Lately, Alfred C. Winkler, M.D., has been frequenting barbershops in New York City’s minority communities.
His mission: turn barbers into educators who can teach clients the importance of early prostate-cancer detection through screenings.
“If prostate cancer is detected in the early stages most patients have four or five treatment options to chose from, but only one or two options are available when the disease progresses,” explains Dr. Winkler, a urologic surgeon who is the regional director of the department of urology at Queens Health Network in New York City and a professor of urology at Mount Sinai School of Medicine.
Today, one in six men is diagnosed with prostate cancer and Black men nearly 2.5 times more likely to die from it than Caucasian men, medical statistics show. “Reaching the man that rarely goes to the doctor and feels healthy is one of the biggest challenges,” remarks Winkler.
Many men simply don’t understand that when they begin to experience symptoms such as frequent nightly urination, painful or burning urination, painful ejaculation, among others, the cancer is already advanced, he complains. Experiencing no symptoms and no growth in the size of the prostate “gives men a false sense of security,” he says.
At Queens Health Network (QHN), Winkler oversees the diagnosis, treatment and care of patients with genitourinary-tract conditions, which include problems with the kidneys and urinary bladder in men and women, and with the prostate and testicles in men. One of six regional networks established in 1994 by the multibillion-dollar New York City Health and Hospitals Corporation to improve the city’s community health care, QHN encompasses Elmhurst Medical Center, Queens Hospital Center, other community-based medical centers and school-based health centers.
A Brooklyn, N.Y., native, Winkler says he was always fascinated by biology and settled on a career in medicine at an early age. “The ability to help a patient solve a problem and return to life as they know it [inspires me],” he says.
The minority doctors he knew tended to practice family medicine and he expected to do the same. However, while pursuing a medical degree at the State University of New York at Stony Brook School of Medicine, a Black surgeon under whom he studied encouraged him to explore the various types of surgical specialties. He did so and chose what he terms his best fit, urology.
Patients are people
When he completed his residency in urologic surgery at the Albert Einstein College of Medicine/Montefiore Medical Center, he became an assistant professor of urology at the Albert Einstein College of Medicine and subsequently was appointed regional director of the division of urology of the North Bronx Healthcare Network in New York City. Like QHN, the North Bronx network was established by the Health and Hospitals Corporation and includes Jacobi Medical Center and North Central Bronx Hospital.
In 2006, Winkler assumed his current position as regional director of the department of urology for QHN. “We are proud to have him,” says Antonio Martin, QHN’s executive director. “Aside from the quality that he brings to his specialty, he works well with the different levels of staffers at the hospital and promotes patient care and teamwork to the utmost.”
Winkler is also site director for the urological residency program at Mount Sinai School of Medicine, rendering him both teacher and mentor to the next generation of urologists. Students and residents alike must treat their patients with the same degree of care they would want a family member to receive, he insists.
“Patients are people,” he constantly reminds them. Before you approach your patient, he urges them, imagine it is you who are about to hear bad news or learn about cancer treatment options, then deliver the news to the patient in the same manner that you would like it to be delivered to you.
Innovative techniques
Winkler’s own patients, 65 percent of whom are men and 35 percent women, suffer from problems ranging from urinary-track infections and erectile dysfunction to kidney stones and prostate cancer. About 40 percent of them are being treated for prostate cancer. Faced with so many cases of the dreaded disease and aware of the disparities in health-care delivery to minority communities, it’s no surprise that Winkler has become an advocate for prostate-cancer patients.
His Queens practice offers a minimally invasive treatment using robotic technology. Since 2006, Winkler began using the da Vinci® Surgical System for prostatectomy and other urologic procedures, a surgeon-controlled technology that allows urologists to perform major surgeries through the small incisions instead of one large incision. The technology gives surgeons an enhanced view of the operation, resulting in greater precision during the procedure and leaving surrounding nerves intact. This is especially beneficial during a prostatectomy since the prostate is surrounded by nerves that affect sexual function and urinary control.
Other advantages over traditional procedures include significantly less pain and a faster return to normal daily activities. On average, the recovery time is cut in half. “[Winkler’s] innovative techniques for treating prostate cancer, particularly his use of the da Vinci Surgical System, has helped enhance the level of care available at our institution and assisted us in our goal of delivering first-rate medical care to our patients,” remarks Chris Constantino, executive director at the Elmhurst Hospital Center.
Raising awareness
While the da Vinci is a great option for patients, doctors agree that the need for surgery can be minimized with early detection. To help catch the disease at an early stage, the American Cancer Society recommends that men at high risk, such as Black men or men with one first-degree relative (father or brother) diagnosed with prostate cancer, start testing at age 45. Those who are at even higher risk — because they have several first-degree relatives with prostate cancer at an early age — should begin testing at age 40.
Over the past 10 years, Winkler has helped to support and organize numerous prostate-cancer screenings in the Bronx and Queens to raise awareness in minority populations. He works primarily with hospitals and churches to reach the men in the community, but barbershops are his newest target.
During the screenings, men not only are tested, but they also are educated about the prostate and the disease. The hope is that greater knowledge will result in increased comfort and repeat screenings. The screening tests include prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE), both of which can detect the presence of prostate cancer even when no symptoms are present. If the results of either test are abnormal, additional testing is conducted.
In an environment where grief is far too common, Winkler is sustained not only by the knowledge that he can relieve some of that grief, but also by the encouragement of medical-school mentors who had advised him to not settle for what other people thought he should do and by his family. He readily acknowledges that his wife, Josiane, a pediatric neurologist, is the person he can turn to with any work-related issue and find complete understanding.
He does his best to resolve those issues, but concedes that victory in the battle against disease is a long way off. “I hope we can continue to improve the quality of life for people, that we can diagnose disease earlier and that we can learn more specifically what we need to do to prevent the disease,” he muses.