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7/29/2019 NJU Bloomfield

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Bloomfeld Location

JULY 2012

New Jersey UrologyInnovative Prostate Cancer Treatment Thats Easy to Live With


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New Jersey UrologyInnovative Prostate Cancer Treatment Thats Easy to Live With

Patients who are treated at New Jersey Urology are greeted each day with a smile

By Iris Goldberg

According to the New Jersey Department

o Health and Senior Services, roughly

7,000 men statewide are diagnosed

with prostate cancer each year. Besides

certain skin cancers, prostate cancer is

the most requently diagnosed cancer

among men in New Jersey and the United

States. Upon receiving a prostate cancer

diagnosis, many patients are uncertain

what the best course o treatment mightbe. In act, today, perhaps more than

ever beore, the questions o how or

even whether to treat remain mired in

controversy.

Consulting with those physicians who

have amassed the greatest amount o

expertise in treating prostate cancer

is the best way or patients to ensure

receiving a treatment plan that will

produce the most successul outcome

in each individual case. For men with

prostate cancer who reside in and around

the central and southern parts o thestate, New Jersey Urology (NJU), located

in Bloomeld, ocuses solely on treating

prostate cancer patients.

Glen Gejerman, MD is New Jersey

Urologys Medical Director. Dr. Gejerman

is board-certied in radiation oncology

and specializes exclusively in the

treatment o prostate cancer. With

greater than 20 years o experience, Dr.

Gejerman has treated more prostate

cancer patients than most physicians in

tri-state area. Additionally, Dr. Gejermanis at the oreront o prostate cancer

research, having written numerous

articles or prostate cancer research and

treatment that have been published in

various medical journals. He is a requent

speaker at prostate cancer conerences

and symposiums across the country

where he is invited to present his work to

other physicians.

By concentrating prostate cancer care

in one center, we have vastly more

experience, Dr. Gejerman states. In act,

Dr. Gejerman, who personally evaluates

each and every patient that comes to

NJU or treatment, estimates the acility is

handling two to three times the volume

(100 patients a day) o prostate cancer

patients seen in non-specialized cancer

centers. This is all we do constantly,

he emphasizes. And that makes a big

dierence.

Perhaps the most unique aspect o New

Jersey Urology is that it is all inclusive

in terms o the treatment modalities

oered. We work with many o the

premier urologists throughout the state

and because there are so many treatment

options, some with equivalent efcacy, it

is important that when a patient comes

in or consultation, we dont direct him

down one path but rather, lay out all o

those options, Dr. Gejerman strongly

believes.

When patients come to see me, I do a

complete history and physicaI exam and

review all o their medical records, he

states. Based on those ndings, wel

talk about what makes the most sense,

relates Dr. Gejerman. And very oten

its not really up to me. Once patients

are educated and ully understand their

options, I nd that patients are much

more comortable with the decision they

make, he shares.

When it comes to deciding whether

to have surgery or undergo radiation

therapy, or example, each patients

individual circumstances and personal

preerences are ully explored. In this

way, we can properly direct patients,

explains Dr. Gejerman. This is, I think,

the most uniquely qualiying actor or

New Jersey Urology in terms o really

oering patients with prostate cancer

the very best care, he adds.


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NJU patients can enjoy a comortable waiting area complete with at screen TV, freplace, a

quiet reading area and plenty o snacks.

For appropriate patients who choose to

undergo a surgical procedure to remove

the cancerous prostate (prostatectomy)

NJU has a number o outstanding

surgeons on sta with signican

expertise in the robotic approach. The

da Vinci robotic prostatectomy is a

minimally invasive procedure involving

less blood loss and a aster recovery time

than traditional open surgery.To treat those patients who preer

or whose prostate cancers are more

amenable to a non-surgical approach

New Jersey Urology oers the innovative

Varian Image-Guided Radiation

Therapy (IGRT) system. IGRT technology

provides precise and exact inormation

on the specic location o the tumor

By precisely tracking cancer, IGRT uses

a smaller radiation eld, sparing healthy

tissue, decreasing side eects and

improving outcomes.

At the onset o the patients course o

radiation treatments, a ducial gold

marker is implanted in the prostate

which helps in the image-guided process

by providing image usion. Beore the

patient starts treatment, a CT scan is

perormed whereby the computer can

download three dimensional images that

are used to outline or contour the target

which is the prostate. Also, the bladde

and rectum are marked so that they can

be avoided.

When patients arrive or their daily

treatment they rst undergo CT imaging

o the prostate gland with the gold

markers. The usion is based on the two

gold markers as well as the bony anatomy

and the sot tissue, which is an exact way

o lining up the prostate.

The benet o IGRT is particularly

signicant or prostate cancer patients

As the bladder lls and empties, the

prostate gets pushed and pulled and wil

not be in the same position each time a

patient receives his radiation treatmentSimilarly, the rectum can be empty or ul

(with gas or stool) and can cause a shit in

the location o the prostate as well.

Without IGRT, the radiation eld mus

be made large enough to incorporate

wherever the prostate might be on a

day to day basis. This means that more

healthy tissue is being irradiated than

necessary. IGRT technology pinpoints

the exact location o the prostate at al

times, making the radiation eld smalle


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NJU ofers the innovative Varian image-guided radiation therapy system.

At the onset o the patients course o radiation

treatments, a fducial gold marker is

implanted in the prostate, which helps in the

image-guided process by providing image

usion.

and reducing damage to surrounding

normal tissue.

The computer system uses RapidArc

therapy that comes around the body

rom dierent directions and allows

the physicians at NJU to design a plan

that can properly cover the prostate

gland with 100 percent o dose while

at the same time minimizing the dose

to the bladder and rectum. Because it

is delivered with such speed, RapidArc

therapy provides maximum targeting

precision in that the treatment is started

and completed within 60 to 120 seconds,so that it actually decreases the chance

that even a minor shit in the prostates

position might occur.

During RapidArc treatment there are

no angles in which the beam stops.

The treatment is delivered in one single

rotation o the gantry around the body.

Thereore, the physicians at New Jersey

Urology have nearly unlimited choices

and degrees o reedom to design the

most sophisticated treatment plan with

less normal, healthy tissue in the high-

dose treatment elds, resulting in less

non-cancerous tissue damage and ewer

side eects.

In act, Dr. Gejerman relates that this

technology, which provides pinpoint

accuracy, completely eliminates the

possibility o urinary incontinence as a

result o treatment. He urther shares

that while 20 to 30 percent o patients do

experience some degree o temporary

erectile dysunction, in the majority

o cases this is eectively managed

with medication. Patients are careullymonitored both during and long ater

their course o radiation therapy in

order to minimize the occurrence o any

adverse eects.

It is important or those who are

considering radiotherapy to treat

their prostate cancer to understand

the dierences between the orms o

radiation that are available today. When

IGRT is compared to some o the newer

modalities that patients may hear about,


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CT Scanning is perormed to download 3 dimensional images to outline the prostate.

Skilled technicians guide the patient through

each treatment.

the benets o IGRT over the others are

difcult to ignore.

For example, Cyberknie, also known

as hypo-ractionation, delivers 5 large

doses o radiotherapy instead o the

standard 44 doses. At rst glance, this

might seem to be the more desirable

option, with 1 week o treatment instead

o 9. However, there isnt any long-term

data to determine whether the shorter

treatment will achieve long-term cancer

control.

Also, there is a real concern amongst

many radiation oncologists that these ew

large doses o radiation will have severe

long-term consequences with rectal and

urinary injury. In act, unless a patient is

enrolled in a clinical trial investigating

Cyberknie and understands that

there is no long-term efcacy data, the

physicians at PCU strongly recommend

that patients avoid this technique.

Another alternative to IGRT is Proton

beam therapy, which is unique in that it

has a Bragg peak a sharp dose gradientthat can limit radiation that is delivered

to normal structures. While Proton

beam has been shown to be eective or

treating tumors at the base o the skull

and or pediatric cancers, it is unclear

whether it will work or prostate cancer.

Due to the sharp gradient in the beam

as well as limitations in image guidance,

parts o the prostate may be missed

during therapy. A large study recently

published in the Journal o the American

Medical Association demonstrated more

severe sexual and bowel side eects as a

result o Proton beam therapy. There are

also concerns about absorbed dose in

the hips, which can lead to hip ractures.

Additional clinical trials will be required

beore Proton beam therapy can be

considered as good as IGRT.

It is an ongoing priority at New Jersey

Urology to update equipment as

technological advancements become

available. So, or example, when Varian

introduces improvements to its IGRT and/or RapidArc systems, NJU will make sure to

acquire the newer technology. In this way

New Jersey Urology maintains its status as

a state-o-the-art acility. This, no doubt,

is an integral actor which contributed

to its recently receiving the prestigious

American College o Radiology (ACR)

Certifcate o Approval.

According to the American College o

Radiology, the goals o the accreditation

program are: to provide impartial, third-

party peer review; to recognize qualityradiation oncology practices through

accreditation; to make recommendations

or improvement in practice and patient

outcomes according to the recognized

standards o the scientifc community; and

to provide a reerral list or patients.

In addition, the on-site surveyors act as

data collectors and submit their ndings

to the ACR Committee on Radiation

Oncology Practice Accreditation, who

makes the nal recommendations.

This committee is composed o board

certied radiation oncologists and

medical physicists who undergo specia

training in order to participate.

Besides cutting edge technology

New Jersey Urology eatures a host o

amenities that are attractive to patients

and thereore, to reerring physicians

as well. A great deal o thought wen

into the construction and decorationo the acility so that men would ee

comortable.

Its almost like a club, Dr. Gejerman

suggests, with a replace, large screen

TVs and even magazines that are geared

towards a male audience, so that men do

eel comortable while theyre waiting to

come in or their treatment.and that

does acilitate men eeling like theyre in

a club, he notes.

We really dont want it to eel like a

clinical situation, Dr. Gejerman explainsPatients come or treatment every

weekday or nine weeks, he adds

reiterating the importance o having a

pleasant environment or the men who

are undergoing radiation therapy to

spend that time in.

The physicians and sta at New Jersey


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In the control area, the treatment is careully monitored.

photography by Michael GoldbergGlen Gegerman, MD, Medical Director o New

Jersey Urology, personally evaluates every

patient.

Urology have been so successul at

making patients eel at home that many

times, at the our month ollow-up visit,

patients share with Dr. Gejerman how

much they actually miss coming or

treatment and seeing the team. From

the moment they rst arrive at our rontdesk, everyone they encounter is upbeat,

warm and riendly, he says.

In act, during the nine week course

o treatment, sta members learn

much about the patients during their

conversations with them. They inquire

about their children and grandchildren

and know about upcoming special

occasions. This is how our sta is trained,

Dr. Gejerman continues. And the men

really appreciate the opportunity to

socialize, he adds.

In terms o accessibility to patients,

there is always a physician available to

answer any questions. In case a patient

encounters a problem while away rom

the acility, Dr. Gejerman provides his cell

phone number so that he can be reached

at all times. It is very important or

patients to know that we are very much

invested in their care and i anything

comes up, we want to know about it, he

emphatically states.

Frank Chimento is sixty-six years old.

He was diagnosed with prostate cancer

earlier this year ater undergoing a

biopsy o his prostate gland. Ater the

results were received, Mr. Chimentos

urologist recommended that he begin

treatment at New Jersey Urology.

He was quite taken with the respectul

way he was treated by the entire sta.

Being handicapped and conned to a

wheelchair, Mr. Chimento had concerns

about how things would be handled.

They helped me out o my wheelchair

and they always

catered to me. I had

a very good time

there, he is pleased

to share.

As ar as the acility

itsel, Mr. Chimento

thought it was

very impressive.

Everything isclean and neat,

he describes.

Very modern, Mr.

Chimento adds.

There was always

something to drink and TV to watch,

he relates. While he ound the waiting

area to be extremely comortable, Mr.

Chimento was pleased with the act

that his treatments always began on

schedule.

Speaking o the technicians whodelivered his treatment, Mr Chimento

says, They were tremendous people in

every way possible their personalities,

the work process everything they did

was excellent. In act, Mr. Chimento was

so satised with the care he received at

New Jersey Urology that he has already

recommended the acility to others.

Like I said, it was perect in every way.

Fity-our year old Peter Kelly decided

to undergo radiation at New Jersey

Urology or his prostate cancer aterconsulting with Dr. Gejerman, on the

recommendation o his urologist. Dr.

Gejerman was very helpul. He explained

everything to me, Mr. Kelly remembers.

For Mr. Kelly, having

treatment or his

cancer in a non-

hospital setting

was benecial. It

was much easier

to digest, he says,

explaining that

he didnt actuallyeel ill and going

to a hospital each

day might have

been somewhat

depressing or him.

As ar as the

actual delivery o

treatment, Mr. Kelly

was very pleased.

He ound the sta

to be extremely

accommodating. When he expressed

a desire to come earlier each day than

when he was originally scheduled, he was

worked into an earlier slot within a short

amount o time.

Perhaps the most positive aspect o

Mr. Kellys experience at NJU was the

opportunity to meet and speak with othe

men who were dealing with the same

situation. Talking with the doctors andthe technicians is very helpul but theyre

not going through it, Mr. Kelly notes. You

could compare notes with somebody

else. I you eel soreness or tiredness and

you hear that others are going through

the same thing, its very reassuring, he

explains.

While prostate cancer continues to be the

most prevalent cancer aecting men in

New Jersey, innovations in diagnosis and

treatment oer promise or increasingly

more successul outcomes. For reerringphysicians and their patients throughout

the state, New Jersey Urology serves as

a valuable resource, providing access to

the highest level o care and treatment o

prostate cancer available today.

New Jersey Urology is located at 1515

Broad Street, Suite B130, Bloomfeld

NJ 07003. For more inormation or to

schedule an appointment, please cal

(973) 873-7000.

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