A new urologist at Marcus Daly Memorial Hospital has been rapidly uncovering types of cancer in the Bitterroot Valley.
Kellan Clark, Doctor of Osteopathic Medicine, started in August and said the need for full-time urology services in the valley is obvious.
“We’re currently booking office appointments out to December and we’re booking surgeries well into November,” Dr. Clark said. “We save appointments for acute needs and need to save more. The ER here is quite busy with urology issues.”
From a urology standpoint, the aging population and general problems of urinary retention has been a significant part of Dr. Clark’s practice. He’s also seen a significant amount of kidney stones.
He said that in regards to cancer, in two months he has diagnosed more prostate cancer and bladder cancer than he expected.
He said the new technology is extremely valuable and with the bladder cancer. The Blue Light Cystoscopy with Cysview has proven to be effective in the cases he has used it on.
“With this technology we were finding small tumors that I otherwise wouldn’t have been able to see,” Dr. Clark said. “That has been really helpful.
“Cysview is basically a substance that you insert into the bladder with a catheter one hour before surgery and it attaches to cancer cells within the bladder,” Dr. Clark said. “Then when you flip on the blue light with a special scope, the cancer within the bladder turns up as a bright pink, with the rest of the bladder being a blue or purplish color.”
He said, the benefit of that technology is that he can see small tumors just starting to form that he couldn’t see with the normal white light.
“Bladder cancer is a disease that is recurrent. Fifty to 60% of patients will have recurrence of what we call ‘Ta’ (a stage of a tumor) or superficial bladder cancer,” Dr. Clark said. “So, when you can find these future recurrences as they are developing then you potentially offer the patient a longer interval between treatments, a longer interval between recurrences.”
The typical course of bladder cancer is a patient would come in with complaints of symptoms of irritation or blood in their urine.
“We would perform a Cystoscopy here in the office where we would look at the bladder with a scope,” Dr. Clark said. “Then we might see a tumor. When we see a tumor the patient goes to the operating room and I go in with special equipment that resects the tumor from inside the bladder. Then you get that specimen to the lab to see if it is low grade or high grade tumor and how invasive it is.”
The results from that resection determine the next course of treatment.
“It is usually when I resect the tumor that I use the Blue Light Cystoscopy to evaluate for any other lesions that I might not be able to see otherwise,” Dr. Clark said.
In the future he may do the blue light Cystoscopy in the office just for screening purposes.
Dr. Clark recommends having symptoms checked. Blood in the urine (that you can see or detected in a “microscopic” urine test), urinary frequency, urinary urgency or a sudden change in urinary habits and irritating voiding symptoms.
“If you see blood in the urine, call me,” Dr. Clark said.
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Having Blue Light Cystoscopy available locally is a major asset for the community. Marcus Daly Memorial Hospital has been the only place with it available in the northwest until recently.
“I used it pretty heavily in my training on the East Coast and I was quite surprised that there was no one in Montana, Idaho, Washington or Oregon that was doing it, until Portland recently started using it,” Dr. Clark said.
He said that often hospitals take their time before embracing new technology.
“But here I just said, ‘I think it is good for patient care, I’ve used it in the past and I’d like to bring it here’ and they said ‘sure,’” he said.
There is the potential that patients may start coming here from out-of-state for Blue Light Cystoscopy.
“It’s a tremendous service, and new technology, for a troublesome disease such as bladder cancer,” Dr. Clark said.
The rescreening timetable is different for all patients, dependent on how fast the tumor is growing and other variables.
“They have to typically come back for screening Cystoscopies after their bladder cancer has been treated, at least every six months for a few years, then annually,” Dr. Clark said. “Bladder cancer is a burdensome disease on the patient even once it has been treated. You still have surveillance and the best way is with Cystoscopies.”
Dr. Clark said Blue Light Cystoscopies have proven to be “very helpful” in cases here in the Bitterroot Valley.
“They would have probably shown up three months later, but you can see the benefit of finding those lesions early – it is fewer trips to the operating room for the patient,” he said. “Outside of skin cancer, prostate cancer is the most common cancer among men. Accordingly, I’ve diagnosed a lot more prostate cancer than bladder cancer since I’ve been here.”
Screening for prostate cancer is based off of Prostate-specific antigen (PSA) testing and rectal exams.
“The current American Urology Association (AUA) guidelines say that any man at risk for prostate cancer should have a PSA every year or every other year from age 55 to 70, and those men should also have a rectal exam, annually, for prostate cancer screening,” Dr. Clark said. “Further PSA monitoring or screening after the age 70 is then based on patient preference and their discussion with their physician.”
Similar to the need for mammograms, Dr. Clark said he sees the need for continual PSA testing.
“There are significant limitations with PSA tests but you look at not just one single number but at the trend,” Dr. Clark said. “If the PSA remains elevated over multiple occasions then the next step is a prostate biopsy to rule out prostate cancer.”
Dr. Clark said he conducts his prostate biopsies “transperineal,” with two small poke holes below the scrotum.
“The infection risk is almost completely zero and I feel it feels like it provides better biopsy samples,” he said. “I feel very strongly about that.”