Dr. Joel Nelson

Dr. Joel Nelson, Chief Clinical Officer, Health Services and Chair, Department of Urology, UPMC discusses new approaches in caring for prostate cancer as well as symptoms that could be an indication of kidney and bladder cancers.

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Read The Full Podcast Transcript

– [Announcer] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need in medical care should consult their personal care provider.

– It’s a new approach to managing prostate cancer. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Dr. Joel Nelson. He is the chief clinical officer of the Division of Health Services and the chair of the Department of Urology. Doctor, thanks so much for joining us.

– My pleasure.

– So we think about prostate cancer. Things have changed over the years in the way that it’s treated.

– Absolutely. In fact, we try not to use the word “treated” because we really think of it as a disease that we need to manage. Very often we’ll diagnose a low-risk prostate cancer that we think is best left alone. It doesn’t mean we ignore it. We monitor it closely, but we don’t treat either with surgery or with radiation low-risk prostate cancer. This is a procedure known as active surveillance, where we kind of keep track of what the cancer is doing. Prostate cancer, uniquely, grows very slowly. And we believe that in men in whom it’s diagnosed, predominantly older men, that the likelihood that the cancer if left alone will cause them a problem is less than the potential side effects of treatment. However, if we feel that the cancer is more serious and more potentially life-threatening, the treatments fall into two large buckets: the surgical removal of a prostate gland, an operation known as a radical prostatectomy, or the treatment with radiation therapy. And radiation therapy can be delivered in a variety of fashions. A beam of x-rays from outside the body focused on the prostate gland, or the implantation of small pieces of radioactive metal into the substance of the prostate, releasing radiation internally. And those treatments are usually done one or the other. Occasionally, a man will require both surgery and then subsequently radiation therapy. But for the most part, newly diagnosed prostate cancer is either treated by surgery alone, or radiation therapy alone.

– So that is good news when it comes to prostate cancer. Bladder cancer and kidney cancers are also two conditions that you deal with as well.

– That’s correct, and those cancers unfortunately are equally common in men and women, although men have higher rates of both of those compared to women, but they also affect women. And unlike prostate cancer, both kidney and bladder cancer are really more serious cancers in the sense that we have to treat and monitor them very closely. Some bladder cancers behave in a fairly indolent fashion, but bladder cancer that is of a higher grade or more invasive into the wall of the bladder requires definitive treatment. And so we almost never will observe patients who have those conditions. Kidney cancer likewise is often incidentally detected for somebody getting a CT scan of their abdomen or pelvis

for an unrelated cause. And then we incidentally discover that they have a tumor growing in their kidney. And when those tumors reach a particular size, usually 3 to 4 centimeters, we recommend that they be surgically removed. Although there have been advances, particularly with bladder cancer, for therapies that use the immune system or therapies that are based on chemotherapy, both the treatment of bladder and kidney cancer is primarily surgical. And that’s why it falls solidly into the domain of a urologist, a surgeon who specializes in the management of those tumors.

– And you said they are often found in a scan for something else. Does that mean there aren’t really symptoms? What should people be looking out for, if anything?

– As you can imagine, both of these cancers arise in the urinary tract, so if there is a symptom, the most common symptom is that people become aware of the fact that their urine is suddenly bloody, either from a bladder cancer or kidney cancer. But because we can’t trace the blood to the bladder or the kidney, we have to evaluate the entire urinary tract. And this is something that absolutely requires the involvement of seeing a physician. You can’t sort of do this on your own. And we would strongly advise people who have blood in their urine to seek medical help because with both of these cancers, the cure rate’s quite high if the cancer’s detected early. The cure rate is dismal if the cancer is detected late. And so the sign of blood in your urine always should lead to an investigation: seeing your primary care doctor, and then possibly a referral.

– And so why is it important now that you want to remind people that they should come back to the hospital for appointments?

– Well, there are medical conditions that are dramatic: trauma, accidents, heart attacks, strokes. And it’s quite evident to everybody who is suffering from one of those things that something’s not right. But there’s a whole bunch of processes, unfortunately, going on in our bodies that we don’t really know about but are continuing to sort of march forward. And unless you’re monitoring those conditions or looking to be diagnosed with those conditions, you won’t know that they’re occurring until they in fact do become crises. Illness doesn’t take a holiday. Illness does not socially distance. Illness is unfortunately part of what it means to be human, and we all know that our ability to best deal with illness is to make the diagnoses early, introduce treatment early, and try to have the best possible outcome. And so none of this can take place if one doesn’t avail themselves of the great systems we have, like at UPMC, for comprehensive care. And we recognize that there is a risk associated with COVID infection. We also know that this has really been disruptive to our lives. But we know that there’s a growing risk of people who have delayed necessary care or people who have chosen not to address the issues of the illnesses that are occurring in their body because they have a fear about COVID and they don’t recognize that this other problem is growing over time to be much greater than the risk of COVID.

– And what do you want to say to patients about the safety precautions that UPMC is taking for them to come into the hospital or to a doctor’s office?

– The safety precautions are really extraordinary and frankly, in my career, unprecedented. Not only are we testing all patients, or offering testing to all patients who are undergoing elective procedures or surgeries, to detect those few patients who may not have any symptoms of COVID, but everybody at the doors of our facility is asked to put on a mask. Their temperature is taken. Fever is one of the signs of COVID. They’re asked questions about have they had a known exposure, are they feeling well. There’s no shortage of ways to keep your hands clean. And that culture is carried out not only from the front door of the hospital, but throughout its halls and into the rooms, and frankly in every setting. The operating room, radiology, even the cafeteria, we’re taking the risk of COVID quite seriously. We’ve also taken a lot of steps to, as much as possible, separate ourselves from one another in ways of physically distancing. As you can imagine, when you come to see a physician, sometimes they have to get pretty close to you. But the physician will always have a mask on, and the patient is asked also to be wearing a mask. And because the rate of infection, in western Pennsylvania at least, is quite low, we think that it’s wise to also allow a support person to come along with a patient into the office. Sometimes four ears are better than two, especially when you’re talking about complex issues. But that support person or visitor is also asked to take the same precautions that the patient would take: masking, washing of hands, maintaining appropriate distancing whenever possible.

– And, doctor, I would like to ask, finally, everything you do there, there is a multidisciplinary approach. And tell folks about that when it comes to their care.

– Well, urology is a small part of a very large community of caregivers. So one of the benefits of a place like UPMC is that we have lots of experts who focus their practices in very discrete ways. So, for example, in the field of urology, I have members of my department who are specializing just in the management of kidney stones, completely separate than kidney cancer, completely separate than prostate or bladder cancer. I have other people that are focused entirely on issues of infertility. And so as part of a community of caregivers, we’re able to comprehensively provide care to patients. I’ve described urology briefly, but that can expand to nephrology, the management of the kidney itself. That can expand to oncology, the systemic management of cancers. That can extend to radiation oncology. I mentioned radiation oncology as a way to treat prostate cancer. That’s done actually by a radiation oncologist. And we all work very closely in a sort of hand-in-glove fashion to provide the care that’s necessary to our patients. And some of the multidisciplinary clinics that we have are virtual. In fact, the majority are, where our communications with our colleagues are done not person-to-person, but done by telephone calls or by video. But in some of the clinics we’re shoulder-to-shoulder with other specialists, and together we work to manage whatever clinical condition is front of us.

– Dr. Nelson, such great information. Thank you so much for spending time with us today.

– My pleasure.

– And I’m Tonia Caruso. Thank you for joining us for UPMC HealthBeat.

About Urology

The UPMC Department of Urology treats all manners of conditions involving the urinary tract and male reproductive organs. We treat those disorders both in children and adults. We have a multifaceted team of physicians and researchers working together to provide the best care. We provide cutting-edge treatments, and we continue to lead research into even better methods for diagnosis and treatment. U.S. News & World Report ranks UPMC Presbyterian Shadyside as among the best hospitals in the country for urological care.