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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.