Central PA Medicine Summer 2021 - 25

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the disease for those with both localized and
advanced cancer. I typically recommend a
repeat test in 8-10 weeks to rule out an initial
false positive. If the level remains high despite
findings on the rectal exam, we proceed with a
biopsy and/or an MRI of the prostate.
If a biopsy shows cancer, the next step
is sitting down with the patient and close
family members to discuss and review the
diagnosis and significance of the disease. The
variables that impact our decision and strategy
include the patient's age, comorbidities, family
history, PSA value, grade and volume of the
cancer, and finally the patient's own inherent
psychological factors.
As mentioned previously, cancer is heterogenous
in its behavior and when combined
with the above variables, each patient and
subsequent treatment strategy is tailored
specifically to them.
Those treatment options span a wide range.
The big decision for most patients with
localized disease is treat or not treat. Choosing
active surveillance (typically reserved for low
grade, low risk disease) utilizes periodic PSA
testing and monitoring with MRI. Periodic
biopsies are performed to determine disease
progression and dictate if treatment should
be instituted.
For those seeking treatment, the options
include external beam radiation therapy,
brachytherapy, cryotherapy, or robotic prostatectomy.
With any decision there are
considerations regarding disease cure, side
effects, and a patient's overall quality of life.
Radiation treatment including brachytherapy
and external beam are usually well tolerated,
but can cause irritation of bladder and prostate,
rectal bleeding, incontinence, as well as the risk
of erectile dysfunction (ED). However, men
have options to help mitigate these side effects
including a new procedure called SpaceOAR™
hydrogel, which protects the rectum and
reduces radiation toxicity and long-term side
effects. The outpatient procedure is done
under local sedation and performed by the
radiation oncologist.
Robotic surgery has been a major gamechanger
in the surgical management of prostate
cancer. It's less intimidating but remains
effective and the preferred therapy to eradicate
intermediate or aggressive cancer in most
men under 70. The surgical technique has
evolved over the years leading to improved
post-operative urinary control, reduction in
ED, shorter hospitalizations, less blood loss,
and a quicker return to normal activity.
High-volume institutions and high-volume
surgeons have been shown to have overall,
better surgical outcomes both in oncologic
control and quality of life measures. Each year,
UPMC surgeons perform more than 3,000
robotic-assisted surgical procedures. This makes
UPMC one of the highest-volume robotic
surgery providers available.
In addition to improving surgical techniques,
we've also adopted pre-operative physical
therapy for men to reduce their risk of post-surgical
incontinence. This helps to strengthen
the pelvic muscle and reduces the risk of
incontinence and gain a sense of control when
incorporated into the pre-operative setting
and applied during the post-operative period.
As a man, it is not lost on me that the decision
to undergo surgery is the most difficult
one a patient likely encounters. A prostate
cancer diagnosis and fear of the post-operative
experience can be dehumanizing. From the
operation itself to having a catheter, wearing
pads to get rid of leaking, ED, and/or worrying
about the cancer returning all evoke raw
emotions as men try to maintain some level
of sanity. My goal is to communicate clearly
with patients and their partners about these
potential mental health realties prior to surgery
and to be sensitive if they arise during the
post-operative period.
Where I see a deficiency in some facets
of patient care is a lack of counseling in the
pre-operative and post-operative setting. It
should be as readily available as physical therapy.
We need to incorporate mental health into our
treatment plans, but we face obstacles even
now. Mental health specialists are limited and
the stigma surrounding men's mental health
remains. Yet, there is such a demand for this
level of care.
This is one of the reasons it's imperative to
establish relationships and provide the resources
available to our patients. As a member of the
UPMC team, I'm proud to say my colleagues
and I do just that. We've treated thousands
of patients for prostate cancer. Our team has
experience with understanding the disease
process and understanding the psyche of the
patient. The more we can clarify expectations
and prepare the patient for what is ahead, the
more successful the outcome.
UPMC Hillman Cancer Center is an
important, collaborative partner for prostate
cancer treatment. Nationally recognized for
excellence in cancer care, its name is synonymous
with quality - the standard you want
when facing a cancer diagnosis. At UPMC in
central Pa., we are an extension of this expert
care. When there is a need for a higher level
of care, there is no need to travel. The ability
to communicate as a team, along with the
computer access to see the patient's real time
diagnosis and disease process is invaluable for
providers and patients.
Our integrated approach gives patients a
broader perspective and ultimately improves
their experience.
Renowned cancer specialists consult regularly
with their colleagues across the region, sharing
cutting-edge research, clinical trials, and the
most advanced therapies and technologies for
cancer detection and treatment. Our patients
have the best of both worlds.
As surgeons, we're working in the one area
of medicine where we are playing an ongoing
role in our patients' lives. When I can sit with
a man who no longer has cancer in his system
and encourage him to live his life, that's
the reinforcement and sense of fulfillment
that we did the right thing. That emotional
sendoff makes me feel very grateful to be in
my position.
Dr. R. Scott Owens is board-certified by the
American Board of Urology and has practiced
medicine for more than 30 years. He is a surgeon
with UPMC Urology of Central PA, treating male
and female patients 21 years and older with a
multitude of urological problems and disease. He
also serves as chairman of surgery with UPMC
in the central region. He has a special interest in
robotic surgery and prostate cancer. Dr. Owens
can be reached at owensrs@UPMC.edu.
Central PA Medicine Summer 2021 25
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