Dr. Kashif Alvi is one of Arizona’s leading experts in diagnosing and treating urological cancers. Cancer is a diagnosis no one wants to hear, so our goal at Urologic Surgeons of Arizona is to provide the best complete and compassionate care possible to our patients with cancer, with the latest and greatest treatment options. The extensive training he has received has allowed Dr. Alvi to become a leader in robotic surgery in the East Valley, allowing him to treat his patients with urological cancers more efficiently. Dr. Alvi treats the following cancers:
In Mesa, Arizona, urologist Dr. Kashif Alvi is an expert in diagnosing and treating prostate conditions. The three most common prostate problems are, enlarged prostate (BPH, or benign prostatic hyperplasia), and prostate cancer.
The prostate is a small gland, about the shape of a walnut. It is part of a man’s reproductive system, which also include the penis, scrotum, and testicles. The prostate is located in front of the rectum and just below the bladder. The gland wraps around the urethra, the tube that carries urine and semen from the bladder to the outside of the body. The prostate is important, as its fluid mixed with semen is important for a man’s ability to fertilize a woman’s egg, and father a child. As a man ages, the prostate grows larger. However, if your prostate becomes too large, it can cause several health issues, including prostate cancer.
Prostate cancer is the most frequently diagnosed cancer in men, and the second-leading cause of cancer death in men behind lung cancer.
To find out if prostate symptoms are caused by cancer, your doctor will ask about your past medical problems and your family’s medical history. Your doctor also will perform a physical exam. During the exam, your doctor will put a gloved finger into your rectum to examine your prostate to check for:
- The size, firmness, and texture of the prostate
- Any hard areas, lumps, or growth spreading beyond the prostate
- Any pain caused by touching or pressing on the prostate
The doctor will most likely collect a urine sample, and do a blood test to check your prostate-specific antigen (PSA) level. PSA levels can be high in men with an enlarged prostate gland or with prostate cancer. You may also need an ultrasound exam that takes computer pictures of the prostate. If tests show that you might have cancer, your primary care doctor will refer you to Dr. Alvi for a prostate biopsy, which takes small tissue samples from several areas of the prostate gland to look for cancer cells.
Treatment for prostate cancer depends on whether cancer is in part/all the prostate, or if it has spread to other parts of the body. It also depends on your age and overall health. Talk with the doctor about the best treatment choice for you and the possible side effects of treatment.
Customized Prostate Cancer Testing
Dr. Alvi often utilizes the 4Kscore® test, a blood test drawn that combines four prostate-specific biomarkers with clinical information to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. These levels are called PSA (prostate specific antigen).
The 4Kscore is also used to help determine the need for a prostate biopsy. After a negative biopsy, the 4Kscore can predict the likelihood of cancer spreading to other parts of the body up to the next 20 years. The blood sample is sent overnight to a reference lab and results are usually available within one week.
PSA tests can often render a false positive result after a prostate biopsy. The 4Kscore test provides better information for doctors and can help avoid an unnecessary biopsy.
Transrectal Ultrasound-Guided Prostate Biopsy
After a digital rectal exam, PSA test, or 4Kscore comes back with a positive result of prostate cancer, a urologist will perform a transrectal ultrasound to determine the size of the prostate and identify any other areas the cancer may have spread to, other than your prostate.
This test is also used to accurately direct the needle used when a prostate biopsy is performed to test for cancerous cells. A prostate biopsy typically takes about 15 to 20 minutes and is an outpatient procedure. Dr. Alvi uses a local anesthetic and often oral sedation to reduce discomfort during the procedure.
During the procedure, a probe with a camera (about the size of a finger) is gently inserted 3 to 4 inches into the rectum. The probe emits sound waves that are converted into video images corresponding to the different prostate zones. The needle quickly extracts 12 small samples of prostate tissue from the prostate.
Afterwards, a pathologist will examine the samples under a microscope to determine whether cancer is present. Dr. Alvi routinely meets with the patient within 1 to 2 weeks to discuss the results of the biopsy and make further recommendations.
If prostate cancer is detected after a biopsy, Dr. Alvi may order an Oncotype DX prostate cancer test. This test, performed on the biopsy tissue, was developed to help men diagnosed with early-stage prostate cancer make the most informed treatment decision. Using minimal tumor tissue from the original needle biopsy, this test builds on traditional clinical and pathologic factors to provide additional, clinical insight into the biology of a patient’s tumor before the prostate is removed.
The result of the Oncotype DX is a more precise and accurate prognosis, which helps more men avoid the lifelong complications associated with treatments they do not need, and allowing men with more advanced prostate cancer to have more aggressive therapy, for those who require immediate treatment.
MRI/Ultrasound Fusion Biopsy
Dr. Alvi is trained in MRI/Ultrasound Fusion Biopsy, which provides greater accuracy during a prostate biopsy. The test combines ultrasound images with high-resolution pictures of the prostate taken by technology called multi-parametric magnetic resonance imaging (mp-MRI).
If prostate cancer is present, the tumors will appear as distinct dark areas on the mp-MRI. By combining the MRI images taken beforehand to the real-time ultrasound images, Dr. Alvi can accurately target suspicious regions of the prostate while steering clear of healthy tissue.
Active surveillance is a protocol used for monitoring early prostate cancer, if the doctor believes that it does not immediately threaten the patient’s health.
After a detailed discussion with Dr. Alvi, and depending upon the specific characteristics of the patient's prostate cancer, patients may opt for this approach, which includes a doctor visit with a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) every 3 months.
High-Frequency Ultrasound Ablation (HIFU)
High-frequency ultrasound ablation (HIFU) is done using a transrectal probe that generates heat; the ultrasound waves attempt to kill cancerous cells in the prostate.
The advantage of the procedure is that only the cancerous portion of the prostate may be treated, but it spares other surrounding healthy tissue and minimizes side effects.
HIFU is performed under ultrasound or MRI imaging guidance, which allows for advanced treatment planning and careful real-time tracking of treatment areas that may be affected by cancer during the procedure. This outpatient procedure usually lasts 1–3 hours.
Robotic Radical Prostatectomy
A Robotic Radical Prostatectomy is an operation to remove the prostate gland and some of the tissue around it, to remove prostate cancer. During this prostate cancer treatment, the patients’ delicate prostate nerves that control bladder and sexual function are left untouched and remain intact during surgery.
What is Bladder Cancer?
The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra.
The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.
Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change shape and grow out of control, forming a tumor inside of the bladder. The cancerous tumor is malignant, meaning it can grow and spread to other parts of the body, if left untreated.
Bladder cancer is the fourth most common cancer in men. People who smoke have an increased risk of bladder cancer, as well as people exposed to certain chemicals and those having chronic bladder infections. The most common sign of bladder cancer to look out for is blood in the urine (hematuria).
The most common type of bladder cancer is transitional cell carcinoma, which begins in urothelial cells that line the inside of the bladder. The other three most common types of bladder cancer are urothelial carcinoma, squamous cell carcinoma (cancer that begins in thin, flat cells lining the bladder), and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).
Sometimes, the best option might include more than one of type of treatment. Surgery, alone or with other treatments, is the suggested treatment for most bladder cancers. Surgery can often remove early-stage bladder tumors. Dr. Alvi has been using these minimally invasive techniques with robotic technology to treat bladder cancer for many years.
Bladder Cancer Management and Treatment
Cystoscopy is a procedure performed by Dr. Alvi to examine the lining of the bladder. A flexible tube called a cystoscope with a camera lens is inserted into your urethra (tube that allows you to urinate) and slowly moves into your bladder. The bladder is examined for stones and abnormal growths, such as cancer. A cystoscopy’s purpose is to get an accurate diagnosis, to see if further treatment is needed. No preparation is required for cystoscopy, and the procedure only lasts for about five minutes.
If small lesions are identified during cystoscopy, Dr. Alvi may then suggest that he perform a bladder biopsy under local anesthesia, to remove a small piece of tissue from your bladder, and send it to a lab to be tested for cancer or other abnormalities. The tissue is examined by the pathologist and Dr. Alvi generally meets with the patient one week after the procedure to discuss the results of the biopsy.
Transurethral Resection of Bladder Tumor (TURBT)
Endoscopic treatment with transurethral resection of bladder tumor (TURBT) is the first-line treatment to diagnose, stage, and treat visible tumors. This procedure is often used to determine if someone has bladder cancer and, if so, whether the cancer has invaded the muscle layer of the bladder wall. During the transurethral resection (TUR) procedure, if tumors were found in the bladder, Dr. Alvi will remove the tumors from the bladder wall by inserting an endoscope through the urethra and into the bladder. TURBT is generally performed in the hospital as an outpatient procedure under anesthesia.
After removing a bladder tumor, Dr. Alvi may determine that intravesical chemotherapy is necessary. This procedure is performed under local anesthesia in the office and involves administering drugs directly into the bladder through a catheter. There are minimal side effects from this therapy. BCG is the most common drug used for intravesical chemotherapy, which is approximately said to be 85 percent effective at preventing future tumor growth.
Robotic Radical Cystectomy
Robotic Radical Cystectomy is a surgical procedure to remove the entire bladder, along with the regional lymph nodes, with the hopes of removing the cancerous tumors. For patients with muscle invasive bladder cancer or aggressive bladder cancer, radical cystectomy is the answer. As bladder cancer tends to spread to other areas of the body, during a radical cystectomy, Dr. Alvi will inflate the patient’s abdomen with gas, and create an incision to remove the bladder, nearby tissue and the surrounding organs. The goal of minimally invasive radical cystectomy, is to reproduce the oncologic results of an open procedure, while decreasing the surgical complications and post-operative recovery time.
What is Kidney Cancer?
Kidney cancer, also known as renal cancer, or renal cell carcinoma, is the sixth most common cancer in men, but can affect women as well. Cancerous cells tend to begin and grow inside the tubes of the kidney. If found early enough, in most cases, kidney cancer is treated before it spreads to other areas of the body.
Symptoms of kidney cancer include: blood in urine (hematuria), unexplained weight loss, low blood cell count, and an adnominal mass. If you are obese, smoke, have high blood pressure (hypertension), a family history of kidney cancer, and are over the age of 50, these risk factors increase the chance that you will get kidney cancer. Note that these symptoms also don’t necessarily mean you have kidney cancer, but if you are experiencing any of these symptoms and also fit into a few of the risk factors above, consult with your urologist about getting a screening immediately.
Surgery is the main treatment for most kidney cancers. The chances of surviving kidney cancer without having surgery are small. Even people whose cancer has spread to other organs may benefit from surgery to take out the kidney tumor. Removing the kidney containing the cancer can help some people live longer, so the doctor may suggest surgery even if the cancer has spread beyond the kidney. Kidney removal can also be used to ease symptoms such as pain and bleeding.
Robotic Radical Nephrectomy
Robotic Radical Nephrectomy is a treatment used for those diagnosed with kidney cancer. Compared with open surgery, robotic kidney surgery uses smaller incisions and doesn’t require cutting through muscle or bone, resulting in less scarring and trauma to the patient and a faster recovery time. For some patients with kidney cancer or a benign kidney tumor, a partial nephrectomy may not be possible due to the tumor’s size or location. In these cases, Dr. Alvi will perform a robotic radical nephrectomy through small incisions, and remove the entire kidney.
Robotic Partial Nephrectomy
Robotic Partial Nephrectomy is a treatment used for those diagnosed with kidney cancer. This procedure provides patients with a safe and minimally invasive technique for removal of just the cancerous tumors, while preserving the remainder of the healthy kidney. Dr. Alvi accomplishes this through small incisions to remove the cancerous tumors in the kidney, requiring only a one or two-day hospital stay.
What is Testicular Cancer?
Testicular cancer mainly affects young men between the ages of 20 and 39. It is also more common in men who have had abnormal testicle development, have had an undescended testicle or have a family history of the cancer. Symptoms include pain, swelling, or lumps in your testicles or groin area.
Testicular cancer is a malignant tumor that starts in the cells of a testicle. Malignant means that it can spread, or metastasize, to other parts of the body. The testicles are part of a man’s reproductive system. They are two egg-shaped organs covered by a sack of skin called the scrotum. The scrotum hangs below the penis, between the legs. Each testicle is held in the scrotum by a spermatic cord. The spermatic cord contains the vas deferens, blood vessels, lymph vessels, and nerves. The testicles make sperm, and the male sex hormone called testosterone.
Cells in a testicle sometimes change and no longer grow or behave normally. In some cases, changes to testicle cells can cause testicular cancer. More than 90 percent of all testicular cancers are germ cell tumors. Germ cells are cells in the testicles that make sperm. The two main types of germ cell tumors that develop in the testicles are seminomas and non-seminomas.
The cause of this particular cancer is unknown, but doctors do know that men who were born with an undescended or partly descended testicle are five times more likely to develop testicular cancer. Other research has suggested that there may be a hereditary factor involved, and that if you have a family member who has had this type of cancer, you are at an increased risk.
Testicular cancer may not cause any signs or symptoms in its early stages because the tumor is very small. Symptoms often appear once the tumor grows into surrounding tissues and structures. Other health conditions can cause the same symptoms as testicular cancer. See your doctor if you have these symptoms:
- Painless lump in the testicle
- Swelling so the testicle is larger than usual
- Pain or dull ache in the testicle or scrotum
- Feeling of heaviness in the scrotum or abdomen
- Buildup of fluid in the scrotum
- Enlarged lymph nodes in the neck
- Pain in the back or abdomen
- Trouble breathing or shortness of breath
- Cough, sometimes with blood (called hemoptysis)
- Chest pain
- Trouble swallowing
- Swelling in the chest
- Buildup of fluid around the lungs (called pleural effusion)
- Buildup of fluid in the abdomen (called ascites)
- Weight loss
- Breast soreness or growth (called gynecomastia)
If you have testicular cancer, Dr. Alvi and his team at Urologic Surgeons of Arizona, will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for testicular cancer, Dr. Alvi will use a physical exam, lab tests, imaging tests, and surgery to diagnose testicular cancer. Most cases can be treated, especially if found early. Treatment options include surgery, radiation, and/or chemotherapy. Regular exams after treatment are important.
Radical Inguinal Orchiectomy
This is usually the first treatment for testicular cancer, and it is done to confirm the diagnosis. When Dr. Alvi is concerned that there may be cancer present (malignancy), he may recommend a radical inguinal orchiectomy. It is called “radical” because the entire spermatic cord is removed as well as the testicle itself.
Performed through a small incision made in the groin area, this outpatient procedure generally takes less than one hour. Depending upon the type of tumor, an oncologist may recommend further treatment such as radiation or chemotherapy.
Retroperitoneal lymph node dissection (RPLND)
This is the surgery to remove lymph nodes at the back of the abdomen (which is called the retroperitoneum). If the lymph nodes on the same side of the body as the tumor are removed, it is called ipsilateral RPLND. If the lymph nodes on both sides of the retroperitoneum are removed, it is called bilateral RPLND. This surgery may be done at the same time as the radical inguinal orchiectomy or as another surgery done later. RPLND can be part of treatment for early stages of testicular cancer. It can also be used to treat advanced testicular cancer after chemotherapy.