The Global Prostate Cancer Research Foundation is a non-profit organization dedicated to advancing prostate cancer care and research worldwide. The Million Strong Men initiative is brought forth by Dr. Ash Tewari, a world-renowned urologist and innovator in robotic prostate cancer surgery. Dr. Tewari, who serves as the foundation's chief medical advisor, has performed over 10,000 robotic prostatectomies and has made significant contributions to the field of urology.
Shared decision-making (SDM) and prostate-specific awareness play crucial roles in reducing the prostate cancer burden in patients. These approaches significantly enhance patients' understanding of prostate cancer, empowering them to better comprehend risk factors, symptoms, and screening options. This increased knowledge allows patients to actively participate in treatment decisions, ultimately reducing decisional conflict and anxiety.
Our groundbreaking approach to prostate cancer treatment minimizes side effects. Quality of life after surgery is of utmost importance for our patients standard of care. Our nerve-sparing technique helps reduce the risk of urinary incontinence and impotence, common side effects of prostate cancer treatment.
Dr. Tewari's nerve-sparing technique is a cornerstone of his approach to robotic prostatectomy. He was the first to describe the nerves responsible for erectile function as a "neural hammock" and has developed various grades of nerve-sparing that utilize information from MRIs.
This allows for incremental nerve-sparing, even in cases that previously would not have qualified for such an approach. By using a multiparametric magnetic resonance imaging (mpMRI)-based nomogram, Dr. Tewari can customize his nerve-sparing technique based on each patient's unique biology and pathology.
The nerve-sparing technique developed by Dr. Tewari helps reduce the risk of urinary incontinence and impotence, which are common side effects of prostate cancer treatment. His approach involves an athermal and traction-free technique during robotic prostatectomy, which minimizes damage to the nerves responsible for erectile function.
Additionally, Dr. Tewari has developed a novel Detrusor wrap technique for early urinary continence, which has changed the approach surgeons use because it offers comparable results for urinary continence and is easier than the traditional posterior approach.
Dr. Tewari's innovations extend beyond nerve-sparing techniques. He developed the total reconstruction technique, which involves restoration of the support structures of the urinary mechanism following prostate removal, for faster continence recovery.
Furthermore, he was the first to perform a catheter-less robotic prostatectomy, where a urethral catheter is avoided to minimize pain and discomfort after surgery. These advancements contribute to improved quality of life for patients undergoing prostate cancer treatment.The effectiveness of Dr. Tewari's approach is supported by research on nerve-sparing prostatectomies. Studies have shown that nerve-sparing surgeries are better than non-nerve-sparing ones at preventing side effects and complications.
One study found that men who undergo nerve-sparing prostatectomy are almost twice as likely to achieve full urinary control after surgery compared to those who have non-nerve-sparing surgery.
Dr. Tewari's work has significantly advanced the field of robotic prostate cancer surgery. His techniques have expanded opportunities for nerve-sparing and improved outcomes for patients. By focusing on preserving sexual function and urinary continence while maintaining oncological efficacy, Dr. Tewari's approach addresses the critical aspects of quality of life after prostate cancer treatment.
This comprehensive, patient-centered approach represents a significant step forward in the standard of care for prostate cancer patients.Another study demonstrated that 90.7% of men who had nerve-sparing operations could have orgasms after recovery, compared to 60.8% of those who underwent non-nerve-sparing procedures.
World-Renowned Robotic Prostate Surgeon Dr. Ash Tewari: Pioneering Precision Urology™ for Optimal Outcomes. Dr. Ashutosh "Ash" Tewari, Chairman of Urology at Mount Sinai Health System, is a global leader in robotic prostate cancer surgery and treatment. With over 9,000 robotic radical prostatectomies performed, Dr. Tewari offers unparalleled expertise in minimizing side effects while maximizing cancer control. Key highlights of Dr. Tewari's approach:
By combining cutting-edge surgical techniques, personalized medicine approaches, ongoing research, and global leadership, Dr. Tewari is working towards his goal of reaching 1 million men and improving prostate cancer outcomes globally.
Risk increases significantly after age 50, with 60% of cases diagnosed in men over 65. Family history, especially first-degree relatives with prostate cancer, doubles the risk. Certain genetic mutations like BRCA1 and BRCA2 are linked to higher risk.
Prostate cancer risk increases significantly with age, particularly after 50 years old. About 60% of prostate cancer cases are diagnosed in men over 65, highlighting the importance of age as a primary risk factor.
This age-related risk is likely due to the accumulation of genetic mutations and cellular damage over time, which can lead to the development of cancerous cells in the prostate gland.
Family history plays a crucial role in prostate cancer risk assessment. Men with first-degree relatives (father, brother, or son) diagnosed with prostate cancer have approximately double the risk of developing the disease compared to those without a family history.
This increased risk is even more pronounced if multiple relatives are affected or if the relatives were diagnosed at a younger age. The familial clustering of prostate cancer cases suggests a genetic component to the disease, although shared environmental factors may also contribute.Certain genetic mutations, particularly in the BRCA1 and BRCA2 genes, are associated with an elevated risk of prostate cancer. Men carrying BRCA2 mutations have a significantly higher lifetime risk of developing prostate cancer, estimated at 60% by age 85. BRCA1 mutations also increase prostate cancer risk, though to a lesser extent than BRCA2. These genetic factors not only increase the likelihood of developing prostate cancer but are also associated with more aggressive forms of the disease and potentially poorer outcomes.
African American men and Caribbean men of African descent face significantly higher prostate cancer incidence rates compared to other ethnic groups. Studies have shown that Black men of African or Caribbean ancestry have almost double the risk of developing prostate cancer compared to non-Black men.
This disparity is particularly pronounced in the Caribbean region, where prostate cancer mortality rates are among the highest in the world.
For instance, in Trinidad, where the population has a mix of African and Indo-Asian descent, the incidence and mortality rates are three times greater among blacks compared to Indians.
The increased risk for these populations is multifaceted. Genetic factors play a significant role, with recent research identifying nine new genetic risk factors for prostate cancer, seven of which are found either largely or exclusively in men of African ancestry.
Additionally, a study examining prostate cancer incidence trends from 2008 to 2015 found the highest incidence rates (per 100,000) in Caribbean countries, with 181.99 in Martinique and 176.62 in Guadeloupe, compared to 178.74 in New York state.
Given these elevated risks, regular screening is particularly crucial for African American and Caribbean men of African descent. However, there are ongoing debates about the efficacy of prostate-specific antigen (PSA)-based screening in these populations. Some Caribbean urologists argue that international guidelines may not be externally valid when applied to predominantly black populations, where prostate cancer biology may be more aggressive.
This has led to calls for continued PSA-based screening in the Caribbean until clinical trials specifically targeting black populations with high prostate cancer incidence and mortality are conducted.
Research has shown that dietary choices can significantly impact risk. High-fat diets and frequent consumption of processed meats have been linked to an increased risk of prostate cancer. In contrast, a diet rich in vegetables, particularly those containing antioxidants and phytochemicals, may provide protective effects against the disease. These plant-based foods can help combat oxidative stress and inflammation, which are thought to play roles in cancer development.Regular physical exercise and maintaining a healthy weight are crucial preventive measures for prostate cancer. Exercise helps regulate hormone levels, improve immune function, and reduce inflammation, all of which may contribute to lowering prostate cancer risk.
Additionally, maintaining a healthy weight is important, as obesity has been associated with an increased risk of aggressive prostate cancer and poorer outcomes in those diagnosed with the disease.
Lifestyle modifications, such as limiting alcohol consumption and avoiding tobacco use, may also play a role in prostate cancer prevention. While the exact mechanisms are not fully understood, these habits are known to contribute to overall cancer risk and may indirectly affect prostate health. Adopting a balanced, healthy lifestyle that includes a nutritious diet, regular physical activity, and stress management can contribute to overall prostate health and potentially reduce the risk of developing prostate cancer.
Regular physical activity helps manage weight and lower risk.
Studies have shown that maintaining a healthy weight is particularly important, as obesity has been associated with an increased risk of aggressive prostate cancer and poorer outcomes in those diagnosed with the disease.
When combined with smoking cessation and moderate alcohol consumption, exercise forms a cornerstone of prostate cancer prevention. Smoking has been linked to more aggressive forms of prostate cancer and increased mortality rates. Quitting smoking can significantly reduce these risks over time. Similarly, excessive alcohol consumption has been associated with higher prostate cancer risk, while moderate consumption may have a neutral or slightly protective effect.
The impact of these lifestyle factors on prostate cancer risk is particularly relevant for African American and Caribbean men of African descent, given their higher baseline risk. For example, a study investigating perceptions of prostate cancer fear and facilitators of screening behavior in African-American and Caribbean-born black men found that Caribbean-born Black men reported significantly higher mean perception of prostate cancer treatment scores compared to African American men (8.23 versus 6.14).
This suggests that targeted interventions promoting healthy lifestyle choices and regular screening could be especially beneficial for these high-risk populations.
Dr. Tewari's mission to reach 1 million men aligns with his commitment to improving prostate cancer outcomes globally. By choosing Dr. Tewari, international patients gain access to cutting-edge technology, multidisciplinary expertise, and a proven track record of excellence in urologic care.
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Barbershops and taxi cab services indeed serve as trusted hubs in many communities, making them ideal settings to provide prostate cancer support. This is particularly true for African American men, who face a higher risk of prostate cancer and may have limited access to healthcare information. Barbershops, in particular, have been successfully utilized as venues for health promotion activities, including prostate cancer education and screening. These familiar and convenient settings allow for easy-to-understand health information to be disseminated by trusted community members, such as barbers who can be trained as health advisors. Studies have shown that partnering with barbershops can lead to improvements in African American men's health by reducing barriers to healthcare and increasing awareness about important health issues like prostate cancer.
A community event offering free prostate cancer screenings and educational resources at local barbershops.
Early Detection:
Regular screenings and early intervention are crucial for successful treatment. Detecting cancer early, before it has spread, may potentially lead to better outcomes and increase the chances of survival. Early diagnosis improves cancer outcomes by providing care at the earliest possible stage, making it an important public health strategy in all settings. When cancer is diagnosed early, treatment may be more likely to be successful, as surgery is often a potential option and additional treatments can be used to lower the risk of recurrence.
Personalized Approach:
We work closely with each patient to develop a customized treatment plan. This approach aligns with the concept of personalized cancer care plans, which serve as one-stop references for information relating to treatment and care.These plans typically include initial treatment details, medicines, potential side effects, and symptoms to watch for. Personalized approaches span the full spectrum of cancer care, from risk assessment to survivorship programs, requiring intimate collaborations among multidisciplinary teams.
Comprehensive Care:
Our team provides physical, emotional, and psychological support throughout the treatment process. This holistic approach is essential in personalized cancer care, which needs to be multidisciplinary, involving radiologists, pathologists, surgeons, oncologists, genetic counselors, and biomedical informaticians. Comprehensive care also extends to personalized survivorship programs, which include risk-adjusted screening for recurrence and secondary malignancies, as well as programs to limit long-term adverse effects of therapy.
Innovative Therapies:
We explore novel treatments, including targeted immunotherapies and gene-based approaches. Advancements in sequencing technologies have significantly improved the ability to rapidly and comprehensively identify genetic phenotypes, fueling efforts towards precision medicine. These innovative treatments, often referred to as biomarker-guided therapies, are chosen in accordance with genetic alterations and have shown potential clinical benefits for an increasing number of diseases.
Precision Medicine:
Our researchers leverage genomics and biomarkers to develop personalized interventions. Precision medicine in oncology takes into account inter- and intra-tumor variability in genes, tumor environment, and individual patient factors to tailor therapy towards oncogenic drivers and modulate the tumor immune environment. Biomarkers play a crucial role in this approach, allowing for more accurate and timely diagnoses, prognoses, and informed treatment choices.
Collaborative Efforts:
We partner with leading institutions to accelerate research and drive clinical breakthroughs. Interdisciplinary collaboration is key to advancing early detection research and transforming cancer survival. For example, the Stratified Medicine Programme launched by Cancer Research UK in 2010 aims to tailor treatment to groups of patients who share similar faults in their tumors, involving partnerships with pharmaceutical companies to provide targeted drugs.
Comprehensive Care:
Precision medicine provides a strategic opportunity for technological developments to improve human health and reduce healthcare costs globally. As new experimental treatments become available, they can be added to existing trials, and those showing no benefit can be dropped, ensuring that each patient gets the best treatment for their type of tumor. This approach to sharing knowledge and innovations helps to accelerate progress in cancer treatment and care on a global scale.
"He's kind, he's nice, he's honest, and he doesn't lie." William was diagnosed with Prostate Cancer, he found confidence in getting treated from Dr. Tewari's team. "I felt comfortable and secure with Dr. Tewari and his team."
"The whole staff was really, really, great. The nurses, the hospital, everybody was so gentle, so kind, and made me feel very happy."
"When we found out that I had Prostate Cancer, it was a big shock. We found out that Dr. Tewari was the best. When you love yourself, you want the best. He looked me in the eyes and told me, "I'm going to take care of you."
Coping with prostate cancer one year later, Mark Spindel shares his experience with robotic prostatectomy.
“I'm so grateful to have met Dr. Tewari, share information with him and eventually be operated on by Dr. Tewari. I am so fortunate the Dr. Tewari and his team were taking care of me.”
An important consideration for Mike, 67 years old musician, were the after effects and quality of life after the treatment. Dr. Tewari and his team, look at giving treatment to you as a person, and not just treating the gland.
"Part of the reason why I went with Dr. Tewari was knowing that I had the ability to be able to maintain the sexual function at its utmost capacity. That's one of the biggest concerns I had in getting the surgery done.“
Richard LoRubbio is celebrating another year being cancer-free. He shares his patient journey with Dr. Ash Tewari, chair of the department of urology at the Mount Sinai Health System.
"The first time I met Dr. Tewari I immediately said - This is the man that's going to take care of me, he came in calmed me down. I knew it right away there was something very warm and sensitive about him. He explained everything to me, answered all my concerns."
“In at 8'O clock Wednesday morning, and out at 4'O clock Thursday afternoon! Pretty amazing!”
Lace up your walking shoes and join us for a community event to raise awareness and funds for prostate cancer research.
Join us for our annual gala, a night of elegance, entertainment, and fundraising to support our mission.
Tune in to our webinar series featuring leading experts discussing the latest advancements in prostate cancer treatment and care.
Holistic care for prostate cancer goes beyond conventional treatments to address the whole person—mind, body, and spirit—to promote overall well-being during and after cancer. It recognizes that physical health is interconnected with mental, emotional, and spiritual aspects.
Here are some key aspects of holistic care for prostate cancer:
A balanced diet rich in fruits, vegetables, and whole grains can indeed support overall health and potentially reduce the risk of prostate cancer. Research suggests that certain dietary choices may play a crucial role in prostate health and cancer prevention. Fruits and vegetables are essential components of a prostate-healthy diet. They provide vital vitamins, minerals, and antioxidants that help protect against cancer. Cruciferous vegetables, such as broccoli, cauliflower, and Brussels sprouts, contain compounds that may reduce cancer risk.
Tomatoes, rich in the antioxidant lycopene, have been linked to a lower risk of prostate cancer. Aim to consume at least five, preferably eight to 10, servings of fruits and vegetables daily for their cancer-protective effects. Whole grains are another important element of a balanced diet for prostate health. They contain fiber, which aids in digestion and helps eliminate toxins from the body. High-fiber diets have been associated with a reduced risk of prostate cancer. Incorporate whole grains like brown rice, oats, and whole wheat into your daily meals to support digestive health and potentially lower cancer risk.
In addition to these plant-based foods, it's important to limit the intake of certain items. Reducing consumption of red and processed meats, which have been linked to an increased risk of prostate cancer, is advisable. Instead, opt for lean proteins like poultry, fish, and plant-based sources. Also, consider incorporating foods rich in omega-3 fatty acids, such as salmon, flaxseeds, and walnuts, which have anti-inflammatory properties that may help reduce cancer risk. By focusing on a diet rich in fruits, vegetables, and whole grains, while limiting processed and red meats, you can support your overall health and potentially reduce your risk of prostate cancer.
Mind-body therapies, such as acupuncture, massage, and aromatherapy, may help manage side effects of treatment and improve overall well-being. Chronic stress can indeed have a significant impact on the immune system and potentially contribute to cancer progression. Research has shown that stress-induced immune dysregulation can create an unfavorable environment for the immune system, facilitating tumor progression. Chronic stress suppresses protective immunity, increases inflammation, and alters the tumor microenvironment in ways that can promote cancer development and growth.
To combat the negative effects of stress, various mind-body techniques have shown promise in helping cancer patients manage stress and improve their overall well-being. Yoga, meditation, and deep breathing exercises are among the practices that can be beneficial. These techniques have been found to reduce common cancer-related side effects such as fatigue, anxiety, and depression. Mind-body therapies, including acupuncture, massage, and aromatherapy, may also help manage treatment side effects and enhance quality of life for cancer patients. Studies have demonstrated that these complementary approaches can be effective in addressing symptoms like pain, nausea, and sleep disturbances. For instance, a meta-analysis of mind-body therapies showed a significant effect in reducing cancer-related pain, although more high-quality research is needed.
Mind-body interventions can offer several benefits for cancer patients:
It's important to note that while these therapies show promise, they should be used as complementary approaches alongside conventional cancer treatments. Patients should always consult with their healthcare providers before starting any new therapies or practices.
In addition to emotional support, supportive care services such as counseling, psychotherapy, and support groups can provide invaluable resources for individuals and their families throughout the prostate cancer journey. Supportive care services play a crucial role in helping individuals and their families navigate the challenges of prostate cancer. Counseling and psychotherapy provide a safe space for patients to express their concerns, fears, and emotions related to their diagnosis and treatment.
These services can help reduce feelings of anxiety, depression, and isolation, while also providing coping strategies to manage the emotional impact of cancer. Support groups offer a unique opportunity for prostate cancer patients to connect with others who are going through similar experiences. These groups, often led by oncology social workers, provide a platform for sharing information, resources, and emotional support. Participants can discuss treatment options, side effects, and practical concerns, fostering a sense of community and reducing feelings of loneliness.For couples, psychotherapy can be particularly beneficial in addressing concerns related to intimacy and sexual function, which are common issues following prostate cancer treatment. Therapists can work with patients and their partners to explore alternative forms of intimacy and communication, helping to maintain strong relationships during and after treatment. Supportive care services also extend beyond emotional support to include practical assistance. Social workers and counselors can help patients navigate the healthcare system, access financial resources, and connect with community services. Additionally, nutritional support and exercise programs may be offered to help patients manage treatment side effects and improve overall well-being.
Regular medical check-ups are essential for monitoring the progress of prostate cancer and ensuring timely interventions. Prostate-specific antigen (PSA) testing is a key component of these check-ups, serving as a valuable tool for tracking the disease's progression. PSA levels can indicate the effectiveness of treatment, potential recurrence, or the need for further intervention. In addition to PSA testing, other diagnostic measures may be employed during regular check-ups. These can include digital rectal examinations, imaging studies, and in some cases, prostate biopsies. The frequency and type of tests performed will depend on the individual patient's risk factors, treatment history, and current health status. Regular monitoring allows healthcare providers to detect any changes in the cancer's behavior early, enabling prompt adjustments to treatment plans and potentially improving outcomes.
Nerve-sparing robotic radical prostatectomy represents a sophisticated surgical intervention employed in the management of localized prostate carcinoma. This procedure entails the complete extirpation of the prostatic gland while concurrently endeavoring to preserve the integrity of the adjacent neurovascular bundles (NVBs). These NVBs are of paramount importance in maintaining erectile function and, to a lesser extent, urinary continence.
The preservation of the neurovascular bundles is achieved through meticulous dissection techniques, often aided by intraoperative nerve monitoring and real-time tissue imaging. This approach aims to optimize oncological outcomes while simultaneously mitigating the risk of post-operative functional deficits, thus potentially enhancing the patient's quality of life following this radical intervention.
Erectile function outcomes vary significantly. Research indicates that men with good preoperative sexual function, younger age, and bilateral nerve-sparing (preservation on both sides) have higher chances of regaining erections—sometimes 50-90% within a year, often with the assistance of medications like Viagra. However, it's important to note that recovery can extend up to two years, and some men may never fully regain function.
The "robotic" component of this procedure refers to the utilization of an advanced robotic surgical platform, most commonly the da Vinci Surgical System. This technology augments the surgeon's capabilities by providing enhanced visual magnification, tremor filtration, and precise instrument articulation. These features collectively enable the surgeon to execute the operation with heightened accuracy and dexterity through minimally invasive portals.
The primary objective of nerve-sparing robotic radical prostatectomy is to achieve comprehensive cancer control by removing all cancerous tissue. Simultaneously, it aims to preserve erectile function and expedite the recovery of urinary continence post-surgery by sparing the nerves. Compared to traditional open surgery, the robotic approach typically results in reduced blood loss, smaller scars, and a quicker recovery period, thus minimizing overall surgical trauma.
Regarding continence, most men experience temporary incontinence after surgery. However, nerve-sparing techniques may improve early recovery rates, with 70-90% of patients achieving pad-free status within 3-12 months.
In terms of oncological safety, nerve-sparing doesn't compromise cancer removal if the tumor is confined to the prostate. However, if cancer is located near the nerves, sparing them might increase the risk of leaving cancer behind, resulting in positive surgical margins.