Leading-Edge Prostate Cancer Care for the Mohawk Valley

By Thomas Crocker
Monday, April 29, 2019

Associated Medical Professionals (AMP) of NY, PLLC, continues a tradition of delivering high-quality management of genitourinary malignancies by providing comprehensive, advanced prostate cancer care to the Mohawk Valley from its soon-to-be expanded office in New Hartford.

Daniel Welchons, MD and Neil Mariados, MD, Director of Research

In 2011, AMP expanded its service footprint eastward from its home office in Syracuse by merging with two urology practices that served Central New York for decades. That merger formed AMP’s New Hartford division. A year later, AMP added radiation oncology services to its New Hartford office, and the practice has continued to grow its services in order to provide cutting edge technology and capabilities in Central New York ever since.

This spring, AMP is putting the finishing touches on a 4,500-square-foot expansion of its office at 2 Ellinwood Drive in New Hartford that will enhance the care experience for patients. AMP expects to welcome patients to the new space in early summer.

“Our expanded office will include state-of-the-art surgical suites for performing minimally invasive procedures for benign prostate conditions,” says Daniel Welchons, MD, board-certified urologist and partner at AMP. “We want to create the best possible experience for patients with this expansion by shortening wait times and providing a more comfortable atmosphere. A larger office will also allow us to see more patients.”

That is good news for individuals with prostate cancer as AMP continues to build on the high-level, comprehensive services it offers for the diagnosis and treatment of the most common non-skin malignancy in men.

“First and foremost, I see myself as a servant to the primary care physicians from whom AMP is fortunate enough to receive referrals. I text, call and share my notes with them — whatever it takes to ensure they know my colleagues and I are taking care of their patients in the best way possible.”
— Daniel Welchons, MD, board-certified urologist and partner at AMP

A Multidisciplinary Approach from Start to Finish

A defining feature of prostate cancer care at AMP is multidisciplinary collaboration among its partners. The care process typically begins with a consultation with a board-certified urologist who can provide or facilitate prostate cancer screening, monitoring and diagnosis, as well as secondary testing to determine patients’ candidacy for a biopsy.

“We offer MRI-fusion biopsies to identify and target lesions,” says Jonathan Block, MD, MBA, a board-certified urologist and partner at AMP who has cared for Mohawk Valley patients for nearly two decades. “We are one of the few practices in the state that offers this without having to refer to another center. AMP is doing cutting-edge work with prophylactics to prevent post-biopsy infections using antibiotic culture-based protocols. That’s becoming more common across the country, and we were one of the first practices to implement that because of our ability to monitor the quality of our care.”

Every patient diagnosed with prostate cancer has the option to see an AMP surgeon and radiation oncologist. The process is swift and seamless, and both appointments can take place under one roof at the New Hartford office, thanks to the size and interconnected structure of AMP. Physicians present complex cases to a monthly tumor board consisting of urologists, medical oncologists, radiation oncologists, pathologists and radiologists. AMP has one of the most well regarded research divisions of any private practice in the country, according to Dr. Block, and members of the research staff attend each tumor board meeting to help determine whether patients are candidates for in-house or external clinical trials.

After consulting with a surgeon and radiation oncologist, patients typically return to their urologist to decide on the most appropriate treatment, which may include active surveillance for low-risk lesions or chemotherapy, surgery and/or radiation therapy for higher-risk tumors.

Easing the Burden of Radical Prostatectomy

AMP features an impressive roster of urological surgeons that includes board-certified urologist and partner David Albala, MD, who has been a national thought leader in laparoscopic and robotic urological surgery for more than 20 years, and board-certified urologist and partner Jeffrey Sekula, MD, who trained with Dr. Albala at Duke University and joined AMP in 2012. Dr. Welchons — a Clinton native who trained at Harvard Medical School and Brigham and Women’s Hospital — joined AMP in 2015. Based at AMP’s New Hartford office, Drs. Welchons and Sekula provide surgical services for benign and malignant diseases, including kidney and prostate cancers, at hospitals in the Mohawk Valley. For many procedures, they use the da Vinci Surgical System.

One of Dr. Welchons’ areas of expertise is performing bladder-neck-sparing robotic prostatectomy using da Vinci, which reduces incontinence following surgery.

“Patients who undergo robotic prostatectomy using the bladder-neck-sparing approach experience quicker recovery from incontinence than other patients,” Dr. Welchons says. “They typically have a catheter in place for five to seven days or less and may experience some leakage two to four weeks after surgery, but that ceases quickly. This approach to prostatectomy has benefited the vast majority of our patients and helped them return to normal activities faster.”

Dr. Sekula believes da Vinci helped laparoscopic surgery finally realize its potential.

“When I started my career in urology, physicians used to say laparoscopy was a technology looking for an application — surgeons performed it because it was available, not because it was better for patients,” Dr. Sekula says. “Back then, open surgery was still best for patients. Now, after nearly 10 years of performing robotic surgeries, it’s amazing how much quicker and easier these urological operations are because only a few small incisions are needed instead of one large one. Patients receive the same surgical benefits as with open surgery but with much less pain and blood loss, shorter hospitalizations, and faster recoveries.”

Use of specialized transversus abdominis plane (TAP) blocks by local anesthesiologists with whom AMP surgeons collaborate helps keep patients comfortable after surgery.

“Perioperative TAP blocks decrease opioid use and constipation, and increase patient satisfaction,” Dr. Welchons says. “In some cases, patients call robotic prostatectomy a painless operation.”

Men who experience incontinence following prostatectomy may be candidates for placement of a mesh urethral sling or an artificial urinary sphincter, but robotic prostatectomy has reduced postoperative incontinence such that these procedures are not needed as often as they once were, Dr. Sekula says.

Comprehensive Radiation Therapy

Accredited by the American College of Radiology, AMP Radiation Oncology provides radiation therapy services at the New Hartford office under the direction of Neil Mariados, MD, board-certified radiation oncologist, Director of Research, Medical Director of Radiation Oncology Services and a founding partner at AMP. Dr. Mariados works closely with other specialists — especially Drs. Welchons and Sekula — to individualize and optimize patients’ care plans.

“If one of my patients is meeting with Dr. Mariados, whose office is right down the hall from mine, I’ll often stop by to be present for the appointment, and he may do the same when patients meet with me,” Dr. Welchons says. “Dr. Mariados and I stay in nearly constant contact to exchange ideas and determine the best plans of treatment for patients.”

AMP Radiation Oncology offers several treatment options for patients with prostate cancer, including brachytherapy — implantation of radioactive seeds in the prostate. Dr. Mariados is fellowship-trained in brachytherapy, a rarity for Central New York.

“To undergo brachytherapy, a patient must be able to tolerate general or spinal anesthesia, and his prostate can’t be too large or too small,” Dr. Mariados says. “During a one- to two-hour operation, we implant radioactive seeds in the gland using ultrasound guidance and specialized computer planning. Patients return home the same day and may resume normal activities within a week.”

Other options include external beam radiation therapy and intensity-modulated radiation therapy, which can deliver radiation that matches the precise shape of a tumor and spares surrounding healthy tissue.

“Patients who receive conventional external beam radiation therapy typically follow a nine-week, five-days-per-week schedule during which they receive treatment for 12 minutes each day and can then go about their normal activities,” Dr. Mariados says. “Side effects are quite minimal. Certain patients may be candidates for a shorter course of treatment that lasts five-and-a-half weeks.”

For Dr. Welchons, AMP’s ability to offer advanced surgery and radiation therapy makes the practice Mohawk Valley’s premier destination for prostate cancer care, and he and his colleagues intend to keep bolstering that reputation.

“I came back home to Central New York to take care of the people here,” Dr. Welchons says. “At AMP, we want people to receive the same quality of care in this region as they could anywhere else. That’s what we deliver.”

For more information about prostate cancer care and other AMP services, visit www.ampofny.com.