Optimal Treatment for Prostate Cancer During a Pandemic February 3, 2021 Back in April 2020, it was all hands on deck in caring for COVID-19 patients at Maimonides Medical Center in Brooklyn, NY, where the number of severe COVID-19 cases was even higher than in neighboring Manhattan. Maimonides, the largest medical center in Brooklyn, is ordinarily a 710-bed teaching hospital. But the hospital had been entirely transformed into a COVID-19 care facility, increasing to more than 1,400 beds, including 400 ICU beds. Apart from trauma, the only patients we were seeing in the ER were patients exhibiting severe COVID-19 symptoms, including fever of 100.5 or higher and shortness of breath. And patients with temperatures exceeding 101 or having severe difficulty breathing were being hospitalized. All non-urgent and elective treatments were on hold until COVID-19 was under control.At Maimonides, our Urology Center and Prostate Center has a combined staff of 10 surgeons and 20 employees. We provide the full range of urologic specialty care to dozens of patients daily. But last April the office limited staffing to one to two physicians daily, and we only saw emergent cases, while the remaining physicians and staff are redeployed to the ICU. Telemedicine took the place of onsite patient visits. For patients newly diagnosed with prostate cancer, the cancer diagnosis combined with the inability to take action during the pandemic, was particularly stressful. We had to reassure patients they could afford to wait a few months since prostate cancer is among the slowest-growing of all cancers. But we also had department staff on hand to counsel patients and families during the delay.Within several months, the state of New York began lifting certain restrictions and elective procedures were limited to high risk patients. As the State opened up elective surgeries for intermediate and low risk patients, we eventually resumed non-COVID surgical care, even during the most recent surge in COVID-19 during the December holidays.To safely treat all Maimonides patients, the hospital established separate streams for COVID and non-COVID patients. COVID-19 patients now enter the ER, are rapidly tested, and if positive sent up to a special ward and isolated from the general patient population. In our department, prostate cancer patients are still evaluated through telemedicine. Following the initial appointment, they are scheduled for further tests and, if surgery is required, we do a pre-op evaluation at one of the campus buildings, separate from the main hospital and away from COVID patients. But even though prostate cancer patients are anxious to receive treatment they still want to minimize their exposure to anyone outside their COVID bubble. One procedure that is especially attractive to our patients is focal therapy high intensity focused ultrasound (HIFU). Focal therapy HIFU is appropriate for patients whose prostate cancer is diagnosed at a higher grade and stage, but is still confined to the prostate. We use guided imagery to locate and destroy only the diseased portion of the prostate. It is done quickly (approximately two to three hours), in a single session at the Maimonides’ ambulatory surgery center. Patients like the ability to get in and out, with minimal exposure to the healthcare system. Focal therapy HIFU is ideal for this.The standards of care for prostate cancer have been radiation and radical surgery. But radiation requires the patient to come to the hospital five to six times a week for seven to eight weeks. And radical surgery which is done in the main hospital, exposes the patient to multiple personnel and instrumentation, and almost always requires a hospital stay. HIFU is different from these other procedures for localized prostate cancer. That’s because there has been a shift in the way we, as urologists conceptualize the treatment of prostate cancer. Doctors wouldn’t think of removing a woman’s entire breast for a small tumor present in one location. Likewise, removing the entire prostate for a tumor that may only be in one location has also become unnecessary. HIFU uses imaging technology that allows urologists to pinpoint the exact location of the tumor, direct sound waves to destroy it and spare the rest of the organ. Urologists no longer have to remove or radiate the whole prostate and have the patient risk losing control of urinary or sexual function. We like to say, “kill the cancer, keep the prostate.”One of my prostate cancer patients, Santoro Pasquale, went through the HIFU procedure because he said, “Quality of life was at the top of my list.” Since having the HIFU procedure Pasquale says, “My life continues to be the same. I enjoy it and I do all the things I did before the treatment.” HIFU is noninvasive. It’s outpatient. It’s a one-shot procedure. It definitely has less side effects than total ablation, or surgery or radiotherapy. And it can be repeated if necessary. And, as of January 1, 2021, we can now submit claims to Medicare and private insurers because the AMA issued a Category 1 CPT code, necessary for reimbursement. HIFU has really increased in popularity, especially during this pandemic, and patients are asking for this because they’ve heard that they can come in the morning, have the procedure and go home before lunch. photos © amessé photography Written by Dr. David Silver. Dr. Silver is Chief of Urology and Director of the Prostate Center at Maimonides Medical Center in Brooklyn, NY. Dr. Silver shares more about HIFU during the pandemic and the CPT code on the Prostate Choices Zoomcast. 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Back in April 2020, it was all hands on deck in caring for COVID-19 patients at Maimonides Medical Center in Brooklyn, NY, where the number of severe COVID-19 cases was even higher than in neighboring Manhattan. Maimonides, the largest medical center in Brooklyn, is ordinarily a 710-bed teaching hospital. But the hospital had been entirely transformed into a COVID-19 care facility, increasing to more than 1,400 beds, including 400 ICU beds. Apart from trauma, the only patients we were seeing in the ER were patients exhibiting severe COVID-19 symptoms, including fever of 100.5 or higher and shortness of breath. And patients with temperatures exceeding 101 or having severe difficulty breathing were being hospitalized. All non-urgent and elective treatments were on hold until COVID-19 was under control.At Maimonides, our Urology Center and Prostate Center has a combined staff of 10 surgeons and 20 employees. We provide the full range of urologic specialty care to dozens of patients daily. But last April the office limited staffing to one to two physicians daily, and we only saw emergent cases, while the remaining physicians and staff are redeployed to the ICU. Telemedicine took the place of onsite patient visits. For patients newly diagnosed with prostate cancer, the cancer diagnosis combined with the inability to take action during the pandemic, was particularly stressful. We had to reassure patients they could afford to wait a few months since prostate cancer is among the slowest-growing of all cancers. But we also had department staff on hand to counsel patients and families during the delay.Within several months, the state of New York began lifting certain restrictions and elective procedures were limited to high risk patients. As the State opened up elective surgeries for intermediate and low risk patients, we eventually resumed non-COVID surgical care, even during the most recent surge in COVID-19 during the December holidays.To safely treat all Maimonides patients, the hospital established separate streams for COVID and non-COVID patients. COVID-19 patients now enter the ER, are rapidly tested, and if positive sent up to a special ward and isolated from the general patient population. In our department, prostate cancer patients are still evaluated through telemedicine. Following the initial appointment, they are scheduled for further tests and, if surgery is required, we do a pre-op evaluation at one of the campus buildings, separate from the main hospital and away from COVID patients. But even though prostate cancer patients are anxious to receive treatment they still want to minimize their exposure to anyone outside their COVID bubble. One procedure that is especially attractive to our patients is focal therapy high intensity focused ultrasound (HIFU). Focal therapy HIFU is appropriate for patients whose prostate cancer is diagnosed at a higher grade and stage, but is still confined to the prostate. We use guided imagery to locate and destroy only the diseased portion of the prostate. It is done quickly (approximately two to three hours), in a single session at the Maimonides’ ambulatory surgery center. Patients like the ability to get in and out, with minimal exposure to the healthcare system. Focal therapy HIFU is ideal for this.The standards of care for prostate cancer have been radiation and radical surgery. But radiation requires the patient to come to the hospital five to six times a week for seven to eight weeks. And radical surgery which is done in the main hospital, exposes the patient to multiple personnel and instrumentation, and almost always requires a hospital stay. HIFU is different from these other procedures for localized prostate cancer. That’s because there has been a shift in the way we, as urologists conceptualize the treatment of prostate cancer. Doctors wouldn’t think of removing a woman’s entire breast for a small tumor present in one location. Likewise, removing the entire prostate for a tumor that may only be in one location has also become unnecessary. HIFU uses imaging technology that allows urologists to pinpoint the exact location of the tumor, direct sound waves to destroy it and spare the rest of the organ. Urologists no longer have to remove or radiate the whole prostate and have the patient risk losing control of urinary or sexual function. We like to say, “kill the cancer, keep the prostate.”One of my prostate cancer patients, Santoro Pasquale, went through the HIFU procedure because he said, “Quality of life was at the top of my list.” Since having the HIFU procedure Pasquale says, “My life continues to be the same. I enjoy it and I do all the things I did before the treatment.” HIFU is noninvasive. It’s outpatient. It’s a one-shot procedure. It definitely has less side effects than total ablation, or surgery or radiotherapy. And it can be repeated if necessary. And, as of January 1, 2021, we can now submit claims to Medicare and private insurers because the AMA issued a Category 1 CPT code, necessary for reimbursement. HIFU has really increased in popularity, especially during this pandemic, and patients are asking for this because they’ve heard that they can come in the morning, have the procedure and go home before lunch. photos © amessé photography Written by Dr. David Silver. Dr. Silver is Chief of Urology and Director of the Prostate Center at Maimonides Medical Center in Brooklyn, NY. Dr. Silver shares more about HIFU during the pandemic and the CPT code on the Prostate Choices Zoomcast.
