Issue Six
Spring 2009
8
Current
Clinical Trials
The Urology Center
TUCC is now enrolling
patients in the following
clinical trials:
spread from the kidney to
another part of the body.
Over-active Bladder
We are currently enrolling
male and female patients
in a clinical trial for the
treatment of over-active
bladder. If you have been
diagnosed with over-active
bladder or have experienced
symptoms such as urinary
frequency, urgency or urge
incontinence, you may
qualify for this study.
Benign Prostatic Hyperplasia
(BPH)
We are currently enrolling
patients in a clinical trial for
the treatment of an enlarging
prostate.
Bladder Cancer
We are currently enrolling
bladder cancer patients
in a study for those who
are newly diagnosed or
experiencing recurrent
low-grade tumors.
Kidney Cancer
Newly diagnosed kidney
cancer patients interested
in enrolling in this trial must
have undergone a nephrectomy or be scheduled to
have the procedure. Lesions
(cancer cells) must have
Phase I Vaccine Study
Requirements for
enrollment:
• Diagnosed with prostate
cancer
• Must have undergone
treatment for the disease
• PSA must be rising
OR
The Urology Center
of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
• Diagnosed with renal cell
or bladder cancer
• Can be Stage II, III or IV
• Cancer must not have
metastasized to distant
areas of the body
Prostate Cancer
We are currently enrolling
prostate cancer patients in
a study for men on hormonal
therapy. Requirements for
enrollment:
• PSA must be rising
• Cancer must not have
spread to the bones
For all study participants:
of Colorado
IN FOCUS
Study medication and
procedures are provided
at no cost.
Participation in all studies
is voluntary.
For more information about
clinical trials at TUCC, please
speak with your physician or
visit www.tucc.com.
Condition Spotlight
Prostatitis
Craig Sakurada, M.D.
The prostate is a walnut sized gland located
at the base of the bladder. Its main function
as a secondary sex gland is to produce fluid
and nutrients that allow sperm to live outside
the body. Unfortunately, once fertility is no
longer an issue for men, the gland often
causes more problems than benefits.
One very common problem affecting men of all ages is prostatitis.
According to some estimates, men have a 5 -10 percent chance
of being diagnosed with some form of prostatitis during their
lifetime. According to the American Academy of Family Physicians, nearly 25 percent of physician visits for genitourinary
complaints can be attributed to prostatitis. Prostatitis accounts
for nearly two million outpatient medical visits per year, costing
more than 6 billion dollars annually. Autopsy studies have
revealed an even higher prevalence of prostatitis in men 64- 86 percent. Why are so many men suffering from prostatitis?
The answer, unfortunately, is not so clear cut. For all of the
great advancements in medicine, prostatitis is still a poorly
understood disease. This is what we do know. Prostatitis is,
by definition, inflammation of the prostate gland. What causes
the inflammation, however, is the million dollar question.
The National Institutes of Health classifies prostatitis into
four categories:
1. Acute bacterial prostatitis: These patients tend to be very
sick with high fevers. They experience burning with urination,
extremely tender prostates on examination and significant
voiding dysfunction.
2. Chronic bacterial prostatitis and 3. Chronic non-bacterial
prostatitis / prostatodynia / chronic pelvic pain syndrome:
These patients tend to have more chronic, low grade and
often intermittent symptoms. The symptoms can range
from intermittent, low grade burning with urination, urinary
frequency, urgency and slow urinary stream to pelvic/
testicular/groin/low back pain. Patients may also experience
burning, pain and even blood with or after ejaculation
as well as sexual dysfunction (premature ejaculation, erectile
dysfunction). Patients may often feel tired, lethargic, run down
and run low grade intermittent fevers and chills (with bacterial
prostatitis).
4. Asymptomatic inflammatory prostatitis: Typically, these
patients do not complain of pain or exhibit symptoms.
While these disease categories do exist, ‘pigeon-holing’ patients
into one or another can be detrimental and shortsighted.
The most challenging groups to treat are the chronic bacterial
and chronic non-bacterial prostatitis patients. The vast majority
of these patients are classified into the chronic non-bacterial
prostatitis category.
It is very difficult to identify and isolate a treatable bacteria
in many, if not most, patients who present with prostatitis
symptoms. However, a significant portion of these patients
do respond favorably to antibiotics, which raises concerns
about such defined labels. Some medical professionals believe
that this is all a spectrum of the same disease, just with varying
degrees of clinical symptoms and bacterial detectability.
Others feel that there are truly non-infectious disease causes
for prostatitis.
One interesting theory currently under investigation is that
some forms of prostatitis may be classified as autoimmune
disorders, in which the body fails to recognize normal prostate
tissue and mistakenly attacks it causing inflammation. Similar
autoimmune disorders already exist within the body such as
rheumatoid arthritis. Others theorize that the reflux of urine
into the prostate ducts, stress, pelvic floor dysfunction,
infrequent ejaculation or various foods and beverages may
contribute to prostatitis.
IN FOCUS
2
Patient Survivorship (continued)
Condition Spotlight (continued)
Regardless of the cause, the different classifications of prostatitis are often treated in a similar fashion. The mainstay of
treatment is antibiotics. Patients may be prescribed a minimum
of 6-12 weeks of antibiotics to adequately treat prostatitis. Other
treatments such as alpha-blockers (Flomax, Uroxatrol, Cardura,
etc.), anti-inflammatories (ibuprofen, NSAIDS), quercetin/
bromelain, zinc, Osteo-Biflex, prostate massages and dietary
modifications all may be used depending on the clinical
situation. Encouraging increased fluid intake, voiding and
ejaculation may all prove to be beneficial as well. Novel
treatment approaches such as cooled thermotherapy (TUMT),
acupuncture, yoga and biofeedback/pelvic floor electrical
stimulation have also been used.
Rick Modderman
from the patient and the physician), frustration, lack of immediate results and fear can all lead to inadequate and ineffective
treatment. With a comprehensive approach targeting the cause,
symptoms and disease manifestations, prostatitis can certainly
be treatable, curable and, at a minimum, manageable.
I was in rehab for four weeks and was released on Christmas
Eve. Now that I look back on it, I was in a hurry to get on with
my life. It would have been better for me to stay for a few more
weeks to firm up all aspects of my spinal cord injury – bowel
and bladder function, strength training and flexibility, more
information on what to expect as I age, more information on
what ‘outside/real world’ resources were available to me at
that time, etc.
Today, my life is busy. I recently moved to Denver due to
a job change. From a wheelchair perspective there is not one
flat spot in this town! After my injury I went to college where
I met a ton of people with disabilities.
In my opinion, prostatitis is difficult because of two reasons.
First, there is a lack of recognition of the disease - both on the
part of physicians as well as patients. Prostatitis is the great
urological mimicker. Oftentimes, it is misdiagnosed as just BPH,
chronic testicular pain, chronic low back pain, overactive
bladder or sexual dysfunction (especially in younger men).
Periodically, prostatitis symptoms are so mild and intermittent
that they are often ignored by patients or just dismissed as
something else. A delayed diagnosis, oftentimes taking years,
leads to the second issue - undertreatment. Impatience (both
The anatomy of the prostate.
understanding and using the resources around me. Having a
fat rolodex of contacts makes my life much easier and more
enjoyable. It also allows me to give back with the most impact
for the disabled community.
If I had one wish, it wouldn’t necessarily be to have not had
this motorcycle accident. I’ve learned a great deal from this
and am still learning. I believe that being paralyzed and in a
chair is more often a problem for the able bodied world than
for me personally. I am happy at age 42. I get the job done
and do most everything I want to. My being in a chair is more
of a speed bump in life compared to conquering a mountain.
With no disrespect to the kind, able bodies of the world, I get
asked a lot of questions that negatively impact my confidence.
I get asked if I need a door opened multiple times a day. Yet,
every day I open doors just fine. Yes, I am out there shopping,
running errands and working like almost everyone else. Many
of us in wheelchairs try very hard to be as independent as
possible.
I would probably wish for one of two things to happen. One,
for everyone to experience being paralyzed for three days.
The world would have such a better understanding of the
issues and real needs of those with disabilities. People may
also realize that whatever they may be going through at the
time might not be that bad. I would also wish for my bowel,
bladder and sexual function to go back to the way it was
when I was 21!
Survivorship to me means independence. I’ve pushed lawn
mowers, hand washed my own car, am successfully employed
and have volunteered and given back to my community.
The big aspects of survivorship for me are obtaining,
Join TUCC Foundation for our first annual patient survivorship
picnic from 1:00 – 4:00 p.m. on Sunday, June 7 at TUCC.
More information about this event can be found in the
TUCC Foundation section of the newsletter.
Newsflash – The Effectiveness
of Prostate Cancer Screenings
Richard Augspurger, M.D., TUCC Medical Director
Much conversation has focused on the
effectiveness of prostate cancer screenings in
the U.S. over the past few weeks. On March 26,
the New England Journal of Medicine
published a decade long study of 75,000 men
indicating that there is no early mortality
benefit from annual screenings. The Journal
also published a 15-year European study in the same issue that
found a 20 percent reduction in the mortality rate of 182,000
men. This varied data - noted as inconclusive even by some of
the authors of the studies - is presenting mixed messages to the
general public.
Prostate cancer is now the second leading cause of death
among American men. In Colorado alone, 3,210 cases were
diagnosed in 2008.
Controversy has surrounded prostate cancer screenings since
the advent of the Prostate Specific Antigen (PSA) test. While
not perfect, it is the best tool available today to diagnose the
slow-growing disease.
What we do know is that when prostate cancer is diagnosed in
its earliest stages, the disease is treatable and survivable, with
cure rates greater than 80 percent. Before PSA screenings,
TUCC physicians could diagnose up to 40 percent of prostate
cancer patients as metastatic. Today, thanks to screenings and
early detection, it is incredibly rare for us to diagnose a metastatic patient.
Abandoning prostate cancer screenings without further
investigation and conclusive data is not the answer. At TUCC,
we recommend that all men participate in annual prostate
cancer screenings (PSA and DRE examinations) beginning at
age 50. African-American men and men with a positive family
history should begin these screenings at age 40. Only then can
patients make informed treatment decisions with their physicians.
Patient Education
TUCC/Krames Online Portal
At TUCC, we know that beginning the treatment process for
any urologic condition can seem daunting to our patients. And
while a wealth of information can be found on the Internet,
how can you be sure it’s correct?
In order to provide our patients with clinically accurate patient
education materials, TUCC launched an online patient education portal last fall. This particular portal provides users with
access to more than 4,000 topics relating to urology, general
health and medicine. Users can also search for descriptions of
33,000 different prescription medications and find information
on their own personal prescription.
The TUCC/Krames Online Portal can be accessed from the
Patient Conditions section of the TUCC Web site. We encourage all patients to utilize it as a 24-hour-a-day resource.
7
IN FOCUS
6
Upcoming Foundation Events
(continued)
October 20, 2009
Annual Presentation on Nutrition
and Supplements
7:00 p.m.
PPA Event Center
2105 Decatur Street
Denver, CO 80211
TUCC Foundation is excited to bring Mark Moyad, M.D.,
back to Colorado for an 11th year. This is a free seminar
for those interested in cancer prevention and those living
with cancer. Dr. Moyad is the primary author of more than
100 medical articles, an author or co-author of five books
and the editor-in-chief of the medical journal “Seminars
in Preventive & Alternative Medicine” by Elsevier. His
presentation is the premier update on nutrition and
supplements for urologic cancers in Colorado.
Prostate Cancer Education Video
TUCC Foundation and the Center for African American Health
are currently filming a five minute video focused on what men
need to know about prostate cancer screenings. The video
seeks to dispel the myths associated with screening and
encourage men to take charge of their health. Stay tuned for
its release on the TUCC Foundation Web site in September 2009.
To learn more about any of these events or to make
a donation to TUCC Foundation, please call 303.783.2777
or visit www.tucc.com/foundation.
Patient Survivorship
After the ambulance picked me up and rushed me to the
hospital, I remember one specific thing. When I was on the
metal slab – as I call it – I remember lots of people (physicians
and nurses) running around me poking and probing. I was on
my back and staring up at all of the different faces around me.
I wasn’t feeling any pain, except for my left shoulder, and was
curious what all the rush was about.
At one point a trauma nurse looked down at my face and asked
me how high I could lift my arms. My left shoulder was killing
me. I was lying flat on my back on this metal slab and was very
confused. My arms were on my belly and I could barely lift
them up. She leaned over and grabbed both my wrists
TUCC Clinical Research
Department Awarded Acceptance
into Society of Urologic Oncology
Clinical Trials Consortium
In February 2009, the TUCC clinical research department was
awarded acceptance into the Society of Urologic Oncology
Clinical Trials Consortium (SUO-CTC). The SUO-CTC is a national
alliance of leading academic and community based urologic
oncologists committed to furthering urologic research.
The SUO-CTC pursues clinical trials in concert with the
pharmaceutical industry to find medicines and treatments to
tackle urological disorders including bladder cancer, prostate
cancer and renal cancer. TUCC is one of only 11 large urology
groups in the country to be accepted into the SUO-CTC.
The TUCC clinical research department actively initiates and
participates in local and national clinical trials focused on
advancing the treatment of bladder cancer, prostate cancer,
renal cancer, testicular cancer and other urologic conditions.
To learn more about the clinical trials currently offered at TUCC,
please consult the back side of this newsletter or visit
www.tucc.com.
Value Added Urology at TUCC
Rick Modderman
On October 9, 1987, I broke
my back in a motorcycle
accident. I was just 21 years
old. As I was riding on a
winding road in Northern
California, I lost control of
the bike and drove head on
into a curb. The front wheel
of the bike went up and the
back wheel launched my
body forward. My chest hit the handle bars stopping my upper
body momentum. My legs went over my head and later at the
hospital my doctor said that my ankles probably made it to
my ears. I broke five vertebrae in the accident – T4 through T8.
I also broke three ribs (two on one side and one on the other)
where they connect to the spine. The ribs punctured the sacks
around my lungs. Today, I am labeled a complete T4 paraplegic.
3
Stephen Ruyle, M.D., TUCC President
and pulled my arms up over behind my head. The pain was
unbearable and I let the expletives fly. Then I passed out.
I woke up many hours later with tubes just beneath both
armpits as well as in other places throughout my body.
What happened? The ribs that punctured my lung cavities
were going to cause my lungs to collapse. I needed to get
the fluid drained immediately. Yet, my blood pressure was
too low to receive any anesthesia/pain killers prior to that
nurse ripping my arms up over my head so the doctor could
poke a hole in my chest and insert a tube.
After I was stabilized, it was off to surgery to repair my spine.
The surgeon put two Harrington rods along with bone
removed from my left hip back on my spine to give it some
stability. I have since broken those rods following many sports
activities and a car accident. A doctor said it would take a
hammer and chisel to remove them. No thank you! Physical
therapy was next. As a 21-year-old who was in good shape,
physical therapy was like a four week gym challenge. The
physical aspect of my injury has always been easier to deal
with than the mental aspect. While in rehab, I focused on the
physical skills and worked hard to figure out my limitations.
It is the ‘real world’ mental aspects that I find most challenging.
At rehab, I focused on learning and mastering my transfers to the bed, car, shower bench, etc. Learning to do wheelies and
going up and down curbs was actually fun and have saved me
a lot of time over the years. Why should I go around a building
to find a ramp when I can just pop up a curb to get inside?
We are experiencing extraordinarily difficult
economic times where getting the most value
for your money is paramount. This has led me
to further examine the multiple services provided
by TUCC which enhance the value of the urology
experience for patients and referring physicians.
These services are provided at no additional
expense.
For instance, did you know that all TUCC clinical personnel are
required to obtain basic life support certification every two years?
For registered nurses and physicians, advanced cardiac life
support training is also required every two years. Hopefully a
patient will never need emergency life support at TUCC, but we
are ready in case such a rare event occurs.
Did you know that TUCC runs three support groups for prostate
cancer, bladder cancer and interstitial cystitis patients? In the near
future we will also be establishing a urological support group for
our patients with spinal cord injury. We are also focused on
improving the overall health of our patients through quarterly
educational seminars on nutrition and exercise and our sponsorship of an annual presentation on nutrition and supplements
given by Mark Moyad, M.D. This presentation is considered to
be the premier update on nutrition and supplements for urologic
cancers in Colorado.
Throughout the year, TUCC employees volunteer their time
and expertise at prostate cancer and men’s health screenings
including the 9Health Fair, the Center for African American
Health’s annual health fair and other community events. TUCC
Foundation, our nonprofit, 501 (c)(3) public charity, promotes
community wide urologic education and provides needed
financial assistance to urologic patients and TUCC employees.
This year, TUCC also hosted our first educational seminar for
primary care physicians and their staff to review current topics
in urology.
Our nationally recognized research department provides
patients access to cutting edge treatments for urologic
diseases. The department also hosts a quarterly speaker who
is an expert in their field to keep TUCC physicians up-to-date
on advancements in urologic research.
For our patients undergoing surgery to remove their prostate,
we provide training on pelvic floor muscle exercises by a board
certified physical therapist. This helps promote the return of
urinary continence following surgery. We have also established
a penile rehabilitation program for the treatment of erectile
dysfunction following prostate cancer surgery. Our nurses
provide additional education and support for all surgery
patients and contact patients following every biopsy and
procedure performed in our surgery center.
4
TUCC Foundation
Advancing urologic care in the Rocky Mountain region through advocacy, research, education and support.
Patient Support
Recent Foundation Events
TUCC Penile Rehabilitation Program
Erectile dysfunction continues to be one of the most common
problems experienced by men following a da Vinci prostatectomy surgery. This issue can be a difficult process for men
and their partners to go through. Following surgery it can
take one to three years of natural recovery time for a man
to see improvement in his erectile function. However, there
is a clinical option for patients looking to recover from their
surgical procedure - the TUCC penile rehabilitation program.
Value Added Urology at TUCC
(continued)
The TUCC standards committee reviews our clinical outcomes
and makes suggestions on how to improve quality and
decrease adverse events. We have a morbidity and mortality
conference every two months to review complications in
an effort to improve our quality of care.
Our physicians are required to undertake 30 hours of category
1 continuing medical education on a yearly basis (many do
more). We have a monthly tumor board to review the cases
of our most challenging cancer patients. This meeting is
attended by all of the TUCC physicians and three of Colorado’s
most prominent urologic oncologists. TUCC also has a monthly
journal club to keep physicians up-to-date on the latest medical
literature. Our staff attend regularly scheduled educational
seminars taught by TUCC physicians that provide further
understanding of urological diseases and treatments. In
addition, we have regular meetings to review difficult kidney
and ureteral stone cases. All of our committees, educational
seminars and meetings promote the value of continuing
education and the TUCC mission of excellence in urology.
In my experience, very few physicians or practices go to this
extent to provide such a high level of value added medical
care. However, at TUCC we are always striving to improve
and welcome suggestions from patients and referring physicians
on what we can do better.
For more information on value added services at TUCC,
visit www.tucc.com or www.tucc.com/foundation.
Chris Hitt, L.P.N., manager of the penile
rehabilitation program, with a patient.
TUCC established this program for our da Vinci prostatectomy
patients four years ago. It serves as an important component
of the prostate cancer treatment process. Patients who elect to
participate are offered treatment options designed to facilitate
recovery and help them attain and maintain an erection.
Patients are encouraged to begin the program in the weeks
immediately following their prostatectomy. Only two in-office
appointments are required. We will explain the various aspects
of the program at the initial appointment. At the second
appointment, patients will receive instructions on how to use
the treatment options they’ve selected. Most other discussions
can be completed over the phone.
The TUCC penile rehabilitation program includes a mechanical
device - the vacuum erection pump - and three different
prescription medication options. Because the mechanical
device and prescription medications will impact each individual
differently, patients are invited to test all four rehabilitation
options during their course of treatment.
To learn more about the treatment options associated with
this program, please contact Chris Hitt, L.P.N., at 303.762.7158
or visit www.tucc.com.
January 31, 2009
Center for African American
Health Annual Health Fair
Approximately 1,000 people
participated in the Center for African
American Health's 7th Annual Health
Fair on January 31st, setting a new
attendance record. TUCC Foundation
clinical volunteers provided free PSA and DRE examinations
for 116 men attending the health fair. African–American men
are at a higher risk of being diagnosed with prostate cancer
than men of any other race.
April 15, 2009
Male Urinary Incontinence and Erectile Dysfunction Seminar
More than 200 people attended this annual presentation at the
PPA Event Center. TUCC physicians, Richard Augspurger, M.D.,
and Jesse Mills, M.D., discussed the latest treatments available
for urinary incontinence and erectile dysfunction. Because
there are so many treatments available for these conditions,
our goal was to provide attendees with the information needed
to find a beneficial solution for themselves – and their partners.
A wide range of treatment options were discussed including
medication, penile implants, artificial urinary sphincters and
male slings.
Upcoming Foundation Events
June 7, 2009
2009 Survivorship Picnic
1:00 p.m. – 4:00 p.m.
The Urology Center of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
This event will celebrate survivors of urologic conditions
(prostate cancer, bladder cancer, kidney cancer, testicular
cancer, spinal cord injury and interstitial cystitis patients).
Survivors and their families and friends develop a bond that
follows a life changing diagnosis and the ups and downs of
treatment. A survivor’s hope and perseverance serves as an
inspiration to all of us. The Survivorship Picnic will feature a
display of classic cars from the Old Car Council of Colorado,
survivorship speakers, catered BBQ courtesy of PRN Medical,
live music, interactive survivorship booths, educational
information, giveaways and much more.
August 5 and November 4, 2009
Quarterly Nutrition and Exercise Presentations
6:00 p.m.
The Urology Center of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
Nutrition and exercise play a key role the
urologic treatment process. The August 5th
presentation will focus on cardiovascular
health – nutrition and exercise. The November
4th presentation will highlight weight loss
and exercise. Registration for both presentations is capped at 40 people. Please call
303.762.7666 or 877.712.3111 (toll-free)
to register.
August 29, 2009
5th Annual Classic
Aircraft and Car Show
9:00 a.m. – 3:00 p.m.
Front Range Airport
5200 Front Range Parkway
Watkins, CO 80137
TUCC Foundation is a proud partner of this event that brings
unique classic and custom cars, aircraft and motorcycles
to Coloradans. As a kick-off to Prostate Cancer Awareness
Month, volunteers will offer free PSA and DRE examinations
and educational materials to those men attending the show
from 9:00 a.m. – 12:00 p.m.
September 26, 2009
Annual Men’s Health Screening
8:00 a.m. – 12:00 p.m.
Inner City Health Center
3800 York Street
Denver, CO 80205
Each year, TUCC Foundation hosts a comprehensive men’s
health screening for the local community as part of Prostate
Cancer Awareness Month. The key to a good prostate cancer
diagnosis is early detection through annual screenings. In
2009, TUCC Foundation will partner with the Center for African
American Health to hold this annual event at Inner
City Health Center. Participating men can take part in numerous
screening opportunities on September 26th including prostate
cancer, low testosterone and vitamin D.
5
4
TUCC Foundation
Advancing urologic care in the Rocky Mountain region through advocacy, research, education and support.
Patient Support
Recent Foundation Events
TUCC Penile Rehabilitation Program
Erectile dysfunction continues to be one of the most common
problems experienced by men following a da Vinci prostatectomy surgery. This issue can be a difficult process for men
and their partners to go through. Following surgery it can
take one to three years of natural recovery time for a man
to see improvement in his erectile function. However, there
is a clinical option for patients looking to recover from their
surgical procedure - the TUCC penile rehabilitation program.
Value Added Urology at TUCC
(continued)
The TUCC standards committee reviews our clinical outcomes
and makes suggestions on how to improve quality and
decrease adverse events. We have a morbidity and mortality
conference every two months to review complications in
an effort to improve our quality of care.
Our physicians are required to undertake 30 hours of category
1 continuing medical education on a yearly basis (many do
more). We have a monthly tumor board to review the cases
of our most challenging cancer patients. This meeting is
attended by all of the TUCC physicians and three of Colorado’s
most prominent urologic oncologists. TUCC also has a monthly
journal club to keep physicians up-to-date on the latest medical
literature. Our staff attend regularly scheduled educational
seminars taught by TUCC physicians that provide further
understanding of urological diseases and treatments. In
addition, we have regular meetings to review difficult kidney
and ureteral stone cases. All of our committees, educational
seminars and meetings promote the value of continuing
education and the TUCC mission of excellence in urology.
In my experience, very few physicians or practices go to this
extent to provide such a high level of value added medical
care. However, at TUCC we are always striving to improve
and welcome suggestions from patients and referring physicians
on what we can do better.
For more information on value added services at TUCC,
visit www.tucc.com or www.tucc.com/foundation.
Chris Hitt, L.P.N., manager of the penile
rehabilitation program, with a patient.
TUCC established this program for our da Vinci prostatectomy
patients four years ago. It serves as an important component
of the prostate cancer treatment process. Patients who elect to
participate are offered treatment options designed to facilitate
recovery and help them attain and maintain an erection.
Patients are encouraged to begin the program in the weeks
immediately following their prostatectomy. Only two in-office
appointments are required. We will explain the various aspects
of the program at the initial appointment. At the second
appointment, patients will receive instructions on how to use
the treatment options they’ve selected. Most other discussions
can be completed over the phone.
The TUCC penile rehabilitation program includes a mechanical
device - the vacuum erection pump - and three different
prescription medication options. Because the mechanical
device and prescription medications will impact each individual
differently, patients are invited to test all four rehabilitation
options during their course of treatment.
To learn more about the treatment options associated with
this program, please contact Chris Hitt, L.P.N., at 303.762.7158
or visit www.tucc.com.
January 31, 2009
Center for African American
Health Annual Health Fair
Approximately 1,000 people
participated in the Center for African
American Health's 7th Annual Health
Fair on January 31st, setting a new
attendance record. TUCC Foundation
clinical volunteers provided free PSA and DRE examinations
for 116 men attending the health fair. African–American men
are at a higher risk of being diagnosed with prostate cancer
than men of any other race.
April 15, 2009
Male Urinary Incontinence and Erectile Dysfunction Seminar
More than 200 people attended this annual presentation at the
PPA Event Center. TUCC physicians, Richard Augspurger, M.D.,
and Jesse Mills, M.D., discussed the latest treatments available
for urinary incontinence and erectile dysfunction. Because
there are so many treatments available for these conditions,
our goal was to provide attendees with the information needed
to find a beneficial solution for themselves – and their partners.
A wide range of treatment options were discussed including
medication, penile implants, artificial urinary sphincters and
male slings.
Upcoming Foundation Events
June 7, 2009
2009 Survivorship Picnic
1:00 p.m. – 4:00 p.m.
The Urology Center of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
This event will celebrate survivors of urologic conditions
(prostate cancer, bladder cancer, kidney cancer, testicular
cancer, spinal cord injury and interstitial cystitis patients).
Survivors and their families and friends develop a bond that
follows a life changing diagnosis and the ups and downs of
treatment. A survivor’s hope and perseverance serves as an
inspiration to all of us. The Survivorship Picnic will feature a
display of classic cars from the Old Car Council of Colorado,
survivorship speakers, catered BBQ courtesy of PRN Medical,
live music, interactive survivorship booths, educational
information, giveaways and much more.
August 5 and November 4, 2009
Quarterly Nutrition and Exercise Presentations
6:00 p.m.
The Urology Center of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
Nutrition and exercise play a key role the
urologic treatment process. The August 5th
presentation will focus on cardiovascular
health – nutrition and exercise. The November
4th presentation will highlight weight loss
and exercise. Registration for both presentations is capped at 40 people. Please call
303.762.7666 or 877.712.3111 (toll-free)
to register.
August 29, 2009
5th Annual Classic
Aircraft and Car Show
9:00 a.m. – 3:00 p.m.
Front Range Airport
5200 Front Range Parkway
Watkins, CO 80137
TUCC Foundation is a proud partner of this event that brings
unique classic and custom cars, aircraft and motorcycles
to Coloradans. As a kick-off to Prostate Cancer Awareness
Month, volunteers will offer free PSA and DRE examinations
and educational materials to those men attending the show
from 9:00 a.m. – 12:00 p.m.
September 26, 2009
Annual Men’s Health Screening
8:00 a.m. – 12:00 p.m.
Inner City Health Center
3800 York Street
Denver, CO 80205
Each year, TUCC Foundation hosts a comprehensive men’s
health screening for the local community as part of Prostate
Cancer Awareness Month. The key to a good prostate cancer
diagnosis is early detection through annual screenings. In
2009, TUCC Foundation will partner with the Center for African
American Health to hold this annual event at Inner
City Health Center. Participating men can take part in numerous
screening opportunities on September 26th including prostate
cancer, low testosterone and vitamin D.
5
IN FOCUS
6
Upcoming Foundation Events
(continued)
October 20, 2009
Annual Presentation on Nutrition
and Supplements
7:00 p.m.
PPA Event Center
2105 Decatur Street
Denver, CO 80211
TUCC Foundation is excited to bring Mark Moyad, M.D.,
back to Colorado for an 11th year. This is a free seminar
for those interested in cancer prevention and those living
with cancer. Dr. Moyad is the primary author of more than
100 medical articles, an author or co-author of five books
and the editor-in-chief of the medical journal “Seminars
in Preventive & Alternative Medicine” by Elsevier. His
presentation is the premier update on nutrition and
supplements for urologic cancers in Colorado.
Prostate Cancer Education Video
TUCC Foundation and the Center for African American Health
are currently filming a five minute video focused on what men
need to know about prostate cancer screenings. The video
seeks to dispel the myths associated with screening and
encourage men to take charge of their health. Stay tuned for
its release on the TUCC Foundation Web site in September 2009.
To learn more about any of these events or to make
a donation to TUCC Foundation, please call 303.783.2777
or visit www.tucc.com/foundation.
Patient Survivorship
After the ambulance picked me up and rushed me to the
hospital, I remember one specific thing. When I was on the
metal slab – as I call it – I remember lots of people (physicians
and nurses) running around me poking and probing. I was on
my back and staring up at all of the different faces around me.
I wasn’t feeling any pain, except for my left shoulder, and was
curious what all the rush was about.
At one point a trauma nurse looked down at my face and asked
me how high I could lift my arms. My left shoulder was killing
me. I was lying flat on my back on this metal slab and was very
confused. My arms were on my belly and I could barely lift
them up. She leaned over and grabbed both my wrists
TUCC Clinical Research
Department Awarded Acceptance
into Society of Urologic Oncology
Clinical Trials Consortium
In February 2009, the TUCC clinical research department was
awarded acceptance into the Society of Urologic Oncology
Clinical Trials Consortium (SUO-CTC). The SUO-CTC is a national
alliance of leading academic and community based urologic
oncologists committed to furthering urologic research.
The SUO-CTC pursues clinical trials in concert with the
pharmaceutical industry to find medicines and treatments to
tackle urological disorders including bladder cancer, prostate
cancer and renal cancer. TUCC is one of only 11 large urology
groups in the country to be accepted into the SUO-CTC.
The TUCC clinical research department actively initiates and
participates in local and national clinical trials focused on
advancing the treatment of bladder cancer, prostate cancer,
renal cancer, testicular cancer and other urologic conditions.
To learn more about the clinical trials currently offered at TUCC,
please consult the back side of this newsletter or visit
www.tucc.com.
Value Added Urology at TUCC
Rick Modderman
On October 9, 1987, I broke
my back in a motorcycle
accident. I was just 21 years
old. As I was riding on a
winding road in Northern
California, I lost control of
the bike and drove head on
into a curb. The front wheel
of the bike went up and the
back wheel launched my
body forward. My chest hit the handle bars stopping my upper
body momentum. My legs went over my head and later at the
hospital my doctor said that my ankles probably made it to
my ears. I broke five vertebrae in the accident – T4 through T8.
I also broke three ribs (two on one side and one on the other)
where they connect to the spine. The ribs punctured the sacks
around my lungs. Today, I am labeled a complete T4 paraplegic.
3
Stephen Ruyle, M.D., TUCC President
and pulled my arms up over behind my head. The pain was
unbearable and I let the expletives fly. Then I passed out.
I woke up many hours later with tubes just beneath both
armpits as well as in other places throughout my body.
What happened? The ribs that punctured my lung cavities
were going to cause my lungs to collapse. I needed to get
the fluid drained immediately. Yet, my blood pressure was
too low to receive any anesthesia/pain killers prior to that
nurse ripping my arms up over my head so the doctor could
poke a hole in my chest and insert a tube.
After I was stabilized, it was off to surgery to repair my spine.
The surgeon put two Harrington rods along with bone
removed from my left hip back on my spine to give it some
stability. I have since broken those rods following many sports
activities and a car accident. A doctor said it would take a
hammer and chisel to remove them. No thank you! Physical
therapy was next. As a 21-year-old who was in good shape,
physical therapy was like a four week gym challenge. The
physical aspect of my injury has always been easier to deal
with than the mental aspect. While in rehab, I focused on the
physical skills and worked hard to figure out my limitations.
It is the ‘real world’ mental aspects that I find most challenging.
At rehab, I focused on learning and mastering my transfers to the bed, car, shower bench, etc. Learning to do wheelies and
going up and down curbs was actually fun and have saved me
a lot of time over the years. Why should I go around a building
to find a ramp when I can just pop up a curb to get inside?
We are experiencing extraordinarily difficult
economic times where getting the most value
for your money is paramount. This has led me
to further examine the multiple services provided
by TUCC which enhance the value of the urology
experience for patients and referring physicians.
These services are provided at no additional
expense.
For instance, did you know that all TUCC clinical personnel are
required to obtain basic life support certification every two years?
For registered nurses and physicians, advanced cardiac life
support training is also required every two years. Hopefully a
patient will never need emergency life support at TUCC, but we
are ready in case such a rare event occurs.
Did you know that TUCC runs three support groups for prostate
cancer, bladder cancer and interstitial cystitis patients? In the near
future we will also be establishing a urological support group for
our patients with spinal cord injury. We are also focused on
improving the overall health of our patients through quarterly
educational seminars on nutrition and exercise and our sponsorship of an annual presentation on nutrition and supplements
given by Mark Moyad, M.D. This presentation is considered to
be the premier update on nutrition and supplements for urologic
cancers in Colorado.
Throughout the year, TUCC employees volunteer their time
and expertise at prostate cancer and men’s health screenings
including the 9Health Fair, the Center for African American
Health’s annual health fair and other community events. TUCC
Foundation, our nonprofit, 501 (c)(3) public charity, promotes
community wide urologic education and provides needed
financial assistance to urologic patients and TUCC employees.
This year, TUCC also hosted our first educational seminar for
primary care physicians and their staff to review current topics
in urology.
Our nationally recognized research department provides
patients access to cutting edge treatments for urologic
diseases. The department also hosts a quarterly speaker who
is an expert in their field to keep TUCC physicians up-to-date
on advancements in urologic research.
For our patients undergoing surgery to remove their prostate,
we provide training on pelvic floor muscle exercises by a board
certified physical therapist. This helps promote the return of
urinary continence following surgery. We have also established
a penile rehabilitation program for the treatment of erectile
dysfunction following prostate cancer surgery. Our nurses
provide additional education and support for all surgery
patients and contact patients following every biopsy and
procedure performed in our surgery center.
Issue Six
Spring 2009
8
Current
Clinical Trials
The Urology Center
TUCC is now enrolling
patients in the following
clinical trials:
spread from the kidney to
another part of the body.
Over-active Bladder
We are currently enrolling
male and female patients
in a clinical trial for the
treatment of over-active
bladder. If you have been
diagnosed with over-active
bladder or have experienced
symptoms such as urinary
frequency, urgency or urge
incontinence, you may
qualify for this study.
Benign Prostatic Hyperplasia
(BPH)
We are currently enrolling
patients in a clinical trial for
the treatment of an enlarging
prostate.
Bladder Cancer
We are currently enrolling
bladder cancer patients
in a study for those who
are newly diagnosed or
experiencing recurrent
low-grade tumors.
Kidney Cancer
Newly diagnosed kidney
cancer patients interested
in enrolling in this trial must
have undergone a nephrectomy or be scheduled to
have the procedure. Lesions
(cancer cells) must have
Phase I Vaccine Study
Requirements for
enrollment:
• Diagnosed with prostate
cancer
• Must have undergone
treatment for the disease
• PSA must be rising
OR
The Urology Center
of Colorado
2777 Mile High Stadium Circle
Denver, CO 80211
• Diagnosed with renal cell
or bladder cancer
• Can be Stage II, III or IV
• Cancer must not have
metastasized to distant
areas of the body
Prostate Cancer
We are currently enrolling
prostate cancer patients in
a study for men on hormonal
therapy. Requirements for
enrollment:
• PSA must be rising
• Cancer must not have
spread to the bones
For all study participants:
of Colorado
IN FOCUS
Study medication and
procedures are provided
at no cost.
Participation in all studies
is voluntary.
For more information about
clinical trials at TUCC, please
speak with your physician or
visit www.tucc.com.
Condition Spotlight
Prostatitis
Craig Sakurada, M.D.
The prostate is a walnut sized gland located
at the base of the bladder. Its main function
as a secondary sex gland is to produce fluid
and nutrients that allow sperm to live outside
the body. Unfortunately, once fertility is no
longer an issue for men, the gland often
causes more problems than benefits.
One very common problem affecting men of all ages is prostatitis.
According to some estimates, men have a 5 -10 percent chance
of being diagnosed with some form of prostatitis during their
lifetime. According to the American Academy of Family Physicians, nearly 25 percent of physician visits for genitourinary
complaints can be attributed to prostatitis. Prostatitis accounts
for nearly two million outpatient medical visits per year, costing
more than 6 billion dollars annually. Autopsy studies have
revealed an even higher prevalence of prostatitis in men 64- 86 percent. Why are so many men suffering from prostatitis?
The answer, unfortunately, is not so clear cut. For all of the
great advancements in medicine, prostatitis is still a poorly
understood disease. This is what we do know. Prostatitis is,
by definition, inflammation of the prostate gland. What causes
the inflammation, however, is the million dollar question.
The National Institutes of Health classifies prostatitis into
four categories:
1. Acute bacterial prostatitis: These patients tend to be very
sick with high fevers. They experience burning with urination,
extremely tender prostates on examination and significant
voiding dysfunction.
2. Chronic bacterial prostatitis and 3. Chronic non-bacterial
prostatitis / prostatodynia / chronic pelvic pain syndrome:
These patients tend to have more chronic, low grade and
often intermittent symptoms. The symptoms can range
from intermittent, low grade burning with urination, urinary
frequency, urgency and slow urinary stream to pelvic/
testicular/groin/low back pain. Patients may also experience
burning, pain and even blood with or after ejaculation
as well as sexual dysfunction (premature ejaculation, erectile
dysfunction). Patients may often feel tired, lethargic, run down
and run low grade intermittent fevers and chills (with bacterial
prostatitis).
4. Asymptomatic inflammatory prostatitis: Typically, these
patients do not complain of pain or exhibit symptoms.
While these disease categories do exist, ‘pigeon-holing’ patients
into one or another can be detrimental and shortsighted.
The most challenging groups to treat are the chronic bacterial
and chronic non-bacterial prostatitis patients. The vast majority
of these patients are classified into the chronic non-bacterial
prostatitis category.
It is very difficult to identify and isolate a treatable bacteria
in many, if not most, patients who present with prostatitis
symptoms. However, a significant portion of these patients
do respond favorably to antibiotics, which raises concerns
about such defined labels. Some medical professionals believe
that this is all a spectrum of the same disease, just with varying
degrees of clinical symptoms and bacterial detectability.
Others feel that there are truly non-infectious disease causes
for prostatitis.
One interesting theory currently under investigation is that
some forms of prostatitis may be classified as autoimmune
disorders, in which the body fails to recognize normal prostate
tissue and mistakenly attacks it causing inflammation. Similar
autoimmune disorders already exist within the body such as
rheumatoid arthritis. Others theorize that the reflux of urine
into the prostate ducts, stress, pelvic floor dysfunction,
infrequent ejaculation or various foods and beverages may
contribute to prostatitis.