2/8/2010

List of Urologists by City, State, County, Neighborhood:

New York, Brooklyn (Park slope, Kings Highway, Manhattan Beach, Gravesand, Brighton Beach, Coney Island, etc), Staten Island, Manhattan - list all boroughs, counties, neighborhoods (Upper west side, downtown, financial district, midtown, central park urologists)

Bath Beach urologist

Bay Ridge urologist

Bedford-Stuyvesant urologist

Bensonhurst urologist

Boerum Hill urologist

Borough Park urologist

Brighton Beach urologist

Brooklyn Heights urologist

Bushwick urologist

Carroll Gardens urologist

Clinton Hill / The Navy Yard urologist

Cobble Hill urologist

Coney Island urologist

Crown Heights urologist

Ditmas Park urologist

Downtown Brooklyn

DUMBO urologist

Dyker Heights urologist

East Williamsburg urologist

Flatbush urologist

Flatlands urologist

Fort Greene urologist

Gowanus urologist

Gravesend urologist

Greenpoint urologist

Kensington urologist

Manhattan Beach urologist

Midwood urologist

Park Slope urologist

Prospect Heights urologist

Prospect Park South urologist

Prospect-Lefferts Gardens urologist

Red Hook urologist

Sheepshead Bay urologist

Sunset Park urologist

Vinegar Hill urologist

Williamsburg urologist

Windsor Terrace urologist

The PLCO study with no appreciable benefit of the current approach to screening and management of prostate cancer and the ERSCP study with small disease specific survival advantage but no overall survival advantage and significant rate of overtreatment are a call to action. 
This is not an argument against screening but an argument against continuing with approaches that have not proven to be of benefit.  The status-quo is likely to be harmful and costly not only financially but also in terms of lost quality of life and opportunity for better outcomes for men and their families alike. 
It is well recognized that PSA screening led to a shift in stage distribution of prostate cancer at diagnosis to lower risk disease.   Many men are still dying from prostate cancer despite advances in diagnosis and management of localized as well as metastatic disease.  The absolute risk of death of prostate cancer is small and does not peak until age 75-80.  
Our failure is twofold.  Even with widespread use of PSA screening we fail to identify most aggressive cancers early enough to administer effective treatment.  When we do identify cancers, we are not very good at identifying which are a threat and which are indolent riders.  This leads to under-treatment of aggressive cancers and overtreatment of less aggressive cancers.

Prostate biopsy has been shown to be a safe procedure.  However complications after prostate biopsy do occur; some are severe.  It appears that infectious complication incidence is also geographically variable and are evolving, probably related to regional antibiotic resistance patterns.  While prior studies showed rare infectious complications, more recent studies demonstrate the risk of requiring admission of 1.9%-4%;  72% of hospital admissions are for infectious complications.  It is notable that patients without prostate cancer have 4 times the risk for admission compared to men who are diagnosed with prostate cancer suggestive that PSA elevations may be infectious- related in these men. Most occur within 1 week of biopsy. (Nam 2010, Raaijmakers 2002, Djavan 2001)

Similarly complications of treatment appear to vary geographically.  While in Europe, only 3.5% developed fever after biopsy, only 0.5% required hospitalization and 0.4% had urinary retention.  In the US, 2% of patients are readmitted for urosepsis.

REDUCE trial demonstrated 22% relative reduction and 5% absolute risk reduction in developing of prostate cancer for men with PSA 2-10 and a negative prostate biopsy at the entry over a 4 year period. Similar risk reduction was observed for patients with family history of prostate cancer, ETC.    Reduction in risk of urinary retention or UTI is a bonus.  In contrast FINASTERIDE trial enrolled patients with PSA,  risk reduction, etc.