Just down near the Gulf in Galveston, Dr. Eric Walser and his team of talented medical health professionals at the University of Texas Medical Branch’s Wavelengh Medical are tackling prostate cancer in a new way.
(GALVESTON) – There are a number of medical concerns that plague the LGBTIA community. When we think about health crises, a lot of thoughts can tend to center around topics such as HIV/AIDS, safe sex practices, hormone replacement therapy, and suicide coupled with the dangers of untreated mental health. While none of these issues are necessarily specific to just our community, they have historically played a larger role in the lives of LGBTQIA people than they have in other communities. However, it is important for queer-identifying people to remember that these are not the only concerns that could arise in their lives. Queer people, just like all other people, are susceptible to problems in all the other varying realms of healthcare. One of which that does not discriminate against people of any sexual orientation or gender identification is cancer.
Cancer appears in individuals of all sorts in various forms. For some, it can affect the brain, others the breasts, but can appear anywhere from within the bones to atop the skin and to any other part of the body. For many, this can mean the prostate. For those who aren’t familiar with the prostate, it is the gland that surrounds the bladder in people born anatomically male. It is the organ responsible for the propulsion of seminal fluid and the velocity of urination. And while it is known to be one of the more treatable cancers and has an extremely high survival rate, it is still an issue that—like all other cancers—can consume the patient’s life while undergoing treatment, especially so if left long undetected. Just like with all other cancers, the key to survival is early detection.
This isn’t just a problem for men, however. Often, the relevance of the prostate can even expand to transgender women, regardless of whether or not they’ve undergone reassignment surgery from male to female. As it turns out, during transitional surgeries (which often happen over the course of several procedures and after intensive hormone replacement therapy) the prostate is not typically removed due to potential complications with the surrounding nerves and blood vessels surrounding it. That said, trans women and those who identify as gender nonbinary, like cisgender men, should be cognizant of the need for prostate cancer screenings.
For this to happen, between the ages of 40 and 50-years-old, a person should be meeting regularly with a licensed physician (typically a primary care physician if the person has one) to begin having the prostate checked regularly throughout the remainder of their adult life. When this happens, the physician will be checking the patient’s prostate-specific antigen (or PSA) typically through blood test, looking to see if the patient has normal PSA levels. What is considerably adequate for good prostate health is a level under 4 nanograms per milliliter (ng/mL) in the blood draw. However, if that number is upward of 4 ng/mL, the doctor will monitor these levels to watch for an uptick. Because PSA levels are not diagnostic, they are not necessarily indicative of prostate cancer. This is only the first step in the process of obtaining a conclusive diagnosis. In fact, stimulation of the prostate resulting in an active gland can cause these levels to rise through exercise, manual labor, or sexual activity. The uptake in PSA levels could also very simply be due to a prostate that is inflamed, but not breeding cancerous cells. That being said, to rule out the chance of prostate cancer, the patient’s physician will at this point refer the patient to a specialist. From there, the specialist—a urologist (or a doctor who specializes in diseases of the urinary tract) in this case— will carry out measures to ascertain a diagnosis.
Now, this is where things get a bit more complicated. The most commonly practiced method for diagnosing prostate cancer from this point is for the urologist to perform what is known as a “blind” biopsy. What is meant by the word ‘blind’ is that the urologist has not performed an MRI (magnetic resonance imaging) in order to assess whether or not a cancerous lesion is visible on the prostate. The process of performing a biopsy without an MRI involves sticking approximately 12-15 needles into the gland to take samples.
Enter Dr. Eric Walser, an interventional radiologist at the University of Texas Medical Branch (UTMB) and physician at Wavelength Medical practice who believes that this may not be the best practice of diagnosing prostate cancer. As a radiologist, Dr. Walser understands the importance and benefits of not performing a biopsy without imaging, and instead has the MRI performed preemptive of the poking and prodding in order to see if a biopsy is even necessary. By performing the scan ahead of the biopsy, Dr. Walser is able to screen for cancerous lesions in the prostate. If a lesion is found, a biopsy can then be ordered with a more specific target zone so that only 2-3 needles need to be inserted into the gland as opposed to the aforementioned 12-15. By minimizing the invasiveness of the procedure, Dr. Walser’s methods can decrease the chance of urinary incontinence and erectile dysfunction that can often be side effects of the biopsy. Additionally, a patient who undergoes a biopsy will still likely be asked to undergo an MRI, as well. Unfortunately due to the amount of blood that will appear on the scan if done too soon after biopsy, the patient can often be asked to wait anywhere from 4 to 6 weeks to have the MRI performed if the biopsy comes back positive. And while this isn’t the standard practice for physicians in this field, evidence supporting it is appearing rapidly. For example, the New England Journal of Medicine published a study just this past May, which concluded that having an MRI performed before a biopsy, or having an MRI-targeted biopsy performed, is the superior method of diagnosis.
But diagnosis isn’t where Dr. Walser’s interest in prostate cancer ends; and understanding his next move may come easier with a little background on his career. Dr. Walser once practiced medicine at the world-renowned Mayo Clinic’s campus in Florida where he was researching focal laser ablation (or surgical removal) of cancer from the lungs and liver. While researching these methods of treatment, Dr. Walser saw the opportunity to make a difference with those suffering from prostate cancer. For a long time, there were only a few options for conquering prostate cancer, which are still the most commonly practiced today. The first of which is radiation therapy (whether it be internal or external) to try to kill the cancer cells, which is sometimes accompanied by hormone therapy. Hormone therapy (though not a cure for cancer) is a method by which a physician will reduce the level of androgens in the body in order to stop or slow the growth of cancer cells, as cancer cells feed off androgens and use them to grow. Radiation, however, does not come without side effects, as radiation is toxic to organic matter, of which the human body is composed. According the American Cancer Society, radiation in its varied forms can lead to troubles with the bowels, urinary incontinence, erectile dysfunction, and impotency. The other option, and often one of the more popular among physicians and their patients, is total removal of the prostate, or prostatectomy. This too can lead to issues of urinary incontinence and erectile dysfunction, but also can leave damaging amounts of scar tissue that may affect a physician’s ability to cut through and reach the area necessary to treat the patient again if the cancer were to recur.
And that’s where Dr. Walser’s love of focal laser ablation is helping those with prostate cancer. With his method, Dr. Walser is using focal laser ablation to excise cancer with a laser rather than removing the entirety of the prostate or poisoning the body with radiation in order to keep the prostate intact and, in turn, minimize the invasiveness of the entire course of treatment—from diagnosis to recovery. According to the Prostate Cancer Foundation, recurrence of prostate cancer can happen in anywhere from 30-90% of people after initial remission. This relapse generally takes places after 5-7 years of treatment and remission. However, through his studies and practices, Dr. Walser is coming to find that the chances of recurrence using his methods is somewhere near 15%—a drastic difference. However, since laser ablation for prostate cancer is new, there is not enough follow up to fully compare it to traditional therapies.
The process of the procedure is typically quite simple. Candidates for Dr. Walser’s program travel to UTMB on a Thursday night or Friday morning for a busy weekend. The first step in this process includes a mid-morning appointment with Dr. Walser’s in-house nurse practitioner, Anne Nance (APRN, NP-C), who talks with patients about their family histories, symptoms, plans, then rounds out to a procedure on a Saturday or Sunday with Dr. Walser (who kindly works weekends to better accommodate the schedules of his patients, who often travel from far beyond Galveston for treatment). The day of the procedure, patients can expect the ablation to last to last approximately 4 hours. From there, a catheter will be inserted into the patient due to the prostate swelling postoperatively, which closes the urethra and prevents urination. The catheter could be worn anywhere from 3-5 days, but sometimes even as little as 2. After that, the patient should take the time to recover for 1-2 weeks. Most patients can go back to normal activities of daily life soon after ablation, but should be mindful not to overexert themselves.
But like all good tales, this story, too, has its down side. Because focal laser ablation of prostate cancer is new to this field of medicine, insurance companies typically do not cover the procedure, which can leave patients having to spend more money to have this performed. But that isn’t a deterrent for Dr. Walser and his team at UTMB, and isn’t always one for his patients. In fact, the team’s biggest concern is making sure that patient’s get treatment and are diagnosed adequately. Speaking with Rebecca White (MBA, BSN, RN) of Dr. Walser’s team at Wavelength Medical, she stated, “Let us help you with the diagnosis. [Patients] may not be able to afford the treatment, but the process of diagnosis is usually covered by insurance.” She went on to say that by having the MRI performed before the biopsy, it could eliminate an additional cost to patients who don’t need the biopsy performed if there are no lesions found by MRI. And the way Dr. Walser and his team are practicing their methods of diagnosis, that could end up being the case for many, as White also states that due to the practice of blind biopsy, there’s a large chance for misdiagnosis or over-diagnosis in this field.
So, even if it comes down to not being able to afford this specific method of treatment, at least the folks at UTMB’s Wavelength Medical can help guide patients through the process of diagnosing in a way that could end up being more cost-effective and to a lesser degree of pain and wait time than many other practitioners in their field. Just because the “disposable gay income” isn’t a myth for everyone in the LGBTQIA community does not mean that money has to be thrown away on tests that could prove to be unnecessary. And Dr. Walser and his staff are only truly concerned about the health and lifespan of those they treat and diagnose. If that means getting a person treated by way of radiation or prostatectomy because focal laser ablation is unaffordable, that’s what these fine people will help you to make happen. It’s also worth noting for the LGBTQIA community that UTMB was recently one of only three Houston-area medical facilities to be named as a “leader” by the Human Rights Campaign (HRC) when it released its 2018 Healthcare Equality Index. This status bestowed upon UTMB is specifically awarded to the best of best, and is held in the highest regard with the HRC. In order for a facility to land this honor, they must score a perfect 100% on the HRC’s index, which takes into account a variety of factors, most notably LGBTQIA patient care and community outreach.
Cancer is scary; and prostate cancer gone undetected could considerably affect the lives of a great number of LGBTQIA people. Like other cancers, it can metastasize to other parts of the body and put a person at risk of larger health issues, some even resulting in death in the worst case. But with the help of people like Dr. Walser, Anne Nance, Rebecca White, and the rest of the incredible team at UTMB’s Wavelength Medical, it doesn’t have to come to that. With innovation like Dr. Walser’s and medical literature supporting these methods being researched and released consistently, their team is here to provide people who may be suffering prostate cancer with the opportunity to live a life not ruled by disease in a brand new way, while also redefining how prostate cancer is treated and the outcomes for patients.