A 2012 report on the latest available data from the Centers for Disease Control and Prevention shows that black men, particularly African-American and Caribbean men of African ancestry, had the highest rate of getting and dying from prostate cancer. According to Dr. Bjurlin, men from other ethnic groups also are at high risk, particularly if there is a family history of prostate cancer. Additionally, the risk of prostate cancer increases as men grow older.
A digital rectal exam, along with a PSA (prostate-specific antigen) test, are the first steps a physician can take to determine whether pain in the hip area or urinary changes are signs of disease that may require further tests.
To further evaluate for the presence and extent of a possible prostate tumor, urologists for years could only make an educated guess as to where in the prostate to place biopsy needles. Now, with the development of Artemis -- a multifunctional computerized ultrasound system that works in combination with diagnostic magnetic resonance images -- Dr. Bjurlin points out with confidence: "Many high-grade prostate cancers are no longer being missed. Artemis eliminates guesswork and allows precise targeting of suspicious areas of the prostate."
The state of the art diagnostic device has been in use at NYU Langone in Manhattan for several years. In conjunction with Dr. Bjurlin's move across the East River, it is now available only in Brooklyn at NYU Lutheran. "Most prostate cancers are slow-growing. Artemis has entirely changed the way we biopsy and actively monitor prostate cancer," added Dr. Bjurlin. "And Artermis's ability to record and store information from previous biopsies greatly aids in the detection of cancer activity."
Robot-Assisted Surgery Also Exclusive to NYU Lutheran
When prostate cancer is detected, doctors often look for a first option to prolong life without routinely removing a prostate that may never pose a significant problem. This is often referred to as "watchful waiting." However, if a patient is found to have an aggressive type of cancer, treatment could include radiation and/or surgery to remove the prostate and surrounding areas where the disease may have spread.
Among surgical options, the da Vinci Xi, also available in Brooklyn only at NYU Lutheran, is the most advanced technology available for robot-assisted surgery. With his extensive experience using the da Vinci robot at NYU Langone in Manhattan, Dr. Bjurlin is building a more comprehensive urologic cancer program at NYU Lutheran.
Although traditional open or laparoscopic procedures are indicated for some prostate surgery, the da Vinci has become increasingly the preferred approach for removing prostate cancer because it is less invasive. In addition, the risk of complications, including urinary incontinence and sexual dysfunction, can be minimized by careful attention to saving the nerves as the cancer is being removed. The da Vinci system provides a 3D view, high magnification and precision in instrument movement and adjustment that give a surgeon greater control and ability to preserve tissues and prevent complications.
"The greatest advantage of robotic-assisted prostate surgery is more rapid convalescence. There is less blood loss, less pain, shorter hospital stay, little scarring and quicker to return to activities of daily living," remarked Dr. Bjurlin. "Patients often are up and about a few hours after surgery, stay in the hospital overnight, and go home the next day."
To patients and their families, Dr. Bjurlin offers this advice, garnered from years of experience treating hundreds of patients.
"The most important message is to help men get over the fear of the initial physical exam," he says. "In this respect, they can certainly benefit from the concern and needling of their loved ones!"