Top Docs: 5 facts about prostate cancer

Though prostate cancer is the most common kind of cancer to strike men, it's also among the most confounding. Many men with prostate cancer will never need treatment. But which ones? And where does 21st century medicine fit in?

Here's what you need to know:

1. MEN MAY BE ABLE TO AVOID BIOPSIES

There's controversy over whether prostate-specific antigen (PSA) blood tests, which can detect signs of prostate cancer, should be routinely given to older men. New federal guidelines suggest they aren't neededif there are no other reasons to suspect prostate cancer because they can lead to unnecessary treatments.

Some doctors, however, including Dr. Aaron E. Katz, chairman of urology at Winthrop-University Hospital in Mineola, still recommend the tests. He thinks men over 50 should get an annual PSA test combined with a digital exam, in which a doctor uses his or her hand to examine the prostate through the rectum. Katz said men with a family history of prostate cancer should get screened starting at 40.

If a PSA test does turn up an indication of possible prostate cancer, Katz said, a new urine test, known as PCA3, can be more specific and indicate whether the man needs to go on to a biopsy. An ultrasound examination can do the same thing, he said.

In both cases, he said, the tests provide extra guidance about whether prostate cancer might exist. If a test indicates it does, the man will need a biopsy to know for sure, Katz said.

2. SURGERY AND RADIATION ARE TREATMENT MAINSTAYS

Radiation and surgery have long been the top treatments for prostate cancer, and they remain so today.

A radiation treatment known by the trade name CyberKnife allows for a quicker recovery -- five days instead of nine weeks -- and can be performed on an outpatient basis, Katz said. "It has very minimal side effects," he said, "and for patients who don't want to have surgery, this is a way to get back to life rather quickly."

Dr. Louis R. Kavoussi, chairman of urology for the North Shore-LIJ Health System, also noted that prostate cancer patients may be able to avoid having radioactive "seeds" implanted, now the favored radiation method for prostate cancer, in favor of a type of radiation known as "stereotactic." It targets the cancer cells, minimizing damage to surrounding tissue, and involves a higher dose but fewer treatment sessions, according to the U.S. National Cancer Institute. However, the seeds may still be appropriate for some patients, Kavoussi said.

In terms of surgery, Katz said that advances include robotic surgery, which involves using a computer to remotely control small surgical instruments attached to a robot, and cryotherapy, in which a surgeon freezes the cancer. Another surgical procedure, which he said is being tested at Winthrop-University Hospital, uses ultrasound waves, rather than radiation, to heat the cancer.

However, older and sicker patients may not be able to undergo some surgical procedures because their bodies are too fragile, Katz said. For example, he said, they may not be able to handle general anesthesia.

3. IN MANY CASES, IT MAY BE SMART TO WAIT

"When first diagnosed, men feel they need to act immediately," Kavoussi said. "But as most prostate cancers are slow-growing, they have a significant amount of time to make a decision."

In the United States, he said, about 250,000 men are diagnosed with prostate cancer each year, but the death rate is below 10 percent.

Katz said that many men with prostate cancer will never need treatment because their prostate cancer won't get to the point where it threatens other parts of the body. He said he often recommends that patients wait to see what happens while getting regular PSA tests and scans -- a process often called "watchful waiting." This monitoring aims to make sure the cancer doesn't get to a threatening point unnoticed.

4. CONSIDER THE SIDE EFFECTS OF TREATMENT

Prostate cancer treatment can lead to incontinence and loss of the ability to ejaculate. Ask your physician about the possible side effects of whatever treatment is being considered -- and not just those that will occur right away, Kavoussi said.

"There can be long-term side effects after initial radiation, even five to 15 years out," he said. "This seems to be glossed over as most people live for the near future, but younger people need to take this into account."

5. GET A SECOND OPINION

Katz said patients should get second or even third opinions from physicians such as surgeons, radiation oncologists and medical oncologists, not only for diagnosis but for treatment recommendations as well. "Get your biopsy reviewed by a doctor at another hospital," he advised. "I tell patients that if you want to get a second opinion, I'm fine with it."

Urologists and nephrologists

UROLOGY

Dr. Richard N. Ashley

233 Seventh St., Ste. 203

Garden City; 516-294-7666

Dr. David J. Beccia

332 E. Main St.

Bay Shore; 631-665-3737

Dr. Anthony Bruno

1305 Franklin Ave., Ste. 100

Garden City; 516-746-5550

Dr. Robert F. D'Esposito

601 Franklin Ave., Ste. 300

Garden City; 516-742-3200

Dr. Robert A. Edelman

601 Franklin Ave.

Garden City; 516-742-3200

Dr. Meyer D. Gershbaum

601 Franklin Ave., Ste. 300

Garden City; 516-742-3200

Dr. Sarah K. Girardi

535 Plandome Rd.

Manhasset; 516-627-6188

Dr. Moneer K. Hanna

935 Northern Blvd., Ste. 303

Great Neck; 516-466-6950

Dr. Steven M. Harris

711 Lincoln Blvd.

Long Beach; 516-431-9800

Dr. Aaron E. Katz

1401 Franklin Ave.

Garden City; 516-535-1900

Dr. Louis R. Kavoussi

Arthur Smith Inst. for Urology

450 Lakeville Rd., Ste. M-41

New Hyde Park; 516-734-8558

Dr. Jeffrey Layne

1181 Old Country Rd., Ste. 1

Plainview; 516-933-6060

Dr. Elliott Lieberman

875 Old Country Rd., Ste. 301

Plainview; 516-931-1710

Dr. Brett Mellinger

Advanced Urology Center of NY

Division of I.M.P.

100 Garden City Plaza, Ste. 101

Garden City; 516-873-5353

Dr. Carl Mills

250 Yaphank Rd., Ste. 15

East Patchogue; 631-475-5051

Dr. Robert Moldwin

450 Lakeville Rd., Ste. M41

New Hyde Park; 516-734-8500

Dr. Elliot M. Paul

Advanced Urology Centers of NY

Lake Success Division

Integrated Medical Professionals

2001 Marcus Ave., Ste. N214

Lake Success; 516-437-4228

Dr. Lee Richstone

450 Lakeville Rd., Ste. M41

New Hyde Park

516-734-8500

Dr. Barry R. Shepard

601 Franklin Ave., Ste. 300

Garden City; 516-742-3200

Dr. Robert D. Sunshine

Advanced Urology Centers of New York

480 Hicksville Rd.

Bethpage; 516-796-2222

Dr. Robert Wasnick

Stony Brook Medical Park

24 Research Way, Ste. 500

East Setauket; 631-444-6270

Dr. Michael M. Ziegelbaum

2001 Marcus Ave.

Lake Success; 516-437-4228

NEPHROLOGY

Dr. Alessandro G. Bellucci

North Shore University Hosp.

Dept. Nephrology

300 Community Dr.

Manhasset; 516-562-4312

Dr. Steven L. Bourla

789 Old Country Rd.

Plainview; 516-433-3600

Dr. Lionel U. Mailloux

50 Seaview Blvd.

Port Washington

516-484-6093

Dr. Joseph Mattana

100 Community Dr., 2nd Fl.

Great Neck; 516-465-3010

Dr. Pravin C. Singhal

100 Community Dr., 2nd Fl.

Great Neck; 516-465-3010

Dr. John D. Wagner

100 Community Dr., 2nd Fl.

Great Neck; 516-465-3010

How they were picked

Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college, board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at castleconnolly.com/ nominations -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.

Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)

Physicians selected for inclusion in this "Top Doctors" feature may also appear as Regional Top Doctors online at castleconnolly.com, or in one of Castle Connolly's Top Doctors guides, such as America's Top Doctors® or America's Top Doctors® for Cancer.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.