A Driving Force Behind Treating Urologic Cancers at SIUH
Since arriving in May 2007 at Staten Island University Hospital (SIUH), Dr. Nicholas Karanikolas has been making strides in the treatment of urologic cancers. “I deal with all urologic cancers: prostate, bladder, kidney and testicular, said Dr. Karanikolas. “I’ve performed major oncologic procedures, including radical and robotic prostatectomies, where I surgically remove the prostate using either the standard open technique or with the use of a robot. For a year now, SIUH has been doing robotic prostatectomies where we utilize the DaVinci Robot to remove the cancerous tissue.”
The breakthrough DaVinci Robot assists physicians with laparoscopic surgery. “‘Laparoscopic’ means that we make a small incision in the abdomen and use a camera to help us visualize the organ of interest,” explained Dr. Karanikolas, director of urologic oncology, a graduate of New York University and SUNY Downstate Medical Center, with subspecialty training in oncology from Sloan Kettering Cancer Center in Manhattan. Before arriving at SIUH, Karanikolas worked at the Veterans Administration Hospital in Brooklyn, where he still works part-time. The Brooklyn resident is married to Dr. Felicia Tenedios, a rheumatologist, and has two children.
Dr. Karanikolas was quick to comment on the many advantages of laparoscopic surgery versus more traditional methods. “We use these long instruments controlled by the surgeon,” he explained. “But the movements themselves are made by a mechanical instrument or robot that allows the surgery to be done in a relatively bloodless field, because the abdomen is filled with carbon dioxide gas that allows for the small vessels to be pressurized by the gas. This allows for magnification of the surgical field for a more precise dissection of the organ of interest.” He noted SIUH uses the DaVinci SI, which is “…the most updated, refined model of robot for prostate cancer treatment.”
In addition, Dr. Karanikolas uses the Calypso, a GPS system, which helps localize the prostate and minimize the negative effects to adjacent organs. “The Calypso directs the radiation beam directly at the prostate, and tells it when the patent is moving,” he added.
Early Diagnosis of Prostate Cancer
The Prostate Specific Antigen (PSA) test has proved integral in early diagnosis of prostate cancer. “We are identifying prostate cancer much earlier as a consequence of the PSA screenings. We’re also confronting the dilemma of how to best manage these cancers,” said Dr. Karanikolas, who also is an assistant professor at SUNY Downstate Medical Center. “After the PSA was introduced, we were able to identity prostate cancers much earlier, even before they came to clinical detection. Many years ago, we would only be able to identify cancer when we felt abnormalities on rectal examinations. If a patient had gone to the operating room and undergone a scraping for symptomatic enlargement of his prostate, that’s when we would find the cancer. By that time, many of the cancers had become more advanced. With the PSA, we can detect cancer even before it is physically detectable. We also have available different varieties of treatment; surgery, radiation, watchful waiting, and in more advanced cases, hormonal treatment and/or chemotherapy.”
New Options for Care
Any diagnosis of cancer brings tremendous anxiety, but Dr. Karanikolas has made a particular point of not compounding that with bad information, or the assumption that surgery is the only option. “We may identify cancers that are indolent or those cancers that can simply be watched; we offer patients the opportunity to monitor the cancer to assess its progression and not necessarily intervene. Though we have a wide array of treatment, at the same time we can offer observation to a select few patients who qualify for it,” he explained. ”
PSA exams, as it turns out, are also pivotal in determining the aggressive nature of the cancer involved. “Patients who have a low PSA and a low volume of cancer as detected on the biopsy are generally in the category of deferred therapy, or watchful waiting. This means the patient’s PSA characteristics are monitored over a shorter interval than the general population,” said Dr. Karanikolas. “This means that rather than see the patient every year, we’d check the PSA every six months, and also repeat a biopsy every year to assess whether the cancer that we originally identified has stayed the same, or if there has been any progress. Even though we initially assess a patient to have indolent disease, he might ultimately have something more progressive that may require intervention.”
Dr. Karanikolas uses state-of-the-art equipment and a multidisciplinary approach to treatment. “The notion of a multidisciplinary approach and all this technology and ability puts us [SIUH] to the forefront in terms of treatment,” he said.
Fighting Urologic Cancers
In addition to treating prostate cancer, Karanikolas specializes in the treatment of other urologic cancers. “I also specialize in the removal of cancerous tumors from the kidney; I am a very firm believer in organ preservation when it can be done safely and prevent any negative effects from the cancer. I’ve also done quite a few removals of the bladder, and reconstruction of new bladders using the small bowel, so patients have a functional bladder after their native bladders are removed. Years ago, when a bladder was removed the only option patients had was to wear a bag on the side. Now we reconstruct new bladders out of intestines, and put it back where the bladder would be. It’s a remarkable advance in treatment, and just one of the reasons why I’m so energized about this field of medicine.”
Photography by Frank PensabeneSIUH is providing free PSA screenings on June 22 (at the Nalitt Institute), June 23 (at Bay Street Health Center) and June 24 (at the Ocean Breeze campus). Visit www.siuh.edu