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Dr. Michael Beat

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Our staff members consist of many professionals that have specific roles and collaborate to form your personal medical management team.

Receptionist

First impressions start at the front desk.  Our receptionist welcomes patients for their appointments, schedules appointments, and helps facilitate our patient’s activities as they visit our department.  She handles incoming calls, directs those calls to the appropriate staff member, answers questions to the best of her ability, and manages incoming and outgoing correspondence.

Patient Financial Counselor

The patient financial counselor is here to help you understand your financial responsibility and co-payments as directed per your insurance plan.  She will call for benefits on your behalf so that she can inform you of the expected out of pocket expense that you may incur while undergoing treatment.  She is always available to answer your questions and has direct communication with our central billing office.

Medical Assistant

Performs administrative and clinical duties under the direction of the physician. Administrative duties may include scheduling appointments and diagnostic testing, maintaining medical records, billing, and obtaining referrals from insurance companies. Clinical duties may include recording vital signs and medical histories, preparing patients for examination, drawing blood, and administering injections and medications as directed by the physician.

Nurse Navigator

The nurse navigator will be the first line of communication to our office when we receive a referral from your primary care physician or urologist.  She may schedule your appointment with our physician or closely monitor your progress and treatment decision within the multidisciplinary practice of urologists and radiation oncology.  She will help facilitate further appointments dependent on your choice of a treatment plan.  Our nurse will provide education and support as you journey through your personalized care plan and treatment management.

Physicist

Advises and consults with physicians in such applications as use of ionizing radiation in therapy, treatment planning with externally delivered radiation as well as use of internally implanted radioactive sources; knowledge of x-ray equipment, calibration, and dosimetry; performs quality assurance and oversees radiation safety requirements for the facility.


Dosimetrist

Measures and calculates radiation dose and develops optimum arrangement of radiation fields necessary to develop a treatment plan capable of delivering the prescribed radtiation dose. Selects beam energy, multiple beam arrangement, beam modifying devices, and other factors based on the physician's prescription and guidance. May simulate treatment procedure, assist in treatment delivery, and provide quality assurance support.


Radiation Therapist

Provides radiation therapy to patients as prescribed by a radiation oncologist according to established practices and standards. Duties may include reviewing prescription and diagnosis; acting as liaison with physician and supportive care personnel; responsible for quality assurance of equipment and delivery of radiation for therapeutic purposes, radiation protection, proper execution of patient's treatment plan, simulation, and setup; maintains acurate records, reports, and files. May assist in dosimetry procedures and tumor localization.
 

Surgery

Surgery to remove the testicle (inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging. Tumors that have spread to other places in the body may be partly or entirely removed by surgery.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Surveillance

Surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the cancer has recurred. In surveillance, patients are given certain exams and tests on a regular schedule.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through aninfusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

Clinical Trials

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment. Some trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Men who have had testicular cancer have an increased risk of developing cancer in the other testicle. A patient is advised to regularly check the other testicle and report any unusual symptoms to a doctor right away.

Long-term clinical exams are very important. The patient will probably have check-ups frequently during the first year after surgery and less often after that.

The following stages are used for testicular cancer:

Stage 0 (Testicular Intraepithelial Neoplasia)

Abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called testicular intraepithelial neoplasia and intratubular germ cell neoplasia.

Stage I

Cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after an inguinal orchiectomy is done.

Stage 1A

Cancer is in the testicle and epididymis and may have spread to the inner layer of themembrane surrounding the testicle. All tumor marker levels are normal.

Stage 1B

Cancer is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or

  • has spread to the outer layer of the membrane surrounding the testicle; or
  • is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle.
  • all tumor marker levels are normal.

Stage 1S

Cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:

  • all tumor marker levels are slightly above normal; or
  • one or more tumor marker levels are moderately above normal or high.

Stage II

Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after an inguinal orchiectomyis done.

Stage IIA

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and

  • has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.
  • All tumor marker levels are normal or slightly above normal.

Stage IIB

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:

  • has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
  • has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
  • All tumor marker levels are normal or slightly above normal.

Stage IIC

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and

  • has spread to a lymph node in the abdomen that is larger than 5 centimeters.
  • All tumor marker levels are normal or slightly above normal.

Stage III

Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after an inguinal orchiectomy is done.

Stage IIIA

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and

  • may have spread to one or more lymph nodes in the abdomen; and
  • has spread to distant lymph nodes or to the lungs.
  • Tumor marker levels may range from normal to slightly above normal.

Stage IIIB

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and

  • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
  • The level of one or more tumor markers is moderately above normal.

Stage IIIC

Cancer is anywhere within the testicle, spermatic cord, or scrotum; and

  • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.
  • The level of one or more tumor markers is high

or, cancer:

  • is anywhere within the testicle, spermatic cord, or scrotum; and
  • may have spread to one or more lymph nodes in the abdomen; and
  • has not spread to distant lymph nodes or the lung but has spread to other parts of the body.
  • Tumor marker levels may range from normal to high.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The testicles will be examined to check for lumps, swelling, or pain. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following tumor markers are used to detect testicular cancer:
    • Alpha-fetoprotein (AFP)
    • Beta-human chorionic gonadotropin (β-hCG)

          Tumor marker levels are measured before inguinal orchiectomy and biopsy, to help diagnose testicular cancer

  • Inguinal orchiectomy: A procedure to remove the entire testicle through an incision in the groin. A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. If cancer is found, the cell type (seminoma or nonseminoma) is determined in order to help plan treatment.

Treatment Options by Stage

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

Treatment of stage 0 may include the following:

  • Transurethral resection with fulguration.
  • Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
  • Segmental cystectomy.
  • Radical cystectomy.
  • A clinical trial of photodynamic therapy.
  • A clinical trial of biologic therapy.
  • A clinical trial of chemoprevention therapy given after treatment so the condition will not recur (come back).

Stage I
Treatment of stage I bladder cancer may include the following:

  • Transurethral resection with fulguration.
  • Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
  • Segmental or radical cystectomy.
  • Radiation implants with or without external radiation therapy.
  • A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).

Stage II
Treatment of stage II bladder cancer may include the following:

  • Radical cystectomy with or without surgery to remove pelvic lymph nodes.
  • Combination chemotherapy followed by radical cystectomy.
  • External radiation therapy combined with chemotherapy.
  • Radiation implants before or after external radiation therapy.
  • Transurethral resection with fulguration.
  • Segmental cystectomy.

Stage III
Treatment of stage III bladder cancer may include the following:

  • Radical cystectomy with or without surgery to remove pelvic lymph nodes.
  • Combination chemotherapy followed by radical cystectomy.
  • External radiation therapy combined with chemotherapy.
  • External radiation therapy with radiation implants.
  • Segmental cystectomy.

Stage IV
Treatment of stage IV bladder cancer may include the following:

  • Radical cystectomy with surgery to remove pelvic lymph nodes.
  • External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
  • Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
  • Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
  • Chemotherapy alone or after local treatment (surgery or radiation therapy).

The following stages are used for bladder cancer:

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

In stage 0, abnormal cells are found in tissue lining the inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:

  • Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
  • Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I

In stage I, cancer has formed and spread to the layer of tissue under the inner lining of the bladder.

Stage II

In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III

In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV

In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
  • Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
  • Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
  • The type of bladder cancer cells and how they look under a microscope.
  • The patient’s age and general health.

Treatment options depend on the stage of bladder cancer.

The treatment that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.

If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.

Surgery

Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

  • Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
    • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
    • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
  • Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
  • Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
  • Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.
  • TURP: A man with advanced prostate cancer may choose TURP(transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate.TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
  • Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.

Hormone Therapy

A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

Hormone therapy uses drugs or surgery:

  • Drugs: Your doctor may suggest a drug that can block natural hormones:
    • Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
    • Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
    • Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
  • Surgery: Surgery to remove the testicles is called orchiectomy.

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.

Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

When prostate cancer spreads, it’s often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer. Doctors call the new tumor “distant” or metastatic disease.

These are the stages of prostate cancer:

  • Stage I: The cancer can’t be felt during a digital rectal exam, and it can’t be seen on a sonogram. It’s found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade is G1, or the Gleason score is no higher than 4.
  • Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn’t extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.
  • Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven’t spread to the lymph nodes.
  • Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. You may also have one or both of the following tests:

  • Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.
  • Blood test for prostate-specific antigen (PSA): A lab checks the level ofPSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. See the NCI fact sheet The Prostate-Specific Antigen (PSA) Test: Questions and Answers.

The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.

The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:

  • Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
  • Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It’s the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

If Cancer Is Found

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread. Read more in the Staging Section.

Patients with recurrent bladder cancer have cancer that has returned following initial treatment with surgery, radiation, chemotherapy or immunotherapy.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of recurrent bladder cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Recurrent Superficial Bladder Cancer

Patients with a diagnosis of superficial bladder cancer have frequent recurrences of cancer throughout their lives. Most of the time, these recurrences are non-invasive and not life threatening. Treatment of recurrent superficial bladder cancer essentially uses the same treatment approaches as were initially offered. Go to Stage I to learn about treatment options. In some instances, partial or total bladder resection may be utilized to control recurrent superficial bladder cancers. To learn more, go to Surgery for Bladder Cancer.

Treatment of Patients with Superficial Bladder Cancer That Progress to Stage II-IV Bladder Cancer

Approximately 20-40% of all patients with superficial bladder cancer will ultimately progress to more advanced stages or muscle invasive bladder cancer. When this occurs, patients are treated based on new staging of the current more invasive bladder cancer. For treatment of patients with superficial bladder cancer who have progressed, select one of the following:

Patients who experience a recurrence after initial treatment for stage II-IV bladder cancer may be treated with cystectomy (if not performed previously), chemotherapy, radiation therapy, or enrollment in a clinical trial,

Strategies to Improve Treatment

The progress that has been made in the treatment of bladder cancer has resulted from improved treatments evaluated in clinical trials. Future progress in the treatment of bladder cancer will result from continued participation in appropriate studies. Currently, there are several areas of active exploration aimed at improving the treatment of bladder cancer.

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials.

Targeted Cancer Therapies: Targeted therapies are drugs interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target”, targeted therapies may slow cancer cell growth or increase cancer cell death. Targeted therapies may be used in combination with other cancer treatments such as conventional chemotherapy.

Several different types of targeted therapy are being evaluated for the treatment of advanced bladder cancer. For example, a phase II clinical trial suggested that the targeted therapy Herceptin® (trastuzumab; a drug used to treat breast cancers that overexpress a protein known as HER2) may be effective in combination with chemotherapy for patients with HER2-positive advanced bladder cancer.1

Phase I Trials: New anti-cancer therapies continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs and/or therapeutic approaches in order to determine the best way of administering the treatment and whether the treatment has any anti-cancer activity in patients with bladder cancer.

Multiple Drug Resistance Inhibitors: Bladder cancer can be drug resistant at the outset of treatment or develop drug resistance after treatment. Several drugs are being tested to determine if they will overcome or prevent the development of multiple drug resistance in bladder cancer and other cancers.

Reference:

1 Hussain MHA, MacVicar GR, Petrylak DP et al. Trastuzumab, paclitaxel, carboplatin, and gemcitabine in advanced human epidermal growth factor receptor-2/neu-positive urothelial carcinoma: results of a multicenter phase II National Cancer Institute Trial. Journal of Clinical Oncology. 2007;25:2218-2224.

ACR Accredited Site for Diagnostic CT Services

Computed axial tomography, also known as CAT scan or CT scan, is an imaging technique that is a widely regarded tool for evaluating the genitourinary tract. CT scanning combines X-rays and computer calculations to produce precisely detailed cross-sectional slices of images of the body's tissues and organs. More specifically, very small, controlled beams of X-rays, rotating in a continuous 360-degree motion around the patient, pass through the tissue as an array of detectors measure thousands of X-ray images or profiles. Computer calculations based on those multiple measures produce the detailed pictures reflected on a screen. These images can be stored, viewed on a monitor or printed on film. In addition, stacking the "slices" of images can also create three-dimensional images of the body's internal structures.

Since CT scans can distinguish between solid and liquid, it is extremely valuable in examining the type and extent of kidney tumors or other masses, such as stones or cysts, distorting the urinary tract. CT technology, however, is also enhanced by other factors. Intravenous injections of contrast agent (dye) intensify the images. CT scans have improved speed and accuracy by gathering volumes of continuous kidney and urinary data in seconds with no gaps between images.

Specialized applications of CT can be performed in specific clinical circumstances. For example, three-dimensional reconstructions of the kidney and blood supply may show vascular abnormalities and provide "road maps" for planning surgeries.

The test is performed in a radiology department by a technician under the supervision of a radiologist. The patient will be asked to lie in a certain position on a narrow table that slides into the center of the scanner. Dye may also be administered into a vein in the hand or arm. The technician will issue instructions to the patient regarding body position and breathing during this test. Upon test completion, the patient can resume their normal daily activities.

CT scanning is a safe, efficient and effective technology that produces minimal risks. The major risk involves a reaction to any iodine-based dye that may be used. Minor reactions to the dye may include hot flashes, nausea and vomiting, which are usually treated successfully with antihistamines. In very rare circumstances, more severe complications — breathing difficulties, low blood pressure, swelling of the mouth or throat and even cardiac arrest — can occur.

There is relatively low radiation exposure during this test. However, a patient who is or may be pregnant should notify their physician prior to this examination as a fetus is susceptible to the risks associated with radiation.

CT/Simulation

CT scans are acquired in conjunction with a Simulation which is the first step in radiation treatment planning.  The CT images are acquired with the patient in treatment position on a flat tabletop the same way the daily radiaiton treatment is delivered.  That is why it may be necessary to undergo a diagnostic CT scan in addition to a CT scan for therapy planning purposes.  Simulation CT images are not read by a radiologist but are reveiwed by the radiation oncologist only. The images are then transferred to the treatment planning system to be contoured, fused with additional imaging modalities, and used for planning the patient's daily treatments. Contouring means the physician and dosimetry staff outline the normal anatomical structures and the tumor target volumes that are defined for the radiation treatment fields.

Laboratory Services

Arch Cancer Care utilizes the laboratory services of St. Louis Urological Surgeons for the processing of PSA's and testosterone testing.  We will draw your blood on site and send it to the lab for processing. It may be necessary to have your blood drawn at another lab if your insurance dictates or if you require additional labwork and testing that our in house lab does not provide. It is best to know your insurance plan requirements.

Image-guided radiation therapy (IGRT) is the use of daily imaging during a course of radiation therapy for the purpose of improving the precision and accuracy of the treatment setup and delivery.

IGRT can be accomplished with special imaging technology that allows the physician to image the tumor immediately before or even during the time radiation is delivered, while the patient is positioned on the treatment table. These imaging  technologies include Computed Tomography (known as CBCT), MRI, X-ray, and Ultrasound (US) in order to visualize the boney or soft-tissue anatomy used for setup. Using specialized computer software, these images are then compared to the reference images taken during simulation. Any necessary adjustments are then made to the patient's position and/or radiation beams in order to more precisely target radiation to the tumor and avoid healthy surrounding tissue. Some of the imaging technologies  use fiducials or implanted markers that show up on the images to further “match” the initial setup and positioning that was captured at the time of simulation. Other methods for IGRT use markers placed on the patient's body surface or markers implanted within the patient's body that emit a radiofrequency.

Arch Cancer Care utilizes the technology of the Clarity Patient Positioning System (ultrasound) to image the prostate and bladder daily for setup accuracy without the use of fiducial or implanted markers. Ultrasound does not emit radiation nor add additional dose to the patient’s treatment. Ultrasound images are acquired at the time of simulation allowing the physician to create  normal tissue and target volumes on the those images which are then compared and  “matched” with the daily acquired images  for setup by the therapists before radiation treatments. The combination of the Clarity Patient Positioning System and the state of the art Varian Clinac 2100ix, produces sub millimeter setup accuracy for the daily treatment of prostate cancer delivered with IMRT technology.

What is Intensity Modulated Radiation Therapy (IMRT)?

Intensity Modulated Radiation Therapy (IMRT) is an advanced form of radiation treatment that allows radiation oncologists to precisely target tumor cells. It is a noninvasive therapy that uses Computed Tomography (CT) or other imaging modalities to build three-dimensional diagnostic images and map treatment plans to deliver tightly focused radiation beams of varying intensity to cancerous tumors without needles, tubes or catheters. Varying the intensity of these beams enhances the ability of IMRT to maximize dosage and minimize the amount of radiation distributed to surrounding healthy tissue.

How does radiation therapy work?

Radiation therapy uses high-energy rays or particles to destroy the cancer cells and shrink the tumor while minimizing the adverse effects on nearby healthy organs and tissue. Although some normal cells are affected by radiation therapy, they recover from the effects of radiation better than cancer cells.

What are the benefits of IMRT?

More precise.
With IMRT, your doctor can target your cancer with a high-resolution radiation beam that conforms as closely as possible to the shape of a tumor. This means the specific cancer can be treated more safely and effectively.

More control.
IMRT allows your radiation oncologist to develop a plan based on the three-dimensional images that delivers varying strengths of radiation to different parts of the tumor. The dose can be higher in the most aggressive areas of the tumor and lower in areas where the beam is near or passing through healthy tissue or structures.

More options.
Because IMRT enhances control of radiation delivery, physicians can now often treat tumors once considered untreatable because they are so close to vital organs and structures. In prostate cancer cases, IMRT reduces radiation to the bladder and rectum. Thanks to IMRT, physicians can more safely treat tumors in the prostate, bladder, and testicle.

What can I expect with IMRT?

Our radiation oncologists will design an individual IMRT treatment for you.

Step 1: Preparation

Before you begin IMRT treatments, you will attend a preparation session, which may take 45-90 minutes. During this session, we will perform X-ray and computed-tomography (CT) exams to help your doctors design your specialized treatment plan. Your doctors may also place marks on your skin with colored, semi-permanent ink or a small tattoo to help them align the IMRT equipment during your treatments.

Keeping the IMRT equipment aligned with the target area means that you will need to maintain a set position and keep very still during your treatments. To make you more comfortable and enhance the accuracy of your treatment, your doctor may develop special molded plastic or foam devices that help you keep the same position.

Step 2: Treatment Planning

Following the preparation session, your doctors will design a treatment that is right for your specific needs. This process may take several days because it will involve input from your radiation oncologist, physicist and dosimetrist. Once it is complete, you will begin your IMRT treatments.

Step 3: Treatment Sessions

The first IMRT treatment session may last longer than subsequent appointments because your doctor may wish to perform additional X-ray exams and checks. A typical IMRT session lasts about 15 to 20 minutes, the same amount of time required for a standard radiation treatment.

In the treatment room, you will see a large machine called a linear accelerator, which will deliver the radiation beams. It can be rotated around your body with great precision.

Using the ink marks on your skin made during the planning session, the radiation therapist will position you on the table below the machine. Before the machine is turned on, the radiation therapist will leave the room. Although the linear accelerator is controlled remotely, the therapist can still see and talk to you. You will not see or hear the radiation and usually not feel anything. However, if you feel uncomfortable, the machine can be stopped at any time.

We know battling cancer is challenging for you and your family, and we are dedicated to providing you with advanced and personal cancer care. Because we offer a full array of cancer treatment and support services, including radiation therapy, and the latest technologies such as IMRT, you and your family can receive all your care and support services in one convenient location. If you have any questions or need more information about your treatment, please let us know.

Will I have any side effects with IMRT?

Many patients react differently to cancer treatment. IMRT may often decrease the risk and severity of common side effects of radiation therapy. In fact, the increased precision of IMRT means some patients experience very few side effects.

However, because this is radiation therapy to the prostate, potential side effects include mild bladder irritation, rectal irritation, change in erectile function, and possible fatigue. Whether or not you experience any of these primarily depends upon the treatment dose and the part of the body that is treated.

Most of the side effects that occur during radiation therapy can be easily managed. Discuss any side effects with your doctor so he or she can work with you throughout your treatment to prevent or control them with medication or diet.

How many treatments will I need?

Radiation treatments are designed to use small amounts of radiation over a series of days in order to help protect normal body tissue is the treatment area. Usually radiation therapy is given five days a week for six to eight weeks.

Because IMRT is specifically designed for each patient, your treatments will vary depending on your specific needs. Your doctor will discuss each stage of treatment with you and will help you understand your overall treatment plan.

Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA. The radiation used for cancer treatment may come from a machine outside the body, or it may come from radioactive material placed in the body near tumor cells or injected into the bloodstream. It can damage normal cells as well as cancer cells. Therefore, treatment must be carefully planned to minimize side effects.

The Arch Cancer Care facility is accredited by the American College of Radiology (ACR) which is a widely recognized validation of the high quality of care our organization provides to cancer patients. This means that our facility’s personnel, equipment, treatment-planning and treatment records as well as patient-safety policies are reviewed and recognized for excellence. 

Your radiation oncologist will develop a treatment plan, which begins with simulation, using detailed imaging scans to show the location of a patient’s tumor and the normal areas around it. These scans are usually computed tomography (CT) scans, but they can also include magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasoundscans.

The type of radiation therapy prescribed by a radiation oncologist depends on many factors, including:

  • The type of cancer
  • The size of the cancer
  • The cancer’s location in the body
  • How close the cancer is to normal tissues that are sensitive to radiation
  • How far into the body the radiation needs to travel
  • The patient’s general health and medical history
  • Whether the patient will have other types of cancer treatment
  • Other factors, such as the patient’s age and other medical conditions.

A patient may receive radiation therapy before, during, or after surgery. Some patients may receive radiation therapy alone, without surgery or other treatments. Some patients may receive radiation therapy and chemotherapy at the same time. The timing of radiation therapy depends on the type of cancer being treated and the goal of treatment.

Testicular cancer is a cancer that forms in tissues of one or both testicles. It is the most common cancer in men 20 to 35 years old. Almost all testicular cancers start in the germ cells. The two main types of testicular germ cell tumors are seminomas and nonseminomas. These 2 types grow and spread differently and are treated differently. Nonseminomas tend to grow and spread more quickly than seminomas. Seminomas are more sensitive to radiation.

A testicular tumor that contains both seminoma and nonseminoma cells is treated as a nonseminoma.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

  • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells that may form in the bladder after long-term irritation and inflammation.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Visit the National Cancer Institute where this information and more can be found about Bladder Cancer or ask your cancer care team questions about your individual situation.

Each year, more than 186,000 American men learn they have this disease. Prostate cancer is the second most common type of cancer among men in this country. Only skin cancer is more common.

Learning about medical care for prostate cancer can help you take an active part in making choices about your care such as the following:

  • Diagnosis and staging
  • Treatment options
  • Tests you may have after treatment

Visit the National Cancer Institute where this information and more can be found about Prostate Cancer or ask your cancer care team questions about your individual situation.

Understanding the type of cancer you or a loved one is battling can be helpful. It makes it possible for you to have a baseline understanding of the disease so that you can ask questions and be as informed as possible about your cancer treatment options and the plan that our specialists prepare.

Click to learn more about one of the cancers that we specialize in at Arch Cancer Care:

If you are seeking information about another type of cancer we recommend visiting the National Cancer Institute.  

At Arch Cancer Care we provide personalized care to our patients every step of the way to ensure their ultimate return to a healthier lifestyle. In close collaboration with St. Louis Urological Surgeons and the US Oncology Network, we are able to utilize our local expertise to help redefine community uro-oncology nationwide.

The team at Arch Cancer Care is considered the local Missouri and Illinois experts at delivering dedicated, individualized, and personalized curative urologic cancer care. Many treatments, including radiation therapy, can be administered with no noticeable or very minimal side effects. This multidisciplinary endeavor is facilitated by close integration of urologic cancer care with primary care physicians, urologist, gastroenterologist, medical oncologist, radiologists, surgeons, and collaborative care network of additional specialized health care providers.

Arch Cancer Care is a comfortable and easily accessible treatment facility in St. Louis. Patients diagnosed with urological cancer undergo a thorough assessment and evaluation of their overall health status. A careful analysis of the cancer pathology and thoughtful consideration of the potential biological behavior of the tumor is undertaken. Available treatment options are then presented based on these specific disease findings, personal patient preferences, and the experience and expertise of the treatment team. A comprehensive discussion of alternative treatment choices might include active surveillance, surgery, radiation therapy, hormonal therapy, or a combination of multiple modalities. For more advanced cancer states, additional systemic therapies might be suggested as part of the overall treatment plan.

It takes detailed attention, sophisticated technology, and a unified network of providers to successfully tackle the complexities of urological cancer care. Arch Cancer Care concentrates its activities and specializes its efforts in overcoming the logistical challenges of cancer treatment so that the patients can continue working, traveling, exercising, playing sports, or enjoying retirement time with friends and family. Our Team provides patients with a community setting where they will receive experienced care in cancer management. During the cancer journey, our primary goal is to cure the malignancy, but also to encourage and promote positive lifestyle changes so that patients will emerge as cancer survivors after treatment healthier than when they started.

You will find patient forms and additional helpful information under Patient Resources.

ACR Accreditation

Arch Cancer Care-St. Louis Urological Surgeons, has been awarded a three-year term (through 2018) of accreditation in radiation oncology as the result of a recent review by the American College of Radiology (ACR). Radiation oncology (radiation therapy) is the careful use of high-energy radiation to treat cancer. A radiation oncologist may use radiation to cure cancer or to relieve a cancer patient’s pain.

“ACR accreditation provides confidence to patients that their treatment will be done at a facility that has met the highest level of quality and radiation safety,” said Michael Beat, M.D., M.P.H., radiation oncologist, Arch Cancer Care. “We at Arch Cancer Care-St. Louis Urological Surgeons are proud to be one of only 7 facilities in Missouri to have this prestigious distinction.”

The ACR is the nation’s oldest and most widely accepted radiation oncology accrediting body, with more than 600 accredited sites and 27 years of accreditation experience. The ACR seal of accreditation represents the highest level of quality and patient safety. It is awarded only to facilities meeting specific Practice Guidelines and Technical Standards developed by ACR after a peer-review evaluation by board-certified radiation oncologists and medical physicists who are experts in the field. Patient care and treatment, patient safety, personnel qualifications, adequacy of facility equipment, quality control procedures, and quality assurance programs are assessed. The findings are reported to the ACR Committee on Radiation Oncology Accreditation, which subsequently provides the practice with a comprehensive report they can use for continuous practice improvement.

The ACR is a national professional organization serving more than 36,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.

Local Support Groups

The Empowerment Network

www.theempowermentnetwork.net - 314-385-0998

The mission of The Empowerment Network, a non-profit 501 (c) (3) prostate advocacy organization, is to work to improve the health and well-being of vulnerable high risk, urban males ages 35+. The Empowerment Network enriches lives by using the power of the public and private sector to provide services to these neediest of men. Call for meeting times and location.

 

International Support Groups

ZERO-The End of Prostate Cancer

www.zerocancer.org – 1-888-245-9455

ZERO’s Mission is to end prostate cancer. They save lives by advancing research, stop the pain and suffering by encouraging action, and providing education and support to men and their families. They are committed to the future generation ZERO, the first generation of men free from prostate cancer.

American Cancer Society

www.cancer.org - 1-800-ACS-2345 (1-800-227-2345)

This is a national organization that works towards elimination caner while improving quality of life from those facing the disease. Their activities include research, public education, advocating responsible cancer legislation, and helping cancer patients and their families manage their conditions.

Nation Coalition for Cancer Survivorship

www.canceradvocacy.org - 1-888-650-9127

NCCS’s mission is to advocate for quality cancer care for all people touched by cancer. Founded by and for cancer survivors, NCCS created the widely accepted definition of survivorship and defines someone as a cancer survivor from the time of diagnosis and for the balance of life.

Patient Advocates for Advanced Cancer Treatments

www.paactuse.org – 1-616-453-1477

This is a website that offers up-to-date information patients as well as physicians on the management of prostate cancer. Information about new treatment options and links to additional sources can be found on this website.

Us TOO International

www.ustoo.org – 1-800-Us-TOO (1-800-808-7866)

This organization was started by prostate cancer survivors. They provide up-to-date and reliable information about prostate cancer and treatments.

The Prostate Cancer Foundation

www.pfc.org – 1-800-757-CURE (1-800-757-2873)

PCF is firmly committed to curing prostate cancer, the Prostate Cancer Foundation is the leading philanthropic organization funding and accelerating prostate cancer research globally.

The National Cancer Institute (NCI)

www.cancer.gov – 1-800-4CANCER (1-800-422-6237)

The National Cancer Institute is part of the National Institutes of Health, which is part of the Federal Government’s principal agency for cancer research and training.

 Urology Care Foundation

www.urologyhealth.org – 1-800-828-7866

The Urology Care Foundation is committed to promoting urology research and education. They work with researchers, healthcare professionals, patients and caregivers to improve patients’ lives. The Urology Care Foundation is the official foundation of the AUA (American Urological Association) and organization of roughly 20,000 Urologist.

Once you and your doctor have identified a care plan that includes radiation therapy, our financial counselor will meet with you to review your insurance information and discuss your insurance benefits. This allows us to file claims for all office visits and treatments on your behalf. If you do not have insurance, the financial counselor will work with you to set up a payment schedule and direct you to agencies that may offer assistance.

It is imperative that you continue to provide us with information concerning changes or expiration of your insurance. Unreported changes in coverage can mean claim denials on your bill and increased financial responsiblity for you.

We accept the following insurance companies:

  • Aetna
  • Anthem Blue Cross Blue Shield
  • Cigna
  • Coventry
  • Essence
  • GHP
  • Healthlink
  • Humana
  • Medicare
  • Mercy Health
  • United Healthcare

Knowing what to expect at your first appointment can minimize stress and better prepare you for a discussion between you and your medical care team. We want to provide the best experience possible.

Your first appointment will be comprehensive, so you should plan to spend an hour or more with us. Please arrive 30 minutes before your appointment to complete and review patient forms and insurance cards. For your convenience, forms are available on this website under Patient Forms along with detailed driving instructions and maps under Our Location.

During your visit, our team of specialists will explain your diagnosis, treatment options and any additional testing required to formulate the best plan indicated for your care management. Most likely, radiation treatments will not begin on your initial visit to our office.

Treatment options can be complex, so you may find it helpful to bring a friend or family member with you. We encourage you, your friend or family member to ask questions about information that is not clear or you would like to find out more about..

Your initial appointment may include:

  • Comprehensive consultation and evaluation with your physician
  • Additional diagnostic testing may be necessary to further guide your treatments
  • A meeting with other members of your medical team
  • A meeting with the patient financial counselor to discuss your insurance and billing

Checklist of items to bring with you:

  • Patient forms filled out and signed
  • A list of ALL your prescription medications and over the counter medications or dietary supplements.
  • Prior medical history
  • Allergies
  • Write down any questions or concerns you may have to discuss with your physician.
  • Bring your updated insurance information and cards to all appointments.  Notify us of changes in your address, telephone number, employment, marital status or insurance.
  • Co-payments

Future appointments:

  • Make your next appointment at the front desk every time you leave the clinic.
  • Call the office as soon as possible to reschedule an appointment if you need to cancel, so that another patient may be seen.  We do charge a $25 no show fee if not notified within 24 hours of a cancellation. We do use an automated system for reminder calls.

A diagnosis of cancer can be frightening. Your choice for treatment and management doesn't have to be. Arch Cancer Care is the logical choice in uro-oncology care. Our physician and team of skilled professionals navigate you through and provide explicit information about your diagnosis, treatment choices, support services, and wellness and lifestyle changes that overall impact your health and quality of life.  Your personalized treatment plan choice will be supported by a collaborative network of resources experienced in providing high level satisfaction.

Patient resources and support services may be provided on site or referred to one of our network associates specially trained in their area of expertise.

We welcome self referrals and second opinion appointments.

Walker Medical Building

12855 North Outer 40

St. Louis, MO 63141

(314) 523-5444

Fax: (314) 523-5550

Entrance is ground level, 100 feet to the left of the North Tower in the Walker Medical Building.

From St Luke’s Hospital (2.3 miles)

  1. From South side exit, turn left (east) onto Conway Road. 
  2. First stop sign at Mason Road turn right.
  3. First stop light turn left onto North Outer Forty Drive.
  4. Proceed down outer road past AAA and Center Oil.
  5. Just past the Lutheran Hour Ministry Building, turn left onto the driveway of the Walker Medical Building.

(It’s at the bottom of the hill and just before you go past the large tower with the high voltage power lines).

Download Directions

Driving Eastbound Hwy 40/64

(from Chesterfield)

  1. Take Mason Road Exit and follow outer road to overpass.
  2. At light, turn left over highway. Stay in right hand lane.
  3. Turn right on North Forty Drive, driving eastbound on the north outer road.
  4. Pass AAA and Center Oil. Just past the Lutheran Hour Ministry Building, turn left into the driveway of the Walker Medical Building. (It's at the bottom of the hill and just before you go past the large tower with the high voltage power lines).

Driving Westbound Hwy 40/64

(from Hwy 270)

  1. Mason Road is the first exit west of Hwy 270. Go up ramp, stay in far right lane.
  2. Make sharp right turn onto North Forty Drive, driving eastbound on the north outer road.
  3. Pass AAA and Center Oil. Just past the Lutheran Hour Ministry Building, turn left onto the driveway of the Walker Medical Building. (It's at the bottom of the hill and just before you go past the large tower with the high voltage power lines).

Download Directions

Physicist

Advises and consults with physicians in such applications as use of ionizing radiation in therapy, treatment planning with externally delivered radiation as well as use of internally implanted radioactive sources; knowledge of x-ray equipment, calibration, and dosimetry; performs quality assurance and oversees radiation safety requirements for the facility.

Dosimetrist

Measures and calculates radiation dose and develops optimum arrangement of radiation fields and exposures to treat patient. Selects beam energy, optimum multiple beam arrangement, beam modifying devices, and other factors based on physician's prescription and guidance. May simulate treatment procedure and assist in treatment delivery.

Radiation Therapist

Provide radiation therapy to patients as prescribed by a radiation oncologist according to established practices and standards. Duties may include reviewing prescription and diagnosis; acting as liaison with physician and supportive care personnel; responsible for quality assurance of equipment and delivery of radiation for therapeutic purposes, radiation protection, proper execution of patient's treatment plan, simulation, and setup; maintains acurate records, reports, and files. May assist in dosimetry procedures and tumor localization.

Medical Assistant/Nursing

Perform administrative and certain clinical duties under the direction of physician. Administrative duties may include scheduling appointments and diagnostic testing, maintaining medical records, billing, and obtaining referrals from insurance companies. Clinical duties may include taking and recording vital signs and medical histories, preparing patients for examination, drawing blood, and administering injections and medications as directed by physician. Provides assistance to the therapists as needed. 

Our goal at Arch Cancer Care is to make cancer treatment as effective and easy as possible for every patient.  Dr. Michael Beat, our radiation oncologist, specializes in the latest cancer therapies for urological cancers including prostate cancer, bladder cancer and testicular cancer so that he can create a custom treatment plan that addresses each patient's specific needs. We offer diagnostic imaging services at our location in St. Louis, making it easier to get your treatment and imaging done all at one location.

Prostate cancer is highly curable when detected early and treated appropriately. The team at Arch Cancer Care is considered the local Missouri and Illinois experts at delivering dedicated, individualized, and personalized curative prostate cancer care to those men diagnosed with early stage prostate cancer. Many treatments, including radiation therapy, can be administered with no noticeable or very minimal side effects. This multidisciplinary endeavor is facilitated by close integration of urologic cancer care with primary care physicians, urologist, gastroenterologist, medical oncologist, radiologists, surgeons, and collaborative care network of additional specialized health care providers.

Arch Cancer Care is an easily accessible community treatment facility in St. Louis. Men diagnosed with prostate cancer undergo a thorough assessment and evaluation of their overall health status. A careful analysis of the prostate cancer pathology and thoughtful consideration of the potential biological behavior of the tumor is undertaken. Available treatment options are then presented based on these specific disease findings, personalized patient preferences, and the experience and expertise of the treatment team. A comprehensive discussion of alternative treatment choices might include active surveillance, surgery, radiation therapy, hormonal therapy, or a combination of multiple modalities. For more advanced prostate cancer disease states, additional systemic therapies might be suggested as part of the overal treatment plan.

It takes detailed attention, sophisticated technology, and a unified network of providers to successfully tackle the complexities of prostate cancer care. Arch Cancer Care specializes its efforts in overcoming the logistical challenges of prostate cancer treatment. Most patients can continue working, traveling, exercising, playing sports, or enjoying retirement time with friends and family. Our Team provides men with a comfortable setting where they will receive experienced care in prostate cancer management. During the cancer journey, our primary goal is to cure the malignancy, but also to encourage and promote positive lifestyle changes so that men will emerge as cancer survivors after treatment healthier than when they started.