First Urology of Louisville Enjoys Many Firsts in Technology and Research

Ganesh Rao, MD

Being the largest private practice urology center in Kentucky has its advantages, said Ganesh Rao, MD, president of First Urology, PSC, in Louisville. The practice was created from a merger between Metropolitan Urology and Allied Urology. First and foremost, it means the practice can provide better and easier access to care for its patients. Rao says with its 24 physicians and offices located in greater Louisville and southern Indiana, patients can expect to receive a multidisciplinary approach to urology-related cancer treatments. Patients with genitourinary cancer can look forward to consulting with an in-house radiation oncologist, medical oncologist, and urologic oncologist.

“All 3 physicians can sit together with the patient and family to discuss the varied treatment options,” said Rao. “The patient doesn’t need to make 3 different appointments, and if the patient has a complex disease, it helps to have all the physicians sitting under the same roof working together to come up with a strategy.”

Cutting Edge Technology

That integration is evident in the practice’s pathology department located in Jeffersonville, Indiana, which is staffed with 2 board certified pathologists licensed to practice in Indiana and Kentucky. The pathology department started providing service in 2009. The department offers expertise in urological specimens, and includes a chemistry department that specializes in prostate-specific antigen (PSA), free PSA and testosterone testing. The laboratory also offers fluorescence in situ hybridization (FISH) testing—a technique used to identify particular DNA sequences in cells, tissues, and also in tumors that may be cancerous.On more than one occasion, the practice was the first to bring cutting edge technologies to the Bluegrass State. “We were the first to bring robotic surgery to town,” said Rao. “We were the first to use intensity-modulated radiation therapy (IMRT) to treat prostate cancer here. And about 2 months ago, we were the first private urologic center in the United States to begin using high-intensity focused ultrasound (HIFU) to treat prostate cancer.”

HIFU uses ultrasound energy that is focused at a specific location in the prostate gland called the focal point. At the focal point, prostate tissue is heated to nearly 195 degrees Fahrenheit (90 degrees Celsius). The tissue at the focal point is destroyed, but the surrounding tissue remains unharmed. Because the technology uses ultrasound energy, not radiation, to destroy targeted tissue, the procedure can be repeated, if necessary. The minimally invasive procedure can be used to perform prostate ablations up to 40 cm3 without previously performing a TURP (transurethral resection of the prostate) procedure. HIFU has been widely available for 15 years in more than 40 countries in Europe, Asia, and Latin America.

“One of my partners, John Jurige, MD, has performed more than 400 HIFU procedures and he’s a national preceptor for HIFU,” said Rao. “Specialists from all over the country come here to learn how to perform the procedure from him, and patients from all over the country come here to receive treatment.” The benefit of the procedure is its minimally invasive methodology with few patients experiencing bladder control problems or erectile dysfunction, which can be common with traditional treatments. In addition, the procedure only takes about 3 hours and the patient gets to go home the same day. “There are a lot of treatments that can cure prostate cancer, but many leave the patient with erectile dysfunction and urinary incontinence,” added Rao. “With HIFU, the patient can get back to work in 3 days. With a radical prostatectomy, a full recovery can take 6 weeks.”

Research Department

Rao also emphasized that patients can also undergo partial treatment, a hemi-ablation. This procedure avoids contact with the nerve bundle, said Rao. In addition, HIFU allows for further treatment, such as surgery or radiation, if it is necessary. Bringing cutting-edge technology to the state is only part of the picture, however. First Urology also performs clinical research, which gives patients access to the latest treatments. This is especially important when patients have exhausted all traditional treatment options.The center’s research department is led by its medical director, James L. Bailen, MD, and Debbie Johnson, CCRC, director of research. The facility has been involved in multiple phase II and phase III trials for the treatment of genitourinary cancers, erectile dysfunction, initial cystitis, osteoporosis secondary to androgen deprivation therapy, overactive bladder, prostate intraepithelial neoplasia, stress incontinence, and urinary tract infections. Traditionally, academic centers were the bastions of clinical research, but with cuts in funding, research needs to take place in other settings. “We now offer more clinical trials for genitourinary cancers than our local cancer center,” said Rao. “Our access to a large, diverse patient population also makes us attractive to pharmaceutical companies who need to test their medications as they progress through the drug development cycle.”

Current Landscape

He noted that First Urology has many of the safeguards that traditional academic centers also employ—internal review board reviews and frequent site visits by the trial sponsor—but not the bureaucracy that can accompany working with a large academic institution in drug development.Surveying the current landscape, Rao warns other group practices to be wary of merging with local hospitals. That warning applies to other specialist practices as well. He said the “money upfront might be enticing” but hospital administration can become too controlling, micromanaging the number of patients seen or cutting salaries.

For practices to remain viable, he recommends exploring ancillary services that provide other sources of revenue, which can improve patient care and supplement the bottom line. “We started an imaging department where we conduct our own computed tomography scans. Our patients don’t have to travel to different locations to obtain scans, we have easy access to the results, and we’re not tracking down scans from other offices,” said Rao. “In a similar way, the clinical research that we conduct provides patients with cutting edge care, but the practice also benefits from the revenue generated from the trial sponsor. The process to get trials up and running can be difficult, but once it is implemented, it’s a steady stream of revenue.”