Prostate Cancer

A diagnosis doesn't always mean aggressive treatment

A prostate cancer diagnosis is frightening, but many prostate cancers — particularly low-risk, low-grade ones — grow so slowly that immediate treatment can do more harm than the cancer itself. New York Urology takes a deliberately least-invasive approach: we work to confirm exactly what kind of prostate cancer you have, and we don't rush to surgery.

How we find it: PSA, then a map, then tissue

Our detection pathway is deliberately clean. PSA is the trigger. When PSA raises concern, a prostate MRI comes before the needle — it maps the areas of concern, guides exactly where any tissue should be taken, and in some men reassures enough to defer biopsy altogether. Only then, if warranted, does biopsy obtain the tissue answer. Imaging the prostate before biopsying it is now the standard in high-quality pathways, and it's a real improvement over the old approach of sampling blindly without a map. Each step earns its place and informs the next.

Active surveillance first for low-risk disease

For many men with low-grade prostate cancer, the right first step is active surveillance — a structured program of monitoring with PSA (typically every six months), exams, imaging, and repeat biopsy at intervals (about every eighteen months), so that treatment happens only if and when the cancer shows it needs it. It is not passive neglect — it's an active protocol.

This also answers the old worry about PSA screening — that it "finds cancers that never needed finding." That argument held when finding any prostate cancer meant treating it. It no longer does: today, low-risk disease is watched, not operated on. Detection has been decoupled from treatment, and in my experience surveillance spares roughly half of these men — across a ten-year horizon — a treatment they would otherwise have undergone, keeping their continence, their potency, and their ordinary life. The one thing surveillance doesn't fix is screening the wrong men, which is why the right question isn't your age — it's your estimated life expectancy. The cancer worth finding is one significant enough to warrant treatment and slow enough that treating it will actually help.

Surgery is a last resort

We view radical surgery as a last resort, reserved for specific situations where it's truly the best option — not the default. In our experience it is uncommon for our prostate cancer patients to need surgery. When a cancer does call for active treatment, there are excellent, far less invasive ways to treat it.

CyberKnife (SBRT) when treatment is needed

How our evaluation works

Good decisions start with a clear picture: your PSA trend, exam, imaging, and the grade and extent of cancer on biopsy. We use that to place you on the right path — surveillance, or, when needed, referral for the least-invasive effective treatment. Our goal throughout is to protect both your length and quality of life.

When to see us

If you have a rising PSA, an abnormal exam, or a new or existing prostate cancer diagnosis and want a least-invasive second opinion, we'd be glad to help. Call (212) 991-9991 or book a consultation. For enlarged-prostate (non-cancer) concerns, see our enlarged prostate (BPH) care and our dedicated prostate center.

Common questions