). This allows the provider to target the biopsy of the suspicious areas much more accurately than the standard TRUS (transrectal ultrasound) biopsy. This is performed as an outpatient service.
The Miriam Hospital is one of a few Northeast locations offering game-changing technology known as NanoKnife, a minimally invasive, ablation therapy for prostate cancer. Unlike other treatments, this outpatient procedure destroys cancer cells using electric current. (Image courtesy of AngioDynamics, Inc. and its affiliates.)
Treatment Options for Prostate Cancer
Our prostate cancer therapies include:
- Robot-assisted laparoscopic radical prostatectomy, using minimally invasive, robot-assisted surgery
- Robot-assisted laparoscopic pelvic lymph node dissection, in which a pelvic lymph node is removed and sent for pathology analysis
- Brachytherapy, an internal radiation therapy delivered by implant of small radioactive seeds at the site of the tumor
- Salvage prostatectomy, a procedure for patients who have previously had radioation therapy.
For certain patients, additional therapies may also be used.
Minimally Invasive Surgery for Prostate Cancer
At the institute, we use minimally invasive, robot-assisted surgery to treat prostate cancer. The da Vinci Surgical System is a state-of-the-art surgical robot that gives surgeons more precise views of the prostate and surrounding tissue, as well as greater dexterity. Benefits of surgery with the system could include preservation of the nerves located along the prostate. The goal for the nerve-sparing, robotic prostatectomy is to enable the patient to retain sexual function. Additional benefits may include:
- Smaller surgical incisions of one inch or less
- Less intraoperative blood loss and need for blood transfusion
- Reduced postoperative pain and discomfort
- Shorter hospital stay (one day)
- Shorter catheter duration (seven to 10 days)
- Faster overall recovery
With the da Vinci Surgical System the surgeon controls the robot from a remote console that precisely translates hand, wrist and finger movements to the robotic arms that manipulate miniature surgical instruments within the patient. The video screen provides a three-dimensional, magnified view of those movements. Using the robot, the surgeon makes small keyhole openings rather than a single large incision. The surgeon then completes the surgery through the small openings.
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