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Health Matters: Providence Saint Joseph Medical Center | 9 A new urologic oncology program at Providence Saint Joseph Medical Center combines state-of-the-art cancer treatment with integrated wellness services to provide truly holistic care. The Center for Urologic Health, headed by urologic oncologist Ramkishen Narayanan, MD, is a partnership between the Disney Family Cancer Center at Providence Saint Joseph Medical Center and Saint John's Cancer Institute. "It represents a cumulative powerhouse of world-class, personalized care for every patient," says Dr. Narayanan. "Our multidisciplinary approach includes nationally renowned medical oncologists, expert robotic surgeons and highly skilled radiation oncologists." The program aims to deliver precision medicine to every patient, while working to protect their dignity and quality of life. It offers leading-edge diagnostic and treatment options for the full scope of urologic oncology: common urologic cancers— prostate, bladder and kidney cancer—as well as less common testicular and penile cancer. DIAGNOSING PROSTATE CANCER Diagnosis involves serum blood testing with the prostate-specific antigen (PSA) test and MRI- guided transrectal ultrasound fusion biopsy. The Center for Urologic Health also offers a transperineal approach to prostate biopsy, to better sample certain locations while reducing the risk of infection. "Our goal is to make the biopsy process as comfortable, efficient and complication-free as possible," says Dr. Narayanan. BLADDER CANCER For cancer management, the program offers multidisciplinary care with minimally invasive treatment, including robotic bladder surgery. "We use blue light cystoscopy with a novel molecule that causes bladder cancer to glow and detect it at a much higher rate and at an earlier stage than traditional white light cystoscopy," says Dr. Narayanan. CLINICAL TRIALS The Center for Urologic Health participates in several bladder cancer clinical trials that offer the possibility of sparing the patient's bladder when they do not respond to standard treatments. As an expert in lymph node metastases, Dr. Narayanan is conducting research that may help some prostate cancer patients avoid pelvic lymph node dissection and its complications. "This individualized approach will determine which patients will need a dissection versus those who do not," he says. For kidney cancer patients, the Disney Family Cancer Center also offers expert robotic surgery using both traditional and more advanced retroperitoneal surgical approaches. "We are also working on research that can determine the relative risk that a tumor detected on imaging could be malignant through simple urine testing," says Dr. Narayanan. Precision medicine with genetic research is the future of urologic oncology, and it's already here at the Center for Urologic Health. "We have a renowned genetics program with the Disney Family Cancer Center and the Saint John's Cancer Institute, headed by Ora Gordon, MD, a nationally recognized expert in hereditary cancers," Dr. Narayanan says. For patients with benign urologic conditions, he adds, "we have integrated wellness services that our community physicians can take advantage of, including a registered dietitian for kidney stone prevention and, for chronic pelvic or bladder pain, pelvic floor physical therapy, acupuncture, yoga and meditation services. To learn more about the Center for Urologic Health at Providence Saint Joseph's Disney Family Cancer Center, call 818-748-4798. PREVENTING UROLOGIC CANCERS With the exception of skin cancer, prostate cancer is the most common cancer in American men. Prostate- specific antigen (PSA) screening allows it to be detected early, increasing a man's chances for the best outcome. Men should discuss when to begin regular screenings with their primary care provider or urologist. "The age at which prostate cancer screening starts depends on a man's level of risk," says Dr. Narayanan. Most men can begin at age 45. The National Comprehensive Cancer Network (NCCN) recommends screening between the ages of 45 and 75. The American Urological Association (AUA) suggests ages 55 to 69. However, screening should start as early as 40 for men at higher risk, including those with an inherited BRCA1 or BRCA2 gene or a family history of cancer. Be aware of your genetics. Talk with your family members about any history of cancer. Genetic counseling and testing, under professional guidance, can help catch potentially lethal types of urologic cancers at early stages. Quitting smoking is one of the best things both men and women can do to reduce their risk of bladder and kidney cancer. An annual urinalysis looking for red blood cells in the urine can help detect urologic disease. Always see a urologist when there is blood in the urine without any associated pain. Obesity and hypertension increase your risk for some kidney cancers. Try to keep your weight and blood pressure in a healthy range to reduce your risk for renal cell carcinoma. To improve overall bladder health, avoid constipation and cut back on alcohol, spicy foods and caffeine, which can irritate the bladder.

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