Avi Elnekave talks with Dr. Joseph Wagner, of Hartford Hospital.
HARTFORD, CT (WFSB) -
There are several advances in medicine to benefit men and women, but one important area for men is the prostate.
West Hartford resident Avi Elnekave started radiation treatments for prostate cancer in mid-March, and his first hint that there was a problem was when blood tests revealed high PSA (Prostate-Specific Antigen) levels.
"There's a whole bunch of things that can cause your PSA to be elevated: an enlarged prostate, an inflamed prostate. Prostate cancer," said Dr. Joseph Wagner, a urologic oncologist.
For a period of years, Elnekave said his PSA levels were high, but his doctors kept an eye on things with repeated biopsies, which never shows any cancer.
"It was comforting for him to see that he already had over 50 needle cores, almost 60 needle cores taken out of his prostate and there was no evidence of cancer. Unfortunately with subsequent blood tests, his PSA continued to rise," said Dr. Steven Shichman, Elnekave's urologist, who added that an ultrasound was done with three-dimensional images.
In January, Shichman suggested he undergo a new high-tech scan called MRI Fusion Imaging, which Hartford Hospital had just acquired.
"Now with this wonderful tool of MRI, we can specifically identify an area where the cancer cells may be residing. We then can fuse that image onto the ultrasound and actually know exactly where to pinpoint the biopsy, so that it's become a really wonderful technique for having the biopsies have a much higher yield in terms of whether there's cancer present or not," said Dr. Andrew Salner, who said this technology may have saved Elnekave's life.
Another advantage of the MRI Fusion is that it helps to find prostate cancer, especially the prostate cancer that are of higher grade, or a more aggressive type.
Some common treatments include active surveillance and watchful waiting, radiation therapy options and surgical options.
Because prostate cancers can be slow-growing, active surveillance, which is just monitoring the cancer with PSA checks, ultrasound biopsies, and now MRI Fusion-guided biopsies, can be enough.
Wagner brought minimally invasive robotic prostate surgery to Hartford Hospital, which is another option for patients with prostate cancer.
"In robotic surgery, we put in five tubes, each about the size of a bigger sized pen. And we pass instruments and cameras through that and hook them to the arms of a robot, and perform the surgery that way," Wagner said, adding that because Elnekave was over the age of 75, doctors suggested radiation was the way to go.
Salner said radiation can either be external or with an implant. He said external radiation is done through a process called IMRT (Intensity Modulated Radiation Therapy), which is a treatment that's given daily for five days per week, for about eight weeks.
The seed implant is another option, where doctors place radioactive seeds inside of the prostate and the radiation is given from the inside, out.
"The external radiation with IMRT was really a treatment that would offer him a high likelihood of success in eradicating the cancer, but it also would allow him to have normal function," Salner added.
Prostate cancer patients are also concerned about urinary and sexual functions.
"Erectile function is preserved in most patients who get treatment for prostate cancer these days both for surgery and radiation. Sixty, 70, 80 percent of men will preserve their erectile function and those that don't can have some restoration of their erectile function with medication," Salner said.
These concerns are also common among men who have enlarged prostates, which tend to happen after the age of 50. The prostate gland, which is normally about the size of a walnut, has a job.
The function of the prostate is to secrete fluid that sort of support the sperm and the female genital track for fertility, Wagner said.
The prostate sits below the bladder, and the urethra is the tube that carries the urine from the bladder out of the body. It passes through the prostate, and if the prostate is enlarged, that tube can get pinched, affecting the flow of urine.
"The biggest issue is that there's been a change in their daily or nightly urinary habits that's beginning to affect their lifestyle, be it work or play," said Dr. Art Tarantino.
While these problems can be prostate-related, sometimes something else is to blame, like an infection or diabetes.
"Sometimes it's a sign of a change in how our body is handling fluids and we may be some of the first physicians to find diabetes for the first time because of that," Tarantino said.
Men can have enlarged prostates and have no symptoms, and Tarantino said urinary issues are not always a sign of prostate cancer.
"Most prostate cancers are discovered way before they get to a point where they would develop any physical changes in the prostate, enough to cause changes to urinary habits," Tarantino added.
He said high PSA isn't always indicative of cancer, but men should know their numbers, which means seeing a doctor regularly.
For Elnekave, the numbers were a sign of cancer. He finished radiation last month, and now he's working through the aftereffects of a hormone shot that helps boost the radiation's effects.
"I know this is a fight, this is a battle that I have to finish. And I will," Elnekave said, adding that he and his wife have been thankful for those who have been supportive during this difficult time.
"I happen to be a medical psychologist, and the attitude of doctors and the emotional contact with their clients is probably as important as whatever medication and treatments they prescribe and both of these doctors have it, have it down," said Elnekave's wife, Helen Rauch-Elnekave.
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