54 Hopedale Street, Suite 3
Hopedale, MA 01747

Urological Cancers

Dr. Jeffrey Steinberg is one of the area’s leading experts in prostate cancer. He also treats testicular cancer in men, as well as kidney cancer and bladder cancer in both men and women. Learn more below.

Prostate Cancer
Bladder Cancer
Kidney Cancer
Testicular Cancer

Prostate Cancer

Prostate cancer is the second-leading cause of cancer death for men in the United States. About 1 in 6 men will be diagnosed with this malignancy within their lifetime.

To check for prostate cancer, Dr. Steinberg will examine the prostate (digital rectal exam) and can perform a prostate specific antigen (PSA) blood test in the office, which takes only 15 minutes to obtain results. If either of these tests is abnormal, Dr. Steinberg may recommend further testing to determine the risk of prostate cancer.

Customized Prostate Cancer Testing

4Kscore® Test

Dr. Steinberg often utilizes the 4Kscore® test, a blood test drawn in the office that combines four prostate-specific biomarkers with clinical information to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer.

The 4Kscore can be used to help determine the need for a prostate biopsy. After a negative biopsy, the 4Kscore can predict the likelihood of cancer spreading to other parts of the body in the next 20 years. The blood sample is sent overnight to a reference lab and results are usually available within one week.

PSA tests often render a false positive result, leading to an unnecessary prostate biopsy. The 4Kscore test provides better information for doctors and can help avoid an unnecessary biopsy.

Transrectal Ultrasound-Guided Prostate Biopsy

If the results of a digital rectal exam, PSA test, or 4Kscore test suggest cancer, transrectal ultrasound is performed to determine the size of the prostate and identify areas of possible cancer.

Ultrasound is also used to accurately direct the needle used for prostate biopsy. A prostate biopsy typically takes about 15 to 20 minutes and is performed on an outpatient basis. Dr. Steinberg uses a local anesthetic and often oral sedation to reduce discomfort during the procedure.

During the ultrasound examination, a patient will lie on his side. An ultrasound probe (about the size of a finger) is gently inserted 3 to 4 inches into the rectum. The probe emits sound waves that are converted into video images corresponding to the different prostate zones.

The needle extracts small pieces of prostate tissue in less than a second. At least 12 tissue samples, or "cores," are taken from the prostate.

A pathologist examines the samples under a microscope to determine whether cancer is present. Dr. Steinberg routinely meets with the patient within 1 to 2 weeks to discuss the results of the biopsy and make further recommendations.

Oncotype DX

If prostate cancer is detected on a biopsy, Dr. Steinberg may order an Oncotype DX prostate cancer test. This test, performed on the biopsy tissue, was developed to help men with newly diagnosed early-stage prostate cancer make the most informed treatment decision for their individual disease, including active surveillance.

Oncotype DX is helpful in identifying those men who need treatment versus those who can confidently choose active surveillance. Using minimal tumor tissue from the original needle biopsy, the test builds on traditional clinical and pathologic factors to provide additional, clinically relevant insight into the underlying tumor biology of an individual patient before the prostate is removed.

The result is a more precise and accurate assessment of risk, which helps more men avoid the lifelong complications associated with treatments they do not need, while directing aggressive therapy to those men who require immediate treatment.

MRI/Ultrasound Fusion Biopsy

Dr. Steinberg has trained in this new technique, which provides greater accuracy for prostate biopsy. It fuses ultrasound images with high-resolution pictures of the prostate made by a newer technology called multi-parametric magnetic resonance imaging (mp-MRI).

Prostate tumors show up on mp-MRI as discrete dark areas. By adding mp-MRI images taken beforehand to the real-time ultrasound images, Dr. Steinberg can more accurately target suspicious regions of the prostate while steering clear of healthy tissue.

Treatment Options

Active Surveillance

Active surveillance is a protocol used for monitoring prostate cancer closely if the cancer is low grade and the doctor believes that it is not potentially aggressive and does not immediately threaten the patient’s health.

After a detailed discussion with Dr. Steinberg and, depending upon the specific characteristics of the patient's prostate cancer, patients may opt for this approach, which includes a doctor visit with a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) every 3 months.

Prostate biopsies may be done every year as well. If test results change, Dr. Steinberg will discuss treatment options.

High-Frequency Ultrasound Ablation (HIFU)

Dr. Steinberg is one of the only urologists in New England to receive training in this new minimally invasive outpatient treatment. High-frequency ultrasound ablation (HIFU) is administered through a transrectal probe and uses heat generated by focusing ultrasound waves to kill cancerous cells in the prostate.

The advantage of the procedure is that only the cancerous portion of the prostate may be treated, sparing surrounding healthy tissue and minimizing sexual and urinary side effects.

HIFU is performed under ultrasound or MRI imaging guidance, which allows for advanced treatment planning and careful real-time tracking of treatment areas during the procedure. This outpatient procedure usually lasts 1–3 hours and does not require a bladder catheter.

Radioactive Seed Implant (Brachytherapy)

Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets or “seeds,” each about the size of a grain of rice. These pellets are placed directly into your prostate under general anesthesia.

Brachytherapy alone is generally used only in men with early-stage prostate cancer that is relatively slow growing (low-grade). Dr. Steinberg partners with radiation oncologists from Dana-Farber/Brigham and Women's Cancer Center to perform this procedure at Milford Regional Medical Center.

Bladder Cancer

The most common type of bladder cancer is transitional cell carcinoma, which begins in urothelial cells that line the inside of the bladder. Urothelial cells are transitional cells, meaning that they can change shape and stretch when the bladder is full.

This type of cancer is also called urothelial carcinoma. Other types of bladder cancer include squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

People who smoke have an increased risk of bladder cancer. Being exposed to certain chemicals and having chronic bladder infections can also increase the risk of bladder cancer.

The most common sign of bladder cancer is blood in the urine. Bladder cancer is often diagnosed at an early stage, when the cancer is easier to treat.

Procedures to Diagnose and Treat

Cystoscopy

Cystoscopy is a procedure performed by Dr. Steinberg to examine the lining of the bladder. A flexible tube equipped with a lens is inserted into your urethra and slowly advanced into your bladder. The bladder is examined for stones and abnormal growths. No preparation is required for cystoscopy, there are no restrictions afterwards, and the procedure only takes 5 minutes.

Bladder Biopsy

If small lesions are identified during cystoscopy, Dr. Steinberg may perform a bladder biopsy under local anesthesia by removing a small piece of tissue and sending it to the lab to be tested for cancer or other abnormalities. The biopsy area is coagulated with an electrical device to prevent bleeding. The tissue is examined by the pathologist and Dr. Steinberg generally meets with patients one week after the procedure to discuss the results.

Transurethral Resection of Bladder Tumor (TURBT)

A transurethral resection is a procedure in which bladder tumors can be removed from the bladder wall. Dr. Steinberg will insert a scope through the urethra into the bladder. TURBT is generally performed in the hospital as an outpatient procedure with the patient anesthetized.

Intravesical Chemotherapy

After removing a bladder tumor, Dr. Steinberg may determine that intravesical chemotherapy is needed. This procedure is performed under local anesthesia in the office and involves administering drugs directly into the bladder through a catheter, instead of injecting them into a vein or being taken orally.

There are minimal side effects from this therapy. BCG is the most common drug used for intravesical chemotherapy, which is approximately 85% effective at preventing future tumor growth.

Kidney Cancer

Kidney tumors are commonly found incidentally when performing Xrays such as CT scans or MRI’s for other unrelated conditions. Other times, kidney tumors are diagnosed when a patient experiences flank pain or blood in the urine. If found and removed early, these tumors are extremely curable without the need for added radiation or chemotherapy. Dr. Steinberg has extensive experience in diagnosing and removing kidney tumors and works closely with the oncology specialists at Dana Farber Cancer Institute at Milford Regional Medical Center to provide a comprehensive approach to care for patients with kidney tumors.

Robotic Partial Nephrectomy

If a tumor is found early and it is located near the edge of the kidney, the tumor only may be removed and the kidney may be spared through laparoscopic or robotic-assisted surgery. This is accomplished through small incisions leading to a quick recovery and usually requiring only a 1 or 2 day hospital stay. Dr. Steinberg has been using these minimally invasive techniques to treat kidney tumors for over 10 years.

Focal Tumor Ablation

Smaller kidney tumors may be removed, without the need for surgery, through Radiofrequency Ablation (microwave heating) or Cryotherapy (freezing) of the tumor. These procedures are performed by an Interventional Radiologist who inserts thin needles through the skin using CT scan guidance. These procedures are performed as an outpatient and allow the patient to quickly return to their normal activities. Dr. Steinberg works closely with Interventional Radiologists at area hospitals to carefully coordinate your treatment and follow up care.

Testicular Cancer

Testicular cancer mainly affects young men between the ages of 20 and 39. It is also more common in men who have had abnormal testicle development, have had an undescended testicle, or have a family history of the cancer. Symptoms include pain, swelling, or lumps in the testicles or groin area.

Dr. Steinberg will use a physical exam, lab tests, imaging tests, and surgery to diagnose testicular cancer. Most cases can be treated, especially if found early. Treatment options include surgery, radiation, and/or chemotherapy. Regular exams after treatment are important.

Lab and X-ray Tests

After an examination, Dr. Steinberg may perform a scrotal ultrasound, which is a painless soundwave test to view the inside of the testicles to look for abnormal growths or tumors. Blood tests including beta-HCG, alpha-fetoprotein, and LDH may be performed to help determine if there is potential malignancy.

Radical Orchiectomy

When Dr. Steinberg is concerned that there may be a malignancy, he may recommend a radical inguinal orchiectomy. It is called "radical" because the entire spermatic cord is removed as well as the testicle itself.

Performed through a small incision made in the groin area, this outpatient procedure generally takes less than one hour. Depending upon the type of tumor, an oncologist may recommend further treatment such as radiation or chemotherapy.

Urology Specialists of Milford, LLC

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