{"id":146,"date":"2014-05-24T05:25:48","date_gmt":"2014-05-24T05:25:48","guid":{"rendered":"https:\/\/www.newyorkurologyspecialists.com\/prostate-cancer\/?page_id=146"},"modified":"2021-01-03T07:18:20","modified_gmt":"2021-01-03T07:18:20","slug":"screening-clinical-update","status":"publish","type":"page","link":"https:\/\/www.newyorkurologyspecialists.com\/prostate-cancer\/screening-clinical-update\/","title":{"rendered":"Screening for Prostate Cancer – 2021 Clinical Update"},"content":{"rendered":"

Screening for Prostate Cancer – 2021 Clinical Update for Medical Professionals<\/strong><\/h1>\n

by Alex Shteynshlyuger MD<\/a><\/strong><\/p>\n

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If you have any questions, to schedule a consultation<\/a>, please <\/a>contact us<\/a> or call\/text: 1-646-663-5515<\/span><\/a><\/strong>.<\/strong><\/p>\n

We have excellent reviews from patients <\/a><\/strong>and their partners.  Information for out-of-state and international patients<\/a>.  Find out our office hours or directions to our office<\/a>. <\/strong><\/span><\/p>\n

We offer affordable appointment prices<\/a> with or without insurance.  <\/strong><\/span>Same-day virtual video appointments<\/strong> and in-person appointments<\/strong> are available.<\/span><\/p>\n

Dr. Alex Shteynshlyuger<\/strong><\/a> is a fellowship-trained urologic oncologist, a robotically-trained surgeon who specializes in all aspects of care for early, advanced, and metastatic prostate cancer<\/b>. He is a member of the Society for Urologic Oncology as well as the American Society for Clinical Oncology.<\/p>\n

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History of Screening for Prostate Cancer<\/strong><\/h2>\n

\"Prostate<\/a>Prostate cancer<\/strong> is the most common solid cancer that affects men with a 12-15% lifetime risk of diagnosis. It is the cause of death in 3% of men in the US and far greater morbidity due to metastatic prostate cancer complications.<\/p>\n

PSA test<\/strong> has been used as a screening test for early detection of prostate cancer<\/a> starting in the late 1980s.  As a screening test, PSA suffers from relatively poor specificity at values less than 10 ng\/dl.  This has led to overdiagnosis of low-risk prostate cancer.  Randomized controlled studies have also shown decreased metastatic disease burden and improved prostate-cancer mortality among screened men (ERSPC). However, overtreatment is both costly and associated with significant morbidity.<\/p>\n

Innovations in Prostate Cancer Screening – 2021 Perspective<\/h2>\n

With >32,000 deaths from prostate cancer per year in the US alone, early detection of disease that is destined to become metastatic and cause morbidity and death present a desirable goal. The goal is to balance the risks of overdiagnosis and overtreatment of less aggressive disease<\/strong> that may never become clinically relevant to the benefits of early detection of aggressive disease<\/strong>.<\/p>\n

Approaches to Improve Detection of High-Risk Prostate Cancer and Minimize Overdiagnosis \/ Overtreatment<\/h2>\n

The search for a perfect screening test is still on to replace the PSA test. Several promising approaches are available. One is to use a better screening test.<\/strong> Here we have a few tests to choose from: PHI (prostate health index) test<\/strong><\/a> has improved the ability to separate men with elevated PSA into those who are more likely to have prostate cancer from those who are more likely to have benign disease. PHI test can prevent unnecessary biopsies, but it only offers incrementally better information compared to the PSA test alone.<\/p>\n

The 4KScore test<\/strong><\/a> is designed to separate men with a high risk for aggressive prostate cancer from those with no prostate cancer and low-risk prostate cancer.<\/p>\n

Another option is to choose men with a higher risk for aggressive disease by stratifying lower Gleason biopsy results using molecular and genetic markers.<\/p>\n

Prostate MRI<\/strong> is another tool that can be used to detect higher-risk prostate cancer and to select men for targeted prostate biopsy.<\/p>\n

Where to Get Screening and Testing for Prostate Cancer in NYC?<\/h2>\n

At New York Urology Specialists, we offer treatment for men with abnormal PSA and prostate cancer<\/strong>.  Same-day virtual video appointments<\/strong> and in-person<\/strong> appointments are available.<\/p>\n

Call\/text today: 1-646-663-5515<\/span><\/a> <\/span><\/strong>or <\/span>make an appointment<\/span><\/a> online.  <\/span><\/span><\/strong><\/p>\n

We perform procedures such as prostate biopsy<\/a>, transrectal prostate ultrasound, hydrogel insertion prior to radiation therapy (SpaceOAR<\/strong>), prostate surgery, prostate enucleation for enlarged prostate, and Urolift procedure<\/span>. We treat prostate cancer, urinary problems<\/a>,<\/strong> and erection problems<\/a><\/strong> and offer comprehensive STD testing<\/a><\/strong> for infections. We offer confidential<\/strong> appointments.<\/span><\/p>\n

Our appointment costs<\/a> are affordable with or without insurance<\/strong>.  We offer free insurance verification<\/strong>.<\/p>\n

Molecular and Genetic Approaches to Patient Stratification<\/h2>\n

A number of molecular and genetic markers<\/strong> have been identified that predict a higher risk of high-risk prostate cancer. Screening for prostate cancer with tests that have higher specificity for high-risk prostate cancer holds the promise of curing men with clinically significant disease (that is likely to become metastatic and cause death) while avoiding overtreatment.<\/p>\n

A number of genetic mutations, including ERG and PTEN have been identified that put men at higher risk for metastatic disease and death. A number of commercial tests, including PersonalizedDx<\/strong> FISH test for ERG+ and PTEN aim to improve prognostication for men diagnosed with prostate cancer.  This will allow us to better select men for active surveillance<\/a> who are low risk and those at higher risk for active treatment.<\/p>\n

Surgical Treatment of Prostate Cancer<\/h2>\n

\"Img013_Si_male_at_SC_PC_VC_sm\"The future of prostate cancer treatment is closely tied to surgical treatment. While fewer lower risk cancers are being treated surgically, we are going to see an expansion of surgery used in later-stage disease, including metastatic disease.<\/p>\n

The interim upgrade of the DaVinci Robotic system to DaVinci Xi is a step toward utilization of the robotic system in more exquisite situations requiring advanced manipulation and access such as metastasectomy and extended lymph node dissections.<\/p>\n

Conclusion<\/h2>\n

Improved sensitivity of screening tests for high-risk disease allows us to detect high-risk cancer while avoiding the problem that plagued PSA as a screening test, namely overdiagnosis.  4KScore appears to be most promising in this regard, with PHI being useful as well.  Combined with genetic profiling of prostate biopsies, our new tools allow us to only select men who are at high risk for symptomatic disease for treatment while allowing a safer approach to active surveillance<\/a> for men who are at low risk of experiencing morbidity of prostate cancer.<\/p>\n

Improved efficacy of treatment, such as Zytiga, Xtandi, Xofigo, and Provenge that lead to improved overall survival in RCTs (randomized controlled trials) provide further rationale for high-impact screening for high-risk prostate cancer.<\/p>\n

Did you know?<\/strong><\/span> Dr. Shteynshlyuger<\/a> <\/strong>has performed over 1,000 prostate, penile, and bladder surgeries,<\/strong> including prostate biopsy, prostate removal, penile implants, Urolift, prostate enucleation, correction of Peyronie’s disease, and MRI fusion biopsy.<\/p>\n

Cost of Prostate Cancer Treatment without Insurance<\/h2>\n

At New York Urology Specialists, we offer affordable treatment for men<\/strong><\/a>. Our prices are low<\/strong> for patients without insurance<\/strong> and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. <\/p>\n

At New York Urology Specialists, we offer flat-fee ‘all-cost-included’ procedures such as prostate biopsy, hydrogel SpaceOAR insertion, circumcision, no-scalpel vasectomy, testicular implant, vasectomy reversal, hydrocelectomy, varicocelectomy, and many more<\/strong>.  The procedures are performed in our office under local anesthesia or sedation. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.  Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles<\/strong>.<\/p>\n

Cost of Prostate Cancer Treatment and Insurances<\/h2>\n

\"InexpensiveAt New York Urology Specialists, we offer affordable treatment for men<\/strong><\/a>. Our prices are low<\/strong> for patients without insurance<\/strong><\/span> and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs. <\/p>\n

We accept many health insurance plans.<\/strong>  We would be happy to verify your eligibility and benefits<\/strong> and provide you with detailed information on your health plan’s coverage.  Financing options<\/a> <\/strong>and credit options are available to help you pay for medical care.<\/p>\n

Why Choose New York Urology Specialists for Prostate Cancer Treatment?<\/h2>\n