CHICAGO – Army Special Forces veteran Jeff Bosley estimates he’s had 10-15 surgeries during his life, mostly for injuries. But earlier this year, Bosley, 46, who lives in the Omaha, Nebraska area, needed one that would save his life after being diagnosed with prostate cancer in May.

While men being diagnosed with prostate cancer under the age of 50 is extremely rare, Bosley also has a family history with the disease, which increases risk. Because of that family history, his prostate-specific antigen (PSA) levels are tested on a quarterly basis. High levels of PSA may indicate the presence of prostate cancer, and the disease is usually detected by that blood test before any signs or symptoms. 

“Prostate cancer is the second leading cause of cancer in men, and less than one percent of prostate cancers are diagnosed in men under 50,” said Edward Schaeffer, MD, PhD, chief of urology at Northwestern Medicine. “Routine screenings can help catch prostate cancer at an earlier stage.”

During a screening in early 2024, Bosley’s PSA levels had quadrupled in a four-month span, which indicated a possible aggressive form of prostate cancer, and a biopsy later confirmed the disease. After seeing multiple doctors near his home in, and feeling unsatisfied with their treatment plans, Bosley discovered a podcast with Dr. Schaeffer detailed diagnostic and management strategies for people with prostate cancer.

“I wanted to get a second opinion, and I also wanted a physician with great bedside manner because this person would have a significant impact on my life,” Bosley said. “When I heard Dr. Schaeffer on the podcast, I really appreciated his approach to patient care and research, and I decided to make an appointment. During our first video consult, I felt a strong connection with Dr. Schaeffer’s attitude and treatment plan.”

Traveling to Chicago for Lifesaving Care

Bosley traveled to Chicago where he underwent surgery on September 10 at Northwestern Memorial Hospital to remove the cancer. Bosley returned home a few days later to recover. His follow-up appointments are being done virtually, and like all cancer survivors, he will continue to have ongoing surveillance.

“Jeff had a great outcome to the surgery and currently has no signs of cancer in his body,” said Dr. Schaeffer, who is also a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University. “We always tell patients that cancer doesn’t read rulebooks, so we will have to continually monitor him, like we do all of our cancer survivors.”

Since his time in the military, Bosley has been working as an actor in television and movies. Following the surgery, he’s returning to his active lifestyle and has been receiving audition requests for acting jobs.

“As a kid, I always said I wanted to be Rambo,” Bosley said. “I didn’t know if I wanted to do it in real life or in movies. I got the real one out of the way and decided to try acting in 2014.”

Serving His Country Aided Him in Choosing a Urologist

Bosley served in the United States Army from 2006-14, serving with the 10^th Special Forces Group out of Fort Carson, Colorado. His deployments included serving in Iraq and missions in Africa.

“I always knew I wanted to join the military,” said Bosley. “I always knew I wanted to do the elite stuff, but didn’t know it was going to be the Green Berets. I value my decision to serve and would have regretted not doing so.”

He has always led an active lifestyle, working as a firefighter before and after his military career. Being a Green Beret, Bosley had a lot of unique training other than just combat duties. He majored in pre-med in college and Bosley’s specialty was medicine in the Army, receiving training beyond the basic combat medical needs.

After being diagnosed with prostate cancer, that medical training aided him in choosing a urologist for his care.

An estimated 1 in 8 American men will be diagnosed with prostate cancer with their lifetime. November is also “Movember,” a time to raise awareness for men’s health, including prostate cancer.  

For more information on prostate cancer care at Northwestern Medicine, visit nm.org/urology or call 833-7-POLSKY (833-776-5759) to make an appointment. To learn more about Northwestern Medicine, visit nm.org.

A new study by Northwestern Medicine in today’s issue of JAMA Oncology suggests that using an alternative approach, a percutaneous, transperineal prostate biopsy, is as effective at detecting cancer as the transrectal approach, but without the risk of infection or need for prophylactic antibiotics.

“While the potential advantages to the transperineal approach have been suggested, high-level Category 1 evidence was limited,” said primary investigator Edward Schaeffer, MD, PhD, The Harold Binstein Professor and Chief of Urology at Northwestern Medicine. “This study shows that transperineal prostate biopsy without antibiotic prophylaxis significantly is associated with a lower risk of infection compared to transrectal biopsy with targeted prophylaxis. Our data supports a transperineal approach to prostate biopsy as a new standard of care.”

The paper reports the results of the PReclude infection EVEnts with No prophylaxis Transperineal (PREVENT), a 10-center randomized controlled trial that compares the infectious complications of clinic-based transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis. The primary outcome of the study was infection, but researchers also considered outcomes including cancer detection, urinary retention and bleeding.

In the trial, 875 participants with suspicion for prostate cancer were randomized with 382 undergoing transperineal prostate biopsy without antibiotics and 370 participants undergoing transrectal biopsy with antiobiotics. Zero infections were reported in the transperineal arm compared to six, or 1.6%, transrectal biopsy infections. There was no compromise in the detection of high grade cancer with the Transperineal approach (55% vs. 52% of TP and TR biopsies)  and rates of other complications were very low and similar.

“Antibiotics are a limited, but essential resource. The more widely antibiotics are used, the less likely they will be effective in the future. With this in mind, we have a responsibility to find alternative approaches to patient care that limit risk of infection while decreasing reliance on antibiotics.” said Dr. Schaeffer, who is also a member of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University. “By transitioning to the transperineal approach as the primary technique to prostate biopsy, we can effectively and safely detect cancer while eliminating the need for antibiotics and improving antibiotic stewardship.”

Northwestern Medicine is consistently recognized as a national leader in urology at the forefront of research and medical advancements in prostate cancer. The Northwestern Medicine Polsky Urologic Cancer Institute of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University's prostate cancer program offers personalized, integrative and innovative care for the diagnosis, treatment and management of prostate cancer. The Prostate cancer program at NM offers a multidisciplinary access point for prostate cancer treatments, such as surgery, chemotherapy and radiation, as well as resources, including genetic counseling. Bolstering promising, active research while strengthening advanced tracking and diagnostic techniques, the program offers precision diagnosis and treatment, groundbreaking innovation in treatment and prevention and sustained wellness beyond diagnosis and treatment through survivorship and follow-up care services.

For more information on prostate cancer care at Northwestern Medicine, visit nm.org/urology or call 833-7-POLSKY (833-776-5759) to make an appointment. To learn more about Northwestern Medicine, visit news.nm.org.

WINFIELD, Ill. - Designed to increase access to ophthalmology, allergy and urology outpatient services, Northwestern Medicine’s new three-story medical office building in Winfield Town Center opens Jan. 30, 2023. Located across the street from Northwestern Medicine Central DuPage Hospital, the 51,000-square foot building has two floors of clinical space and ground-floor commercial and retail space.

“With easy access to Northwestern Medicine Central DuPage Hospital, a Metra station and the new Riverwalk Park, Winfield Town Center is an ideal location to offer new and expanded medical services to local residents,” said Patrick J. Towne, MD, president of Northwestern Medicine Regional Medical Group.

The new building is a milestone in the development of Winfield Town Center, a partnership with the Village of Winfield to revitalize the downtown district. As part of the project, Northwestern Medicine also constructed a four-level parking deck with ground-floor retail and restaurant space; and developed significant portions of Riverwalk Park, including new pathways, a band shell, picnic shelter, and a bean bag toss and bocce court.

“The new medical office building is a beautiful anchor for Winfield Town Center that will spur further retail development,” said Kenneth Hedley, president, Northwestern Medicine Central DuPage Hospital. “Additional outpatient services and the amenities at Riverwalk Park will contribute to a vibrant downtown environment.”

The modern building features a natural stone facade, ribbons of windows and space for outdoor patio dining. A green roof, partially covered in vegetation, reduces storm water runoff into the sewer system and mitigates urban heat island effects.

“This historic partnership with Northwestern Medicine Central DuPage Hospital was the result of a public-private partnership which addresses the need for development of Winfield’s Town Center and the growth needs of Northwestern Medicine,” said Carl Sorgatz, president, Village of Winfield. “This great leap forward sets the stage for more impressive opportunities identified in the recent Town Center Plan update to grow Winfield as a destination.”

The new ophthalmology clinic has 26 exam rooms, three of which are designed specifically for pediatric patients. The clinic offers state-of-the-art technology for the diagnosis and treatment of a full range of ophthalmic conditions, including cataracts, glaucoma, macular degeneration, diabetic retinopathy and eyelid surgery. The staff includes four ophthalmologists: Michelle E. Andreoli, MD; Michael T. Andreoli, MD; Sachin Jain, MD; and Stacy Scofield-Kaplan, MD; and two optometrists: Randall Andreoli, OD; and Barbara Andreoli, OD.

The allergy and immunology clinic is relocating to the new Winfield Town Center building from the Central DuPage Hospital Outpatient Building to allow for expansion of services. Allergist Jennifer C. Simonaire, DO, will join Farheen Mirza, MD, and Amiinah Y. Kung, MD, to support the growing need for allergy services in the region. The clinic has eight exam rooms and six dedicated allergy observation bays for allergy testing, food challenges and nurse injections.

Urology will open in the new building this March. With 10 exam rooms and three procedure rooms, specialists will offer diagnosis and treatment of a variety of urological conditions including benign prostate diseases, genitourinary cancer, vasectomies, erectile dysfunction and kidney stones. Urologists at the new location will include: Steven M. Baughman, MD; John G. Christensen, Jr., MD; Vikas Desai, MD; Michael A. Rashid, MD; and Timothy J. Roth, MD.

CHICAGO —  Demand for testosterone therapy has soared in the United States with more men seeking to increase hormone levels in hopes of enhancing virility, strength and energy. Testosterone therapy has become a burgeoning business with direct-to-consumer men’s health platforms proliferating online in recent years. While testosterone therapy benefits some men, it can be harmful for others, making it critical that patients understand the benefits and risks before starting the therapy.

A new Northwestern Medicine study published in JAMA Internal Medicine found that many of these platforms are not providing care in concordance with the American Urological Association (AUA) and Endocrine Society (ES) guidelines for the safe and effective management of men on testosterone therapy.

“Testing and treatment for low testosterone is more accessible than ever before thanks to these online platforms. Men can be evaluated and even start testosterone therapy without leaving home,” said Joshua A. Halpern, MD, senior author on the paper and urologist at Northwestern Medicine. “While there’s benefit in improving access, there’s also potential for harm when providers fail to follow evidence-based guidelines, or when the benefits and risks of treatment are not appropriately communicated.”

Men with low testosterone levels, or hypogonadism, may experience symptoms such as erectile dysfunction, decreased libido, fatigue, and depression among other issues. While therapy to increase the hormone can improve these symptoms for some, it can be ineffective or even harmful when prescribed to men who don’t meet the criteria for hypogonadism including increased risk for infertility and cardiovascular events, as well as other side effects.

Using a secret shopper, the study authors evaluated seven US-based online companies that provide testosterone therapy in all 50 states. Utilizing a script to inquire about and initiate testosterone therapy, the secret shopper identified himself as a 34-year-old man with hypogonadal symptoms, including low energy and low libido, who was interested in future fertility. For each of the platforms, he completed the intake evaluation, required laboratory diagnostic testing and initial telemedicine consultation, which was conducted by either a nurse practitioner, physician assistant or non-medically licensed individual.

“While my interactions with the telemedicine platforms were pleasant and efficient, I was surprised by some of the gaps in their counseling and their recommendations that I pursue testosterone therapy,” said Justin Dubin, MD first author and secret shopper of the study.

The authors found that online platforms are offering therapies to men who do not meet guidelines for testosterone deficiency, while also failing to convey the risks and benefits of therapy. The study is the first to identify guideline-discordant practices by direct-to-consumer testosterone therapy platforms, with the following key findings:

• 85.7% of the platforms offered testosterone therapy despite the secret shopper having normal total testosterone (TT) and free testosterone levels and desiring future fertility.
• Only 1 of the 7 platforms asked the secret shopper about recent cardiovascular events or his desire for future fertility.
• Criteria for offering testosterone therapy were discordant with AUA and ES guidelines with one platform only offering treatment for men with TT below 450 ng/dL (normal range = 264 – 916 ng/dL), while the other six have no threshold for treatment initiation.
• Half of the platforms quoted a treatment goal of more than 1,000 ng/dL TT levels and did not discuss fertility risks of testosterone therapy.
• 83.3% did not discuss the risks of polycythemia, which is an increase in blood thickness.
• In addition to testosterone therapy, the secret shopper was also offered a broad range of off-label medications.

As the popularity of direct-to-consumer testosterone therapy grows, the authors hope that future policy initiatives will facilitate more consistent and guideline-based care by these entities.

“Online platforms have great potential for expanding access to men’s healthcare screenings and treatments, especially for issues like erectile dysfunction and infertility,” says Dr. Halpern. “However, until these services are providing therapies based on established guidelines, it’s important that patients and providers are educated on the potential pitfalls of seeking this type of treatment online.”

For men with concerns about their testosterone levels, Dr. Halpern recommends seeing a provider with expertise in hypogonadism, such as a urologist, endocrinologist, or even beginning with their primary care physician. For some men, lifestyle modifications alone may improve their physical symptoms and enhance mood.

“Testosterone isn’t a magical solution, but it can be a very effective therapy when prescribed appropriately and within guidelines,” says Dr. Halpern. “For others, making lifestyle choices that emphasize exercise, healthy eating and adequate sleep, may be the right answer. Working with an experienced provider is the first step to finding the right, individualized care plan to fit your personal needs.”

The Northwestern Medicine Urology Program ranks amongst the nation’s most experienced and well respected, providing comprehensive inpatient and outpatient care, including state-of-the-art diagnostic and treatment capabilities for men, women and adolescents.

To learn more about Northwestern Medicine, visit https://news.nm.org/.

DEKALB, Ill. -  Northwestern Medicine Kishwaukee Hospital will soon begin a $15 million renovation of its surgical suite. The 19,000-square-foot area has not had a major remodel since the new hospital building opened in 2007. Additionally, the hospital has upgraded to the latest-generation surgical robot, the da Vinci Xi, to offer a wider variety of minimally invasive procedures.

“With the new layout and a little more space, we have room for two additional Same Day Surgery bays, which we need to continue growing surgical services offered at Kishwaukee Hospital,” said JoAnn Ricketts, MSN, director of Surgical Services and Interventional Labs at Kishwaukee Hospital. “The renovation will improve workflow and efficiency, and enhance the environment for our staff and patients.”

Operating rooms and sterile processing areas will remain as is; all other areas are being refreshed and upgraded. The new floor plan will include:

• Seven Post-anesthesia Care Unit (PACU) bays
• Two new flex bays (rooms that can be used for PACU or Same Day Surgery)
• 25 Same Day Surgery bays
• Two endovascular procedure rooms with shared scope reprocessing space
• Renovated waiting room and reception area
• New team areas
• Updated staff break rooms and locker rooms

For patient privacy and comfort, all Same Day Surgery bays will become private rooms, with breakaway sliding glass entry doors. Other improvements include new boom technology and surgical lighting in the endovascular procedure rooms, and all new, state-of-the-art scope reprocessing equipment and scope drying cabinets. The area will get new furniture throughout.

“Our team is passionate about providing the highest-quality outcomes and best patient experience,” said Sarah Snyder, RN, manager of Surgical Services at Kishwaukee Hospital. “This renovation will create a more optimal space to provide exceptional care.”

Preparation work is underway, and construction is scheduled to begin in December. To keep the surgery suite open and operational during construction, the project will be done in four phases. The expected completion date is September 2024.

Kishwaukee Hospital has made an additional investment to upgrade technology within the robotic-assisted operating suite. The da Vinci Xi Surgical System, the latest generation of surgical robots, expands surgeons’ capabilities to perform minimally invasive surgery for even the most complicated scenarios. Surgeons sit at a nearby console to view 3D images of the surgical site and manipulate the arms of the robotic instruments inside the body. The tiny robotic arms allow surgeons to make smaller incisions with greater precision, typically resulting in less pain and less blood loss for the patient.

“The new robot has thinner robotic arms and joints, an improved camera, and is attached to a rotating operating table, which will allow for smaller incisions with more precision,” said Ricardo Soares, MD, urologist and robotic surgeon at Kishwaukee Hospital. “This upgrade will keep us up to date on the most cutting-edge technology.”

Currently, a surgical robot is used for prostate, kidney, bladder and gynecological surgeries at Kishwaukee Hospital. With the new technology, additional robotic-assisted general surgeries will be possible, including hernia repair and bowel resections.

The da Vinci Xi is also available at seven other Northwestern Medicine locations: Northwestern Memorial Hospital, Northwestern Medicine Delnor Hospital, Northwestern Medicine McHenry Hospital, Northwestern Medicine Palos Hospital, Northwestern Medicine Lake Forest Hospital, Northwestern Medicine Central DuPage Hospital and Northwestern Medicine Grayslake Outpatient Center.