REIMAGINING HEALTH CARE BY THE INNOVATIVE USE OF ARTIFICIAL INTELLIGENCE
BY DAVID GASPERACK, DO
PROSTATE CANCER SCREENING IN 2025: THE PSA CONTROVERSY PAUL SIEBER, MD, FACS
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2025 BOARD OF DIRECTORS
OFFICERS
Sarah E. Eiser, MD President
Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women
Stacey S. Denlinger, DO
Immediate Past President
Highlands Family Practice & UPMC Wound and Hyperbaric Center
Robin M. Hicks, DO President-Elect
UPMC Supportive Care & Palliative Medicine
Christopher R. Scheid, DO Vice President College Avenue Family Medicine
James M. Kelly, MD Treasurer
Penn Medicine Lancaster General Health Physicians Family Medicine Lincoln
David J. Gasperack, DO Secretary WellSpan Health
DIRECTORS
Lena Dumasia, MD
Laura H. Fisher, MD
Anna Goetze, DO | Resident Logan Lawson, DO, MPH | Resident
Jessica Miller, MD | Resident
Karen A. Rizzo, MD, FACS
Daniel J. Schlegel, MD, MHA, FAAFP
Susanne E. Scott, MD, MPH
Danielle Rubinstein, DO
Osvaldo Zumba, MD
EDITORS
D awn Mentzer
Bet h E. Gerber
Lancaster City & County Medical Society
Stacey S. Denlinger, DO
LancasterPhysicianis a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patientcentered care in an increasingly complex environment.
Hello Lancaster County,
Spring can’t come soon enough! This winter has been brutal with exceedingly high infection and hospitalization rates. We will all be looking forward to warmer weather and sunshine.
This season, the magazine will feature articles surrounding fertility options amongst the health systems in Lancaster County, prostate cancer, as well as how AI is being used in health care. I know some health systems have started introducing AI dictation assistants into their exam rooms with seemingly great success. This will be very interesting to watch unfold in the near future!
The magazine will cover the regular features as well. I hope everyone enjoys a healthy spring.
Sarah Eiser, MD Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women
You’re proud to be a physician. Support the organization dedicated to serving you and your passion. United we are stronger and can work together to make a positive impact in Lancaster County medicine and beyond.
If you aren’t already a member, we hope you’ll consider a membership investment in LCCMS.
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best pr ctices
• Seeking Help Without Stigma; WellSpan Recognized as a Champion of Physicians’ Mental Health
• Penn State Health Partners with Lancaster Orthopedic Group, Prime Anesthesia Associates; New Affiliations Expand Access to Expert Orthopedic Care in Lancaster and Berks Counties ALSO IN THIS SECTION
NEW BEHAVIORAL HEALTH CENTER
Earlier this year, behavioral health advocates and community leaders came together to mark the opening of the Behavioral Health Center at Penn Medicine Lancaster General Hospital (LGH). Opened in January, the Center is the first of its kind in Lancaster County, offering specialized care for low-risk behavioral health patients dealing with conditions such as depression, anxiety, substance-use disorders, and other mental health issues that don’t require inpatient or emergency treatment.
The Behavioral Health Center is part of Penn Medicine’s commitment to bring more mental health care support to patients in each community the health system serves. While the focus of this 3,000-square-foot center, located on the Lime Street-side of LGH, is on those patients that do not require emergency or inpatient care, comprehensive screening will allow patients with more serious behavioral health concerns to be quickly transferred to the hospital’s Trauma & Emergency Department.
Crisis Walk-In Center
Among the services offered at the Behavioral Health Center is a Crisis Walk-In
Center. Serving patients age 6 and up, the Crisis Walk-In Center provides immediate behavioral health assessments, treatment, and support while building a bridge to ongoing care that may be needed. Licensed behavioral health counselors meet with each patient to develop an immediate care plan, and psychiatrists and mental health nurse practitioners are available for interim psychiatric medication recommendations. Certified peer support specialists assist patients in scheduling follow-up appointments and connecting them with community-based services or resources, including recovery support.
The Crisis Walk-In Center also connects patients to additional support services, such as counseling and medication management, as they transition to ongoing community care.
“The Center serves as a bridge to other services, including counseling and/or medication management, while the patient is waiting to be seen by another provider in the community,” said LGH’s executive director of behavioral health, Tracey Lavallias. “We also hope to reduce demand on LGH’s Trauma & Emergency Department
by operating at the times when the hospital historically sees the highest demand for behavioral-health services.”
The Crisis Walk-In Center operates Monday through Friday from 11 a.m. to 8 p.m., and Saturday and Sunday, 9 a.m. to 2 p.m.
Interventional Psychiatry Services
The Behavioral Health Center also includes LGH’s Interventional Psychiatry Program, which provides specialized treatments for psychiatric conditions that do not successfully respond to typical “first-line” treatment options. For patients with a diagnosis such as depression or anxiety, the first treatments administered are usually counseling and medication. Many patients experience improvement from these treatments, but in some cases where improvement does not occur, patients may benefit from interventional tools that offer direct-brain stimulation. A referral from one’s provider is required for these services, which include Transcranial Magnetic Stimulation (TMS), Intranasal and IV ketamine therapy, and Electroconvulsive therapy (ECT).
The hours for Interventional Psychiatry are Monday through Friday from 6:30 a.m. to 6 p.m., by appointment only.
A true community effort, the Behavioral Health Center received major funding support from the Pennsylvania Redevelopment Assistance Capital Program (RCAP), Joy Allen, High Foundation, and the Capital Area Behavioral Health Collaborative (CABHC), a private non-profit formed by the elected commissioners of Cumberland, Dauphin, Lancaster, Lebanon and Perry counties to manage the Behavioral HealthChoices Program.
Seeking Help Without Stigma
WELLSPAN RECOGNIZED
AS A CHAMPION OF PHYSICIANS’ MENTAL HEALTH
Physicians struggle with stress and burnout, but surveys show they are not always comfortable seeking help to address those challenges.
A survey by Medscape showed that 41% of physicians do not seek mental health help because they are afraid that it will be reported to a medical board. And 30% are worried an attempt to get help will be disclosed on an insurance report, thereby being discoverable on an official document.
Dr. Kristen Sandel, immediate past president of the Pennsylvania Medical Society and emergency medicine director at WellSpan Ephrata Community Hospital, has strived to bring back the joy of practicing medicine to physicians struggling with stress.
“These are alarming numbers, but fortunately there is a growing recognition that we need to reduce the stigma for physicians who seek mental health treatment,” says Dr. Kristen Sandel, emergency medicine director at WellSpan Ephrata Community Hospital and immediate past president of the Pennsylvania Medical Society.
Consider these recent actions at the federal, state, and local levels:
• In 2022, the Dr. Lorna Breen Health Care Provider Protection Act was enacted to promote well-being and assistance for mental health concerns of all health care workers, including physicians. The act promotes the altering of state board licensing applications and reapplications by removing intrusive personal health questions and encourages health systems and hospitals to eliminate these questions from their credentialing forms.
• In 2024, Pennsylvania modified language on both the osteopathic and allopathic licensing applications for physicians to reduce the stigma of mental health and physician impairment, and to promote well-being and encourage physicians to seek help when they recognize they are struggling with various life stressors.
• This year, WellSpan Health was recognized as a Wellbeing First Champion by the Lorna Breen Heroes’ Foundation. This work was accomplished by Dr. Ridge Salter, WellSpan medical director of well-being, Mike Diller, Psy.D., WellSpan program administrator of Wellbeing, and an interdisciplinary team of leaders. The health system’s credentialing questions and peer reference forms were modified to reduce stigma and remove intrusive mental health questions. This important change encourages physicians to seek mental health and substance use help when needed instead of suffering in silence. WellSpan joins just two other health systems in Pennsylvania in achieving this important and prestigious designation.
A survey by Medscape showed that 41% of physicians do not seek mental health help because they are afraid that it will be reported to a medical board.
DO NO HARM
In light of these new recommendations and changes that make disclosure and treatment easier for health care professionals, programs are in place to ensure that physicians are practicing safely and patients are continuing to receive high-quality, safe care, Dr. Sandel notes.
Physicians and other health care professionals who recognize they need—or are recognized by others to need—assistance with their mental health, behavior, or impairment can engage in treatment through multiple venues including the Physicians’ Health Program (PHP), a program of the Pennsylvania Medical Society Foundation. This program is a confidential service designed to help health care professionals receive the recommended assessments and treatment without fear of stigma or repercussions on their license or board certification when they are in compliance with the program.
The PHP works with the state board of medicine and other state professional licensing boards as well as the Professional Health Monitoring Program to safeguard that physicians and other health care professionals adhere to the requirements of the program thereby allowing them to continue to practice in their desired profession. The program, has an excellent success rate in keeping health care professionals in practice while assuring public and patient safety, Dr. Sandel says.
KEEP THE FOCUS
More work is needed, Dr. Sandel believes.
“During my time as president of the Pennsylvania Medical Society, I focused on restoring the joy of practicing medicine,” she says. “I know the impact that stress and burnout can have on dedicated and caring physicians. Stressors from the pandemic, staffing issues, employer expectations and work/life balance challenges take a toll on all of us. The society offers ideas, educational opportunities and resources all designed to restore pride in the profession that we love.
“Let’s continue to take steps in leading the way in the promotion of health for both patients and their physicians. Only through these efforts can we continue the journey of restoring the joy in medicine and revitalizing our profession.”
New Affiliations Expand Access to Expert Orthopedic Care in Lancaster and
Berks Counties
Orthopedic surgeons from Penn State Health and Lancaster Orthopedic Center come together to enhance patient access to convenient, high-quality orthopedic care in Lancaster County, supported by the health system’s academic specialty and subspecialty resources.
Lancaster Orthopedic Group (LOG), a physician-owned and operated orthopedic specialty group, became affiliated with Penn State Health in February, expanding access to high-quality orthopedic care in Lancaster and Berks Counties. The affiliation was a response to the growing patient demand for orthopedic services in the region.
The 18 orthopedic physicians and 15 advanced practice providers from LOG are continuing to see patients at their three practice sites and perform surgeries at their ambulatory surgery center and Surgery Center of Lancaster. Over the next several months, the LOG physicians will start performing surgeries in a number of Penn State Health’s regional facilities.
OFFERING NEW LOCATIONS AND ADVANCED SPECIALTY AND SUBSPECIALTY CARE
“Our affiliation with Penn State Health enables us as a group to grow and expand our services to meet the needs of patients and referring physicians,” said Bryan Warren, chief executive officer of LOG. “We’re able to expand our practice locations and our surgery locations. And if there’s a subspecialty we don’t have—like pediatrics or ortho oncology—we now have our Penn State Health colleagues to help us make sure our patients get the care they need.”
For Penn State Health, the region’s only locally based academic health system, the affiliation with LOG supports its commitment to enhancing patient access to convenient, high-quality orthopedic care and its academic specialty and subspecialty resources.
“The demand for orthopedic services in Lancaster and Berks Counties continues to grow, and it’s essential that Penn State Health pursues creative opportunities like this great affiliation with LOG to expand access to meet this increasing need,” said Joseph Frank, president of Penn State Health’s East Region. “It’s also vitally important that we have a breadth of orthopedic specialists offering high-quality medical care and surgeries to our patients at Lancaster and St. Joseph medical centers. This affiliation helps us achieve that goal.”
In February, Lancaster Medical Center earned The Joint Commission’s Gold Seal of Approval for Joint Replacement – Knee Certification and Joint Replacement – Hip Certification. The Gold Seal demonstrates continuous compliance with the commission’s performance standards and highlights Lancaster Medical Center’s exceptional efforts to foster better outcomes by meeting the specialized needs of patients receiving knee and hip replacements.
“Our skilled, board-certified and fellowship-trained surgeons use the latest advances in the field and the most minimally invasive methods possible,” said Dr. Daron Kahn, Lancaster Medical Center’s interim chief medical officer. “Our team of experienced nurses, rehabilitation therapists, and clinical staff helps ensure that our patients receive the personalized orthopedic care they need—before, during, and after surgery.”
CONTINUITY OF CARE, SUPPORTED BY EXPERT ANESTHESIA SERVICES
Providers from LOG, founded in 1985, will continue to operate under the LOG name until they are fully integrated into Penn State Health. The group will maintain billing for its existing practice sites and coordinate patient scheduling. Additionally, LOG will continue to participate in all insurance plans it accepted prior to becoming affiliated with Penn State Health. Its referral relationships will also remain unchanged.
In March, Penn State Health hired the care team from Prime Anesthesia Associates to provide top-tier anesthesia service to patients. The three physicians and two full-time equivalent certified registered nurse anesthetists currently practice only at the Surgery Center of Lancaster.
“Our joining Penn State Health will allow us to further strengthen our mission of providing the highest standard of anesthesia services while ensuring a seamless patient-centered experience,” said Dr. Robert Garvin, a physician anesthesiologist who previously practiced with Prime Anesthesia Associates.
“Prime’s expertise allows us to operate efficiently while prioritizing patient safety and comfort, leading to the best possible surgical outcomes,” Warren noted.
Dr. Corey Troxell, a board-certified orthopedic surgeon who has been with LOG since 2010 and currently serves as its board president, sees strong outcomes from his group’s affiliation with Penn State Health.
“Lancaster Orthopedic Group has been proud to serve the people of this region for the past 40 years,” he said. “Our partnership with Penn State Health enhances our ability to build a better coordinated care model and bring to our patients the best orthopedic care possible.”
HEALTH CARE ON THE FOREFRONT OF AI
A series featuring different Lancaster County health care providers and how they are leveraging artificial intelligence to improve the patient experience.
FEATURED IN THIS ISSUE: WELLSPAN
Reimagining Health Care
by the Innovative Use of Artificial Intelligence
WellSpan Health continues to be at the forefront of transforming health care in central Pennsylvania, with a strong focus on innovation and care transformation to deliver greater accessibility and affordability for our patients. Our approach focuses on internal and external initiatives to ensure we are appropriately addressing the needs of our patients.
Often, innovation in 2025 includes some form of artificial intelligence. Our innovation team, which includes a research and design team and an enterprise digital health team, is dedicated to managing consumer-facing digital ecosystems and leveraging emerging technologies in areas that benefit our organization and our patients.
WellSpan’s external innovation efforts include investments in early-stage companies through their ventures program, such as Hippocratic AI, and participation in the General Catalyst Health Assurance network. This network allows WellSpan to co-develop ground-breaking ideas in collaboration with other leading health care organizations. It also includes WellSpan’s implementation of the Artisight virtual patient monitoring and nursing platform to alleviate the nurses’ workload, allowing them to focus on patient care at the bedside. These tools, now rolled out to nearly every WellSpan hospital, cover tasks such as discharge instructions and sitter duties. With almost 700 cameras using AI-driven sensors, computer vision, vital sign monitoring and more, our patients can be assured that in addition to the onsite team, a virtual care expert is available to provide and coordinate an immediate care response. The virtual nurse now averages more than 800 hours per month in completing clinical tasks. As a result, we have seen an impressive 59% reduction in patient falls. The goal is to help patients stabilize sooner so they can transition out of the hospital and continue their road to recovery.
We are also championing new adaptations to enhance our patient experience, embrace cutting-edge clinical resources, and prevent physician burnout while maintaining the highest level of quality and safety for our patients. We utilize AI-powered diagnostics with Aidoc to quickly alert surgeons and radiologists to potential abnormalities. We also employ ambient listening technology tools like Microsoft Nuance’s DAX to automate writing clinical notes, allowing physicians to remain focused on their patients.
Business operations have also improved through platform-level decisions and software innovations such as the adoption of Oracle (a business management tool), and eventually the use of Zipline for home delivery of medicine using autonomous drones.
At WellSpan we know that an innovation strategy requires whole-brained thinkers who combine analytical, practical, relational, and experimental thought to achieve success. Our approach to tapping into the expansive world of AI is having a full understanding of how these tools can and will be used to provide the highest quality care for our patients.
A Hair Loss Primer
JENNIFER SCEPPA, MD Dermatology Associates of Lancaster
Hair loss (alopecia) is a common concern for both men and women. While not life-threatening, alopecia can have significant impacts on psychological well-being and quality of life. Correct diagnosis is important to provide patients with an accurate prognosis and appropriate treatment options.
Alopecia can be divided into two groups: scarring (cicatricial) alopecia and non-scarring alopecia. Scarring alopecia causes permanent hair loss due to follicular destruction from inflammation or external causes such as traction, trauma, or chemotherapy.
Examples of scarring alopecia include lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, discoid lupus erythematosus, dissecting cellulitis, and acne keloidalis nuchae. Patients with scarring alopecia should be referred to a dermatologist for definitive diagnosis and treatment due to the risk of permanent hair loss.
Non-scarring alopecia can be reversible, especially when treatment is initiated early in the disease course, as follicles are not destroyed. Examples of non-scarring alopecia include telogen effluvium, alopecia areata, patterned hair loss (androgenetic alopecia), trichotillomania, tinea capitis, and early traction alopecia.
This article will focus on summarizing common causes of nonscarring alopecia, since non-scarring alopecia can potentially be treated in the primary care setting.
Telogen effluvium is a common cause of diffuse hair shedding that can be seen equally in both sexes and in any age group. It often occurs after a physical or emotional stressor, including pregnancy, high fever, rapid weight loss, changes in medications (including anticoagulants, oral contraceptives, thyroid disease, beta blockers, retinoids, and anticonvulsants), severe chronic disease, acute infections, or endocrine disorders. The stressor can cause many hairs to enter the telogen (shedding) phase of the hair cycle simultaneously, resulting in rapid hair loss occurring 3-6 months after the inciting trigger, corresponding to the length of the telogen phase. It is usually self-limited, resolving after 3-6 months, but can sometimes last for years. Treatment consists of resolving the trigger and reassuring patients that the hair loss will resolve on its own. Of note, COVID-19 is a common trigger of telogen effluvium, affecting 60.8% of COVID-19-infected female subjects in a recent study.
Alopecia areata is an autoimmune condition that typically presents as sudden hair loss in
circles or ovals on the scalp, eyebrows, eyelash, and beard area. Alopecia areata can also be diffuse or patterned. Examination of the scalp can reveal exclamation point hairs or yellow or black dots, and nails can sometimes demonstrate pitting. Treatment for limited cases includes intralesional triamcinolone and high-potency topical steroids, while patients with more extensive involvement should be referred to a dermatologist for consideration of either immunotherapy or systemic immunosuppression. Alopecia areata can be associated with other autoimmune conditions, most commonly autoimmune thyroid disease, type 1 diabetes, and vitiligo, and appropriate screening is recommended.
Patterned hair loss (androgenetic alopecia) results in miniaturization and subsequent thinning of the hair predominantly in the frontal and vertex areas of the scalp that occurs with aging, often in patients with a family history. Examination of the scalp will reveal an increase in vellus (fine) hairs without inflammation. Treatment can include topical or oral minoxidil or oral finasteride or dutasteride.
Trichotillomania is a mental health condition that causes the urge to pull or twist hair, resulting in round to irregularly shaped patches of hair loss in the scalp, eyebrows, and eyelashes. It is more common in females, and can be associated with other mental health conditions, such as anxiety, depression, attention-deficit/hyperactivity disorder, and obsessive-compulsive disorder. Examination will reveal broken hairs or follicular openings. Treatment includes behavioral modification techniques, such as cognitive behavioral therapy, habit reversal training and stimulus control. Oral N-acetylcysteine has shown some benefit as well.
Tinea capitis is caused by dermatophyte infection that results in broken hairs and patchy areas of alopecia. There can be associated scaling, erythema, posterior auricular adenopathy, pustules, and pruritus. A potassium hydroxide preparation of a scraping from an active border can reveal hyphae, or a fungal culture can be performed to
confirm the diagnosis. Systemic treatment with oral antifungals, including terbinafine, itraconazole, fluconazole, or griseofulvin, is required.
Traction alopecia is caused by tension on the hair follicle from tight hairstyles, including ponytails, braids, and weaves. It causes localized hair loss in the part or frontal scalp, corresponding to the areas of greatest tension. It can lead to scarring alopecia if the tension is prolonged. Treatment is to change the hairstyle to reduce traction.
The first step in diagnosis is taking a detailed history.
Important topics include:
• how abruptly the hair loss occurred
• nutritional status (including dietary habits and recent weight loss)
• life stressors
• family history of hair loss
• related medical conditions (such as autoimmune diseases, thyroid disease, pregnancy, and polycystic ovarian syndrome)
• history of psychiatric diagnoses
• recent surgery or illness
• hair styling practices (such as chemical treatments and tight hairstyles)
Physical examination should include an assessment of whether the hair loss is patchy or diffuse. A hair pull test, in which approximately 40-60 hairs are grasped between the thumb and index finger and gently pulled away from the scalp, may signify active shedding if more than 4-6 hairs are obtained in a pull. A hair pull test is common in acute forms of hair loss, such as telogen effluvium and alopecia areata. A dermatoscope or magnifying glass may be used to closely examine the hair shafts for signs of breakage as well as to evaluate for specific findings such as the exclamation point hairs of alopecia areata or the loss of follicular openings in scarring alopecia.
There is no standard laboratory workup for alopecia. History and physical exam are important in guiding the clinician regarding what labs to order. Labs that may be helpful include a complete blood count, hormonal tests (such as thyroid function tests, free and total testosterone, and dehydroepiandrosterone sulfate), iron studies, vitamin D levels, and possibly zinc and B12 levels in patients in whom nutritional deficiency is suspected. A 4 mm punch biopsy to fat for horizontal sectioning can be performed to help definitively diagnose the cause of the alopecia. For non-scarring alopecia, the biopsy should be performed from an active area of hair loss. For scarring alopecia, an ideal site is an area with inflammation and some residual hair.
A more recent development in treatment of hair loss is the use of low-dose oral minoxidil. Topical minoxidil is FDA approved to treat androgenetic alopecia in both men and women; however, the use of oral minoxidil for hair loss is off-label. There are several recent studies that have shown that use of oral minoxidil in low doses (0.25 to 5 mg per day) can be beneficial for various causes of alopecia, including androgenetic alopecia in both
men and women, alopecia areata, chronic telogen effluvium, and lichen planopilaris. The mechanism of action is not well understood. The main side effects include hypertrichosis and cardiovascular side effects, such as hypotension, leg edema, tachycardia, and EKG changes such as premature ventricular contractions. No severe cardiopulmonary events have been reported and the risk of pericardial effusion was similar to placebo in a small study. Contraindications to low-dose oral minoxidil include a history of or risk factors for congestive heart failure, hypersensitivy to minoxidil, pulmonary hypertension with mitral stenosis, and pheochromocytoma.
Hair loss is a common issue which may be encountered by physicians in all medical specialties due to stressors of illness and surgery, medication side effects, and underlying medical conditions. An awareness of the common presentations and causes of hair loss is essential, given the significant psychological stress that can be associated with alopecia.
References:
Awad NEHA, Obaid ZM, Zaky MS, Elsaie ML. Hair disorders associated with post-COVID-19 infection in females: a cross-sectional study. Ir J Med Sci. 2024 Apr; 193(2):761-767.
Gupta AK et al. Low-dose oral minoxidil for alopecia: a comprehensive review. Skin Appendage Disord 2023;9(6):423-437.
Phillips TG, Slomiany WP, and Allison R. Hair loss: common causes and treatment. Am Fam Physician 2017;96(6):371-378.
Workman K and Piliang M. Approach to the patient with hair loss. J Am Acad Dermatol 2023;89(S3-S8).
PROSTATE CANCER SCREENING IN 2025:
THE PSA CONTROVERSY
In 2025, 13-year data suggests that the absence of prostate cancer screening has resulted in an increased incidence of prostate cancer and stage migration. This observation is particularly concerning given the availability of 12 new prostate cancer drugs in the last 12 years. Current screening methods, including the prostate-specific antigen (PSA) test, have been a source of controversy since their FDA approval in 1986. This commentary aims to shed light on the ongoing debate and provide insights for informed clinical decision-making in prostate cancer screening.
A recent comment from Karen Knudsen, immediate past president of the American Cancer Society, highlighted “misconceptions about prostate cancer screening” [1]. This was in reference to prostate cancer and an increase in disease, particularly advanced disease. The striking U.S. Preventive Services Task Force (USPSTF), in its 2012 recommendations, initially assigned a D rating (harmful) to any screening for prostate cancer and subsequently changed that to a C rating (no benefit) in 2018. That is now being questioned. A review of recent Surveillance, Epidemiology, and End Results (SEER) data [2] reveals declines over the last ten years in both colorectal and lung cancer mortalities, but not for prostate cancer. This is particularly troubling when considering the advancements
PAUL SIEBER, MD, FACS Keystone Urology Specialists
in prostate cancer treatment, with a dozen new drugs developed over the past 12 years.
An additional study from California supports the SEER data, indicating, “The incidence of distant-stage prostate cancer increased by an average of 6.7% per year from 2011 to 2021” [3]. USPSTF invited public comments in 2023 but has not issued updates to date.
A recent article in the American Family Practice Community Blog referenced the UK-based Protect T study [4], which followed a large group of men who were screened and treated with either observation or immediate surgery or radiation. The 15-year survival rates were excellent across all groups. However, most men had Gleason grade group 1, for which current practice favors observation. Note that this commentary does not reflect the subsequent significant stage migration of the last 12 years. Notably as well, at 15 years, 60% of the observed men eventually received definitive treatment (surgery or radiation therapy) and were more likely to receive androgen deprivation therapy and develop metastatic disease compared to the initial treatment group.
A recent VA review highlighted the increasing challenge of men presenting with advanced prostate cancer, a contrast to the screening population observed in the Protect T study 15 years ago. The review noted that most men in the low-risk group are being treated with surveillance. The difficulty today is twofold. First is determining the best approach for higher-risk
patients with potential comorbidities, who face a disease that is not slow growing and carries a significant risk of morbidity and mortality. Second, referring back to Protect T, is how to approach the significant number of observed patients who eventually progress in observation.
The core issue remains screening. As Dr. Knudsen stated, “The science has progressed to the point that we can much more effectively place men into risk categories and thus select the most appropriate treatments which include observation versus treatment now. The clinical decision making and not the test is the concern” [1].
The European Commission (EC) guidelines offer a valuable framework for screening in today’s population. They recommend offering PSA testing to men at age 50 with a 10-year life expectancy, at age 45 for men of African descent or those with a positive family history, and at age 40 for men with the BRCA2 mutation. Additionally, men at age 40 with a PSA <1 and age 60 with a PSA <2.0 are considered at lower risk and can be screened less frequently.
A review in European Urology [5] emphasized the efficacy of PSA screening at a younger age in predicting cancer mortality over a lifetime. As previously alluded to, men with PSA below 1 at age 50 have a very remote chance of mortality by age 75 from prostate cancer and if PSA remains below 1 at age 60, they have almost no chance of prostate cancer mortality in their remaining lifetime.
It also sheds light on the initial controversy surrounding the PSA cutoff of 4. While numerous men with significant cancers had PSA levels between 2.5 and 4.0, the high number of negative biopsies led to the selection of 4 as the normal threshold. The EC upper limit for normal was set to 3.0 but recognizes there is no absolute number for normal.
The European Commission guidelines also highlight the availability of downstream tests for more effective screening of significant prostate cancer in men with rising or abnormal PSA levels. These include urine tests like ExoDx® and SelectMDx, which use proprietary urine biomarkers and blood tests such as 4Kscore®, Prostate Health Index (phi) score, and IsoPSA®, which utilize various serum biomarkers.
Multiparametric MRI is also a valuable screening tool for men with abnormal PSA, aiding in risk validation and MRI-fusion biopsy.
The PSA test itself presents another screening challenge. The original monoclonal assay, developed by Hybritech, has been succeeded by numerous polyclonal variants that are not directly comparable. Fortunately, the World Health Organization and Hybritech developed a conversion factor, approximating a monoclonal PSA of 4 to 3.2 with a polyclonal assay. This conversion factor is essential to account for the differences between the original PSA test and its polyclonal variants, which can lead to variations in PSA level measurements. Clinicians must consider these differences to accurately interpret PSA test results and make informed decisions about further diagnostic or treatment steps, ensuring that the choice of PSA test does not inadvertently affect patient care due to comparability issues.
In conclusion, the 13-year data indicating an increase in prostate cancer incidence and stage migration underscores the impact of the absence of prostate cancer screening. The PSA test, since its FDA approval in 1986, has been central to the screening controversy. The concept of “informed choice” has emerged, but as Dr. Knudsen pointed out, “For there to be an informed choice, you have to be informed by something. We would agree that something is the test. Otherwise, what are you informed by?” [1]. The data in this commentary gives some new insight into the complex discussion surrounding prostate cancer screening, emphasizing the significance of informed clinical judgment in navigating the complexities of prostate cancer screening.
References:
1. Knudsen, K. (n.d.)American Cancer Society ASCO POST March 10,2023
2. SEER Cancer Statistics Review. (n.d.). National Cancer Institute.
3. Kirby, G. et al. (2023). The Burden of Rising Prostate Cancer in the United States Today. UroToday International Journal, 16(6).
4. Hamdy,F. et al. (2016). 15-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. New England Journal of Medicine, 388:1547-1588
5. Zhu x. et al. (2024). Risk Based Prostate Cancer Screening EurUrol 61(4) 652-61.
LEGISLATIVE UPDATES SPRING 2025
PAMED Advocacy in Action: Updates from D.C. and Harrisburg
It’s been a busy start to the year for PAMED’s advocacy efforts! Earlier this year, a group of 20 dedicated PAMED members made their way to Washington, D.C., for the AMA’s annual National Advocacy Conference. One of the highlights? Productive meetings with legislators—or their staff—from 12 different offices in Pennsylvania’s congressional delegation, including conversations with Congressman Glenn Thompson and Congressman Dwight Evans.
The big topic of discussion was the 2.8% Medicare physician payment cuts that took effect on January 1. This marks the fifth year in a row of payment reductions. PAMED physicians stressed the importance of reversing these cuts, which are straining medical practices and jeopardizing patient access to care. Reversing this trend is critical to stabilize health care practices across the country.
Governor Shapiro’s Budget Address: Wins and Concerns
Switching gears to Harrisburg, Governor Shapiro’s recent budget address caught our attention with several health care-related
proposals. PAMED was thrilled to hear the governor tackle private equity’s growing influence in health care. Private equity takeovers are putting profit over patient care, creating unnecessary pressure for physicians and eroding patient trust. PAMED couldn’t agree more with the governor’s call for action here—we must protect the integrity of health care.
Another win? The governor’s proposal to increase incentives for the Primary Care Loan Repayment Program, which will help bring more physicians and health care professionals to rural areas in Pennsylvania. We also strongly support his focus on expanding mental health services statewide, ensuring all Pennsylvanians have access to the care and support they need. Breaking the stigma surrounding mental health is a mission we fully endorse.
However, there was one major disappointment in the governor’s address: his position supporting independent practice for nurse practitioners without physician supervision. While we respect the vital role nurse practitioners play, independent practice introduces significant risks, and
we urge the governor to reconsider this stance. As PAMED President Dr. Lynn Lucas-Fehm so perfectly put it, “Patient safety should always be our top priority.”
Your Voice Matters: New Legislative Priorities
Looking ahead, PAMED has set its legislative priorities for the next two years, based on feedback from our December 2024 survey. Here’s what’s on the agenda:
• Medicare and Medicaid Reimbursement
• Scope of Practice
• Noncompete Clauses
• Mental Health Services Access
• Reproductive Rights
With these priorities in focus, 2025 promises to be a pivotal year for advancing health care legislation and protecting the interests of physicians and patients alike.
For more information about any of the items mentioned above, please visit the Advocacy Section of PAMED’s web site at www.pamedsoc.org/advocacy
Protections for Pennsylvania Health Care Workers
Workplace violence is not a new problem in health care, but the incidence of violence has increased throughout the years and was recently pushed to the forefront again, with the tragedy in York. The increase in violent situations threatens the safety of not only health care workers but also the safety and care of patients.
OSHA defines workplace violence as “any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors.”
Historically, health care workers have faced significant risks of violence due to the nature of their work. Over the years, data shows a worrying trend: health care workers accounted for a majority of nonfatal workplace injuries resulting from violence. According to the Bureau of Labor Statistics, health care and social assistance workers are five times more likely to experience workplace violence injury compared to employees in other industries.
In Pennsylvania, assaulting a health care worker is a felony, and there are ongoing efforts to strengthen protections against workplace violence.
In 2020, then-Governor Wolf signed into law a bill to strengthen penalties for assaults against health care practitioners and technicians. At the time, existing state law provided stiff penalties for assaults against certain health care professionals, including doctors, residents, nurses and paramedics. Act 51 extended the same protections to a broader range of health care practitioners and health care technicians.
Under the law, the penalty for an assault against a health care practitioner in which there is bodily injury was upgraded from a misdemeanor of the second degree to a felony of the second degree. The law went into effect in 60 days from the July 1, 2020 signing.
Despite ongoing efforts to implement workplace violence prevention strategies, such as de-escalation training for health care providers and security measures, the problem persists. Health care settings continue to see a rise in both physical assaults and verbal abuse, affecting not only the safety but also the mental health and job satisfaction of workers.
In February of this year, Pennsylvania HB 926, the Health Care Workplace Violence Prevention Act (a bill which has been introduced in every legislative session since 2017) was reintroduced. The Act would require every health facility to create a violence prevention committee with frontline worker representation. The legislation does the following:
• Requires a health facility to establish a workplace violence prevention committee that will create, review, administer, and provide guidance on programs relating to the prevention of workplace violence at Commonwealth health care facilities.
• Requires the workplace violence prevention committee to annually perform a risk assessment evaluation of the factors that may put a health care provider or employee of a health facility at risk for workplace violence.
• Requires the workplace violence prevention committee to meet quarterly to review all cases of workplace violence and to perform duties as required.
• Requires the workplace violence prevention committee to prepare a report from the risk assessment and
to establish a workplace violence prevention program.
• Requires the workplace violence prevention committee to provide training to employees and health care providers at the time of their hire and annually thereafter.
• Protects employees and other health care providers from retaliatory action for reporting instances of workplace violence.
Unfortunately, at a federal level, health care workers are not yet protected from violence and intimidation. The former SAVE (Safety from Violence for Healthcare Employees) Act, which has been supported by both the American Medical Association (AMA) and the American Hospital Association (AHA), was not passed last session and has not yet been reintroduced in the current year.
The previous version of the bipartisan Act was modeled after federal protections for airline workers and would:
• Establish federal criminal penalties for knowingly assaulting or intimidating hospital employees, with exceptions for individuals who may be mentally incapacitated due to illness or substance use.
• Authorize grant funding for initiatives to improve hospital employee safety.
There is hope that legislation like the SAVE Act (from the 2023/2024 Congress) will be reintroduced soon.
A Range of Fertility + Reproductive Services
AVAILABLE THROUGH LANCASTER COUNTY HEALTH SYSTEMS
SUSAN SHELLY Writer
Reproductive health has been thrust into the spotlight over the past several years as it’s increasingly become part of the national political arena.
Following the rollback of Roe v. Wade in 2022, removing the constitutional right to abortion, in vitro fertilization (IVF) came under scrutiny last year when the Alabama Supreme Court ruled that embryos are children under the law.
That legislation caused some providers to suspend services in the state and raised many questions among providers elsewhere.
More recently, President Donald Trump signed an executive order intended to cut costs of IVF, offering cautious optimism to patients and their providers.
While politicians juggle hot potato issues related to fertility and reproductive services, Lancaster County providers are celebrating advancements being made in the field, looking for ways to improve services, and encouraging their patients to continue to seek the care they need.
Lancaster Physician reached out to the health care systems serving Lancaster County to learn more about the services they offer, the advancements providers are celebrating, and how they’re working with patients.
We spoke with representatives from Penn State Health, WellSpan Health, Penn Medicine Lancaster General Health, and UPMC.
PENN STATE HEALTH
Patients in Lancaster County can benefit from all Penn State Health’s comprehensive treatments and services related to reproductive health and fertility care—including clinical trials, according to Dr. Stephanie Estes, director of Outpatient Women’s Health Services at Penn State Health.
Dr. Stephanie Estes
Penn State Health has recently completed several clinical trials related to polycystic ovary syndrome and endometriosis, common conditions that can affect a woman’s fertility and reproductive system.
“Our Lancaster County patients can take advantage of all the resources available at Penn State Health Milton S. Hershey Medical Center, as well as those in their local communities,” said Estes, who added that expanded reproductive endocrinology and infertility services will be made available at Penn State Health Lime Spring Outpatient Center in Lancaster, beginning next year.
Providers at Milton S. Hershey Medical Center work together to provide all areas of care related to fertility and reproductive services.
“We know that reproductive and fertility care is not just physical,” Estes said. “Patients can see social workers or get counseling when necessary. They can get help with insurance and financial issues. We work together as a group to provide all the services our patients need throughout their journeys.”
Providers also are cognizant of faith-based issues and respect patient decisions made according to their religious beliefs.
“Lancaster County is such a diverse population,” Estes said. “We need to be able to apply services that meet the needs and wishes of all our patients.”
Many fertility and reproductive services can be provided using telemedicine, Estes explained, eliminating the need for patients to travel and enabling them to experience a comfortable setting when meeting with specialists.
She believes the telehealth option results in patients seeking treatment who may not otherwise do so.
“There’s so much that can be accomplished outside of our facility,” Estes said. “It’s an extra step we can take to meet our patients where they are and increase their level of comfort and satisfaction.”
A reproductive surgeon, Estes specializes in minimally invasive surgery to treat conditions such as endometriosis, ovarian cysts, uterine and vaginal abnormalities, fibroid tumors, and others.
She’s excited about the advancements she’s seen in minimally invasive and robotic surgery during her 25 years in practice and is confident the specialty will continue to improve.
“All the improvements we’ve made in these areas really benefit patients,” Estes said. “People who need surgery want to get back to their lives as quickly as possible, and we can help them do that.”
Other areas in which Estes cited major improvements in care are genetic testing, better visualization for gynecological procedures, and recovery protocols.
Specialists at Penn State Health employ pre-implantation genetic testing of embryos, greatly reducing the possibility of genetic disorders.
Increased visualization when performing gynecological procedures such as dilation and curettage provides a more accurate and safer technique than blindly conducting the procedure, as was done previously, explained Estes. Use of hysteroscopy provides significant improvement over previous methods.
Also, enhanced recovery after surgery (ERAS) protocols have been put into place to improve post-surgical outcomes in patients. ERAS, a pathway aimed at enhancing the recovery phase following surgery, has been shown to help patients recover more quickly, reduce complication rates, decrease hospital stay times, and reduce costs.
“It’s a recovery mindset,” Estes said. “Everyone is focused on all the components of recovery.”
As the need for fertility and reproductive services continues to increase, Penn State Health is well prepared to work with patients to provide the treatments that are best for them.
“No two patients or cases are the same, and we need to be sure we’re providing what’s best for each individual or couple,” Estes said. “That’s something we strive to do every day.”
WELLSPAN HEALTH
WellSpan Health treats all types of women’s health issues, ranging from routine gynecological and pregnancy care to highly specialized interventions.
Patients who are identified by their OB/ GYN physicians as having concerns with fertility issues often are referred to WellSpan Fertility Care—first-stop resource for couples hoping to conceive.
Lindsey Zwerko, an advanced practice provider who specializes in fertility care services there, understands that facing issues when trying to conceive can seem overwhelming and are often a source of anxiety—even despair.
“Our patients are vulnerable. They’ve often been trying to have a baby for a long time, and they’re frustrated and upset that they haven’t been able to,” Zwerko said. “But we want couples to know they’re not alone and there is help available for them.”
Located in York, WellSpan Fertility Care serves patients from Lancaster County, offering both in-person and virtual visits. Zwerko, who is one of the first points of contact for patients with fertility concerns, conducts most of her visits via telehealth.
“We’re meeting people where they are—in their own environments,” she said. “We want them to feel comfortable and know that they’re able to connect with us.”
She explained that couples who have been unable to conceive often feel anxiety, fear, and hopelessness, and may be intimidated and unsure about what to do. Many jump to the conclusion that they will require expensive, high-tech interventions and are hesitant to seek help or take additional steps in attempting to conceive.
Continued on page 24
Lindsey Zwerko
Often, however, infertility is attributed to a problem that requires less intensive treatment.
“A lot of patients can benefit from relatively simple treatments they may not even know about,” Zwerko said. “Their minds go right to IVF (in vitro fertilization), but we know there are simpler interventions that can help a couple achieve pregnancy.”
Following an initial consultation, Zwerko normally will ask that a patient has some bloodwork done, undergo a pelvic ultrasound, contribute a partner’s sperm sample for analysis, and have X-ray tests of the uterus and fallopian tubes. Tests can be done at a WellSpan outpatient facility that is convenient for the patient.
If it’s determined that both of a woman’s fallopian tubes are blocked or the fertility issue is caused by a male factor, patients are referred to advanced treatment at Shady Grove Fertility in York, a facility WellSpan Fertility Care has partnered with since 2022.
Other issues, such as ovulatory dysfunction, a frequent contributor to fertility issues, can be handled by WellSpan Fertility Care.
If ovulatory dysfunction is present, the patient will be prescribed an oral medication used to induce ovulation.
If pregnancy has not been achieved after three rounds of that medication, those patients also are referred to Shady Grove Fertility for further treatment.
“We’re able to provide an easy, warm handoff for our patients,” Zwerko said. “It’s a very integrated system.”
After referral to Shady Grove Fertility, patients can access services including intrauterine insemination, IVF, fertility preservation, pre-implantation genetic testing, male infertility diagnosis and treatment, and reproductive urology.
WellSpan specialists also are available to serve patients.
WellSpan Fertility Care was formed in 2020 with a goal of centralizing care for patients in South Central Pennsylvania. Prior to that, area OB/GYNs would refer patients to various reproductive endocrinology practices for care.
Many patients were intimidated by the thought of going to one of the centers, Zwerko explained, resulting in lack of follow-up in some cases.
“It would seem too overwhelming, and some thought they wouldn’t be able to afford it, so they just wouldn’t go,” she said. “We were seeing this huge need in the community, and we opened WellSpan Fertility Care to fill that need. Now patients can potentially get the care they need through low-tech interventions and avoid further referrals.”
While most patients are referred to WellSpan Fertility Care by their OB/GYN doctors, self-referrals also are accepted.
“We want patients to feel empowered to get help sooner rather than later,” Zwerk said. “There are a lot of couples out there who need services, and we want them to know that we’re here for them.”
PENN MEDICINE
LANCASTER GENERAL HEALTH
An increasing ability for single-embryo transfers, advances in embryonic genetic testing, and improvements in freezing of eggs and embryos are just some of the reasons that Dr. Christine Skiadas, medical director at Penn Fertility Care – Lancaster General Health, is upbeat about the future of reproductive health.
“The treatments we have available now have significantly increased success rates for our patients, and I’m optimistic they’ll continue to improve,” Skiadas said. “It’s an exciting time to be in this field of medicine.”
As demand for fertility and reproductive services increases, patients in Lancaster County have access to a full range of care through Penn Fertility Care – Lancaster General Health.
The practice offers services including preconception planning, ovulation induction, intrauterine insemination, in vitro fertilization (IVF), reproductive surgery, management of conditions such as polycystic ovary syndrome and endometriosis, and others. It also is home to the only embryology laboratory in Lancaster County.
Access to fertility and reproductive services is increasingly important as more couples experience infertility issues, Skiadas noted.
“Infertility is becoming recognized as a medical problem, and that’s a good thing,” she said. “There’s less stigma surrounding the issue and people are more willing to talk about it and seek help.”
An impediment to reproductive care in Pennsylvania remains a lack of an infertility insurance law, which could mandate employers to cover treatments. Still, more and more companies are voluntarily offering coverage for employees, Skiadas said, and she’s hopeful that trend will continue.
An executive order aiming to reduce the costs of IVF signed by President Donald Trump on February 18 also is reason for cautious optimism.
Skiadas explained that single-embryo transfer, a procedure during which only one embryo is transferred back into the uterus during an IVF cycle, is preferred by most patients because it avoids the possibility of multiple pregnancy.
Having insurance coverage for IVF treatments likely will make single-embryo transfer more financially feasible for patients, potentially enabling them to undergo additional attempts at transferring embryos one at a time if a prior attempt is unsuccessful. This can increase their chances of pregnancy while eliminating the concern of a multiple birth and its ongoing consequences.
“Being able to reduce the costs for treatment would be a huge benefit for patients who don’t have insurance to cover it,” she said.
Dr. Christine Skiadas
Skiadas cited improvements in the ability to evaluate embryos to decrease the risk for genetic diseases and to identify those that have the least risk for miscarriage as major advances in the field of fertility and reproductive care.
And she is optimistic that artificial intelligence (AI) will be integrated into the field for continued advancements.
“I feel that AI will be one of the next big advantages,” she said.
Meanwhile, Skiadas urged patients to explore all potential treatment options with their physicians, and to remain encouraged about their chances for pregnancy and childbirth.
“This is a wonderful field of medicine and it’s a great privilege to work with our patients,” she said. “We get to see miracles all the time.”
UPMC
Dr. Gretchen Makai is a strong advocate for empowering women through education.
She believes that possessing as much knowledge as possible about conditions that affect their reproductive health enables women and their partners to make informed decisions that are best for them.
“The amount of information available to women is increasing,” Makai said. “Having that information and a better understanding of what’s available lets patients seek out treatments they perhaps didn’t even know about.”
Consulting with their health care providers, patients can choose medically appropriate treatments with which they are most comfortable, and which best suit their lifestyles and financial situations.
“Women are taking charge of decisions concerning their treatment,” Makai said. “Providers need to work with patients to provide individualized care that meets their needs.”
A specialist in minimally invasive gynecological surgery at UPMC Magee-Womens in Central Pa., Makai works closely with patients suffering from endometriosis, fibroid tumors, hydrosalpinx, adenomyosis, and other conditions that can affect fertility. She is encouraged by the marked improvements she’s seen during her 16 years of practice.
“Studying the science of reproductive health has led us to much better treatments,” Makai said. “There’s a lot we can do to enhance a woman’s fertility.”
Minimally invasive surgery can in many cases make treatment of conditions that affect fertility more effective, while minimizing pain and recovery time for patients. Once problems caused by those conditions have been resolved, women are often able to achieve pregnancy.
She wants patients to understand that treatment of conditions such as endometriosis and fibroids is covered by most insurance, including plans that don’t cover more advanced fertility care, such as in vitro fertilization (IVF).
Correcting those conditions can open the door for pregnancy, allowing women and their partners to decide how they wish to proceed. Depending on insurance and other factors, some couples may immediately opt for IVF, while others will delay more aggressive methods while attempting to conceive naturally.
“There’s no one-size-fits-all in this field,” Makai said. “When patients understand their options, they’re able to make the best decisions for themselves.”
Minimally invasive surgery has been employed in the field of fertility and reproductive health since the 1980s and has improved dramatically, with the first robot-assisted surgeries performed in 2006. Robot-assisted surgery has made minimally invasive surgery more accessible, with an increasing number of patients benefiting.
“These surgeries certainly are nothing new, it’s just that they keep getting better and better and more physicians are performing them,” Makai said. “It’s really improved the opportunity for care.”
However, she explained, while minimally invasive surgery often is a desirable option, it is not always the best choice.
“We need to use the science and look at what works best for each patient,” she said. “If a patient has 15 fibroids, open surgery might be a better choice than minimally invasive, even though it’s a major procedure and involves a longer recovery time.”
While considering the medical needs of patients, Makai believes it’s also important to respect cultural and religious beliefs and acknowledge people of all identities. She said UPMC makes it a point to provide interpreters and be accommodating of all patients.
She advocates careful listening of patients by providers and stresses the need for doctors to meet patients where they are.
“We should listen to the concerns of our patients and work with them,” she said. “If a woman says her period is too heavy, it’s too heavy.”
As telehealth has become more accepted and widely used since the start of the pandemic, listening has become increasingly important.
“How we deliver care has changed since I started medical school in 1999,” Makai said. “The laying on of hands is now the listening. We must hear our patients and respond to their needs.”
Dr. Gretchen Makai
Penn Medicine Lancaster General Health Physicians Gynecologic Oncology
At Penn Medicine Lancaster General Health, we pride ourselves on providing exceptional care to women facing gynecologic cancers. Our gynecology oncology practice brings together a team of highly skilled professionals who are deeply committed to offering the most advanced treatments, compassionate support, and personalized care. Whether you’re facing a diagnosis of ovarian, cervical, uterine, or other gynecologic cancers, our expert providers are here to guide you through every step of your journey with confidence and care.
At Penn Medicine Lancaster General Health, we understand the challenges that come with a gynecologic cancer diagnosis. That’s why we offer a multidisciplinary approach to care that addresses every aspect of the patient’s journey. From diagnosis to treatment, we provide a full spectrum of services, including:
Surgical Options: Our team specializes in both traditional and minimally invasive surgeries, ensuring that every patient receives the most appropriate surgical intervention based on their unique needs. We also specialize in radical vulvar surgery for vulvar malignancy and inguinal dissection.
Chemotherapy and Radiation Therapy: For patients who require additional treatments, we personally deliver chemotherapy care and refer to radiation oncology for comprehensive treatment of gynecologic malignancies.
Support Services: We offer a wide range of support services, including counseling, nutrition advice, Cancer Boutique, and financial assistance, to help our patients maintain their physical and emotional well-being during treatment.
No two patients are alike, and neither are their treatment needs. That’s why we take a personalized approach to each patient’s care plan. The gynecology oncology team works closely with patients to develop tailored treatment plans that reflect their unique diagnoses, preferences, and goals. Whether you’re undergoing surgery, chemotherapy, or radiation, our team is committed to guiding you through each step with clear communication, compassion, and expertise.
Our gynecology oncology team provides cutting-edge care, backed by the resources and support of one of the nation’s leading health systems. With an emphasis on collaboration, we bring together a diverse team of specialists to ensure that every aspect of your care is carefully considered. The extended gynecologic oncology care team includes excellent pathologists,
radiologists, radiation oncologists, and support services. And with access to the latest treatments and clinical trials through Penn Medicine, we are at the forefront of gynecologic cancer research and innovation.
Whether you’re in need of treatment of premalignant conditions, a second opinion, or advanced treatment options, our team is here to provide the compassionate care you deserve. At Penn Medicine Lancaster General Health, we believe that every woman deserves exceptional care, and we’re here to make sure you receive it. We welcome patients to contact us for more information or to schedule an appointment.
MEET OUR EXPERT TEAM
The cornerstone of our practice is our dedicated team of physicians and advanced practice providers. Led by Dr. Lori Cory, Dr. Bethany Bustamante, and Dr. Katherine Hicks-Courant, each with years of specialized experience in gynecologic oncology, we offer patients the highest standard of care grounded in clinical expertise and compassionate service. Together with our advanced practice providers, Emily Gehron and Amanda Gaziano, they form a cohesive and dynamic team that focuses on the individual needs of each patient.
DR. LORI CORY
Dr. Cory serves as the Medical Director for Women’s Surgical Oncology service, which encompasses gynecologic oncology and breast surgical oncology. She is recognized for her expertise in advanced treatments and surgical techniques for gynecologic cancers. She has a strong focus on utilizing minimally invasive techniques to ensure quicker recovery times for her patients, without compromising on the quality of care. Dr. Cory graduated from Perelman School of Medicine at the University of Pennsylvania and continued for her residency and fellowship at HUP. She joined our
gyn onc group in October 2023 and has served as the managing physician for this team. During her tenure she has built a successful collaborative surgical team and is using her expertise to enhance and build our surgical oncology program.
DR. BETHANY BUSTAMANTE
Dr. Bustamante joined the practice in August 2021 and is known for her compassionate approach and dedication to evidence-based care in managing gynecologic cancers. She has been developing the HIPEC program (heated intraperitoneal chemotherapy) for ovarian cancer patients at LGH, which should be ready to serve patients in the Fall of 2025. She is passionate about the care of patients in Lancaster and abroad and works as an international collaborator with a cancer clinic in Lesotho. Dr. Bustamante graduated from Joan C. Edwards School of Medicine at Marshall University and then completed residency at Adventist Health White Memorial and fellowship at Zucker School of Medicine at Hofstra/Northwell. She brings a personalized, patient-centered approach that makes every individual feel heard, supported, and empowered.
DR. KATHERINE HICKS-COURANT
Dr. Hicks-Courant works hard for her patients to receive expedited, guideline-based, and gracious care. She believes in bringing clinical trials to the community-based cancer program and is the primary investigator on multiple clinical trials available to gynecologic cancer patients at LGH. Dr. Hicks-Courant completed medical school at the University of Massachusetts Medical School, followed by residency at Tufts Medical Center and fellowship at HUP. Dr. Hicks-Courant is known for her ability to foster strong,
trusting relationships with her patients, empowering them to make informed decisions about their care.
EMILY GEHRON, NURSE PRACTITIONER
Emily Gehron, one of our dedicated advanced practice providers, works closely with the gynecology oncology team to provide direct patient care, from initial consultations to post-treatment follow-ups. She has a particular interest in sexual health after cancer treatments and assists in counseling and treatment of pelvic floor pain, hypoactive sexual desire disorder, and dyspareunia. She is first assist trained and works closely with the surgeons in the operating room to ensure the best operative outcomes. Her extensive training in oncology allows her to address complex questions and concerns with ease, ensuring that each patient feels confident and supported throughout their treatment journey.
AMANDA GAZIANO, NURSE PRACTITIONER
Amanda Gaziano is a highly skilled advanced practice provider with a passion for improving patient outcomes. She previously worked in Trauma Surgical ICU and brings expertise in critical illness to her care of the gyn
Elegant Contemporary Masterpiece
oncology patient. She is working to become first assist trained as well, and then will be assisting the surgeons in the operating room. She works tirelessly to support the whole team and make sure patients have their needs met promptly.
East Hempfield Township, Lancaster
Welcome to this stunning contemporary home custom-built by Bowser Construction, where luxury meets functionality in a serene, natural setting. Built with commercial-grade steel, cinderblock, and expansive windows, it offers lasting durability and panoramic views. Nestled on nearly 3 private acres at the edge of the woods, the property is rich with wildlife and tranquility. Inside, the open floor plan and 29-foot ceilings in the great room create a bright, inviting space. The home features 5 bedrooms, 4 full baths, 4 half baths, and standout details like marble accents, spiral staircases, and built-in planters. The cozy living room with a wood-burning fireplace flows into a bar room ideal for entertaining. The luxurious primary suite includes a gas fireplace, sitting area, walk-in closet, and spa-like bath. Other highlights include an indoor spa, gourmet kitchen, family and game rooms, and a finished basement with an art studio and theater. This modern gem offers upscale living in a peaceful, private retreat.
Prasad Krishnakurup, MD
Interventional Radiology
WellSpan Ephrata Community Hospital
Where do you practice and why did you settle in your present location or community?
I currently practice at WellSpan Ephrata Community Hospital in Ephrata, PA. I am a full-time interventional radiologist there. I am part of a group of 18 radiologists that includes two other interventional radiologists and an Advanced Practice Provider (APP), covering the East Region for WellSpan from WellSpan Ephrata Community Hospital and WellSpan Good Samaritan Hospital in Lebanon.
I decided to practice at WellSpan Ephrata Community Hospital because of the unique opportunity the practice provides and due to my wife and her family being from Lancaster County. I was offered the opportunity to build an IR department from the bottom up immediately out of training, which has subsequently enabled me to practice medicine the way I believe it should be practiced. I am allowed the opportunity to practice near the top of my license and provide patient-centered care.
What do you like best about practicing medicine?
What I enjoy most about practicing medicine is problem solving and patient interaction. I thoroughly enjoy getting to know our patients, providing them hope and reassurance when possible and solving uniquely challenging health care problems. I enjoy the creative freedom interventional radiology allows, particularly in complex situations with limited options.
Are you involved in any community, non-profit, or professional organizations? If so, please list the groups. I am a member of Rad-Aid, specifically the Guyana Chapter. Rad-Aid is a radiology specific nonprofit whose mission is to provide radiology to resource-poor regions of the world by delivering education, equipment, infrastructure, and support. I am also a question writer for the interventional radiology section of the Diagnostic Radiology In-Service (In-Training) exam (ACR DXIT) given to radiology trainees during their training.
I am a member of professional societies, including the Pennsylvania Radiological Society and the American College of Radiology.
What are your hobbies and interests when you’re not working?
I am a consummate “foodie” and enjoy trying new restaurants and cuisines from different cultures. I also enjoy traveling. One of the best things about living in Lancaster County is the abundance of access to delicious, healthy produce and meats. Since moving to this area, I have picked up archery and took lessons at Lancaster Archery Academy. My goal is to eventually go on a hunt when I become more proficient with a bow. I also try to sneak in some time weightlifting, boxing, or rowing when I am not running after our twoyear-old son or helping placate our 5-month-old daughter.
For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?
I became an LCCMS member recently to connect with other physicians in the county. I value this community as the physicians who are members understand the unique challenges and opportunities practicing in Lancaster County affords.
FRONTLINE GROUPS SPRING 2025
Frontline Practice Groups have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.
Avalon Primary Care
BestFit Virtual Health + Wellness PLLC
Carter MD Aesthetics
Community Services Group
Conestoga Eye
Dermasurgery Center PC
Dermatology Associates of Lancaster Ltd.
Dermatology Physicians, Inc.
DermDox Dermatology Centers PC-Leola
Eye Associates of Lancaster Ltd.
Eye Health Physicians of Lancaster
Family Eye Group
Family Practice Center PC - Elizabethtown
General Surgery of Lancaster
Glah Medical Group
The Heart Group of Lancaster General Health
Hospice & Community Care
Hypertension & Kidney Specialists
New Members
Emily R. Broomell Burnett, DO UPMC Obstetrics & Gynecology Specialists-Lititz
Richard Easterling, MD Lancaster General Hospital, resident
Mackenzie L. Ferry, MD Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women
Sara Elizabeth Henderson, DO University Health Center, resident
Tobias C. Long, MD Lancaster Plastic Surgery Associates, PLLC
Michael R. McAllister, DO
Sarah Margaret Schuessler, MD Hospice & Community Care
Saamia Shaikh, DO Penn State Health Milton S. Hershey Medical Center, resident
Patti Stripling, RN Community Services Group, practice administrator
Yamin Zaw Thein, MD resident
Tierney Wolgemuth, MD
Lancaster Arthritis & Rheumatology Care
Lancaster Cancer Center, Ltd.
Lancaster Family Allergy
Lancaster Radiology Associates, Ltd.
Lancaster Skin Center PC
LNC Oculoplastics
Luz Medicine
Manning Rommel & Thode Associates
Nemours duPont Pediatrics Lancaster
Patient First - Lancaster
Penn Medicine Lancaster General Health Care Connections
Penn Medicine Lancaster General Health
Physicians Diabetes & Endocrinology
Penn Medicine Lancaster General Health Physicians Family Medicine Manheim
Penn Medicine Lancaster General Health Physicians Family Medicine Norlanco
Penn Medicine Lancaster General Health Physicians Family Medicine Susquehanna
REINSTATEMENTS
Emma Batchelder, MD
Penn State Health Milton S. Hershey Medical Center, resident
Tyler C. Gillmen, DO
Penn Medicine Lancaster General Health Physicians Anesthesiology
Adam Lake, MD Union Community Care-New Holland Ave
Wednesday, June 18 6 - 9 p.m. | The Inn at Leola Village, Casa di Fiori
Holiday Social & Foundation Benefit
Saturday, December 6 6:30 - 10 p.m. Lancaster County Club
for more information, and to register, please visit lancastermedicalsociety.org
At MADJ, we specialize in helping medical practices and health systems of all sizes thrive in competitive landscapes. From small beginnings to significant success, our tailored strategies have transformed healthcare providers into community cornerstones. If you’re ready to iMADJine the possibilities for your medical practice, let’s start the conversation
BONES & JOINTS
We’re growing and so are your care options.
As we surpass a decade of service to Berks County, both our team and our patient care services continue to grow. We are proud to offer best-in-class services – now including expert sports medicine care – to help our patients relieve pain, regain mobility, and restore their quality of life.
• Dedicated Case Manager and Physical Therapist for Joint Replacement Patients
• Fracture Care
• Infection Free Dedicated Joint Replacement Unit with Private Rooms
• Iovera° Cryotherapy
• Mako Robotic Assisted Joint Replacements with Same Day Discharge for Qualifying Patients
