One-day team approach simplifies prostate cancer care

After months of low testosterone levels, Steve Gustafson knew something wasn’t right. But what he did not expect were the results of his prostate-specific antigen (PSA) test that revealed an extremely high PSA level, a protein that at an elevated level, may be a sign of prostate cancer.

At just 48 years old, Gustafson was young for a prostate cancer diagnosis. But he prepared for the worse. He began to do his research and anticipated a series of doctors appointments to get a firm diagnosis and treatment plan.

But the Nebraska Medicine multidisciplinary genitourinary clinic simplified the process. After the results of his diagnostic tests were in, Gustafson scheduled an appointment and was able to meet with each of his doctors and leave with a treatment plan in hand, all in the same day.

“I really liked the team approach,” notes Gustafson. “I got to meet with each of the doctors at the same visit and everyone was in agreement as to what we needed to do, instead of going to three different doctors at three different facilities who might each provide different opinions. Having that congruency among my doctors was very reassuring.”

At the Nebraska Medicine multidisciplinary genitourinary clinic, all of the doctors involved in a patient’s case, collaborate before the first visit and develop a coordinated plan of care to share with the patient.

Gustafson met with Nebraska Medicine urologist Chad LaGrange, MD, medical oncologist Benjamin Teply, MD, and radiation oncologist Charles Enke, MD. They were all in agreement that the prostate should be removed in a procedure called robotic prostatectomy, a surgery Dr. LaGrange has performed more than 600 times.

“Everything was so convenient and went very smoothly,” says Gustafson. “My first inclination when I suspected I may have prostate cancer was that I would need to leave Omaha to seek a diagnosis and treatment. But after some research, I discovered I could get some of the best care in the region, right here at Nebraska Medicine.”

Not only does Nebraska Medicine have the only urologic oncologist in the state, but it also offers some of the most advanced diagnostic and treatment technology.  

Gustafson’s diagnostic care started with a targeted MRI ultrasound fusion guided biopsy, a test that significantly improves biopsy accuracy and minimizes diagnosis of insignificant prostate cancers. Nebraska Medical Center is the only hospital in the state with this technology.

“This test provides very important information about the tumor,” says Dr. LaGrange. “For non-aggressive prostate cancers, national guidelines recommend that doctors monitor the tumor as many prostate cancers are slow-growing and in some cases may never need treatment. This can spare men unnecessary treatment and possible side effects.”

The test revealed that Gustafson’s tumor was a more aggressive form. The next question – had it spread? Gustafson then underwent an Axumin PET scan, the most advanced technology available for detecting prostate cancer metastasis. “We found no obvious spread, which told us we should go forward with surgery to try to cure it,” says Dr. LaGrange. “The surgery was successful. His PSA levels dropped to near undetectable levels so no further treatment was needed.

“We will continue to monitor his PSA levels on a regular basis. If they should rise above .2, we will consider radiation therapy combined with hormonal therapy, which has been a successful combination therapy that reduces long-term recurrence.”

Gustafson and his wife recently celebrated their 27th wedding anniversary with a get-away to his grandfather’s lakeside cabin in Springstead, Wisconsin, a trip that he has been making for most of his life. And with the expertise of his doctors at Nebraska Medicine, Gustafson says he is looking forward to making that trip for many more years. “I believe in the process and the outstanding skill set of the doctors there,” says Gustafson. “I couldn’t be in better hands.”