Basir U. Tareen, MD
For a urology practice to thrive, its physicians, nurses, and administrators need to be unified in providing advanced prostate, kidney, and bladder care, said Basir U. Tareen, MD, a urologist at Metro Urology of Minneapolis. At Tareen’s practice, urologists are at the forefront of introducing new techniques and technology, especially with respect to advanced prostate cancer care.
“As a specialty, we need to be the experts in prostate cancer by offering all aspects of care, from the initial diagnosis, offering curative treatments, and providing late-stage therapies that include infusions and oral oncolytics.” said Tareen. “We want to provide the best, most up-to-date care to our patients.” In many cases, better scanning techniques and the use of advanced prostate cancer care clinics have significantly improved urologists’ ability to manage the disease.
Tareen’s group of 26 physicians was founded in 1994 and is now is the largest, independent urologic specialty practice in Minnesota.
Significant medical advancements have made it possible for Metro Urology to improve the quality of its care. Tareen noted that in 2013 the introduction of MRI-guided biopsies in prostate cancer was “practice changing.” Biopsies that use MRI-guided technology are much more accurate than the traditional ultrasound-guided biopsy and “increase the chance of finding tumors that may have otherwise been missed.”
In particular, Tareen noted the emergence of MRI-ultrasound fusion biopsy and the excitement it has generated among urologists. Clinical trials have suggested that the combination of this type of biopsy with a multiparametric MRI was more effective at detecting aggressive prostate cancer compared with either procedure alone.1 “Many urologists are describing this technology as revolutionary in terms of prostate cancer diagnosis and eventually treatment.”
Using the MRI-guided approach, urologists can more accurately locate the tumor. “This opens up the door for focal therapy,” said Tareen. He explained that MRI technology allowed his group practice to develop a focal therapy program, which was one of the practice’s short-term goals. “We are currently evaluating ablative techniques such as high-intensity focused ultrasound, cryotherapy, and laser therapy.”
Focal therapy is a general term for a variety of noninvasive techniques for destroying small tumors inside the prostate while leaving the gland intact and sparing most of its normal tissue. In appropriate situations, focal therapy can offer several advantages for men with early prostate cancer:
It can effectively destroy specific areas of cancer within the prostate while preserving normal prostate tissue and function.
Side effects, including changes in urinary and sexual function, are often temporary and may be less severe than those associated with radical treatments.
Because it causes minimal injury to the prostate gland, it does not prevent further treatment with radical prostatectomy, radiation therapy, or additional focal treatment to another part of the gland, if necessary. Cancer that returns after radiation therapy may be treated with focal therapy.
It can be performed on an outpatient basis or with a single overnight hospital stay.
“I rarely perform standard biopsies anymore,” added Tareen. “It’s a big change in the standard workup. The real potential benefit of it is once you have the results, you can go back and know exactly where your biopsies were positive. You can use that information to focally target lesions.”
Joint Cancer Clinic
Another innovation in practice management that Metro Urology has initiated is the creation of a joint cancer clinic in which the urology practice partners with a local, large medical oncology group. “Some urologists might not be comfortable administering cytotoxic chemotherapy such as Taxotere (docetaxel),” he said. When the joint cancer clinic was originally initiated, a medical oncologist would consult and meet with urologists once a month at the urology practice. “There’s a lot of different models that groups use, but we highly recommend doing something like this. It’s been very successful for us.”
Rather than have the patient go to the urology office, then drive across town to a second appointment with a medical oncologist, we go to the patient, said Tareen. “If I have an advanced prostate cancer patient who I think will need chemotherapy, I will schedule the patient to come in when both the medical oncologist and I are in the joint clinic. It’s great for continuity of care because everybody is on the same page.”