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The basics:

• RWJBarnabas, Atlantic Health, HMH expand prostate cancer programs
• Robotic surgery, MRI-guided diagnostics improve outcomes, reduce costs
• Atlantic Health launching proton therapy system in 2026
• Precision medicine, radioligand therapy advance personalized treatment

Prostate cancer can only affect those assigned as male at birth, but it’s still the overall second leading cause of new cancer diagnoses nationally, striking New Jersey residents more often than the national average, according to the Rutgers Cancer Institute. Garden State hospitals have developed cutting-edge prevention, monitoring and treatment programs, but they must balance high upfront costs with reduced reimbursements from government agencies and private insurers.

In healthcare, cutting-edge technology and financial sustainability are rarely mentioned in the same breath. At RWJBarnabas Health and the Rutgers Cancer Institute, they’re the same strategy.

According to Dr. Thomas Jang, chief of urologic oncology at RWJBH and RCI, the program’s clinical investments are deliberately designed to reduce system-wide costs while delivering superior outcomes. “Employing enhanced recovery after surgery (ERAS) protocols, structured active surveillance programs, and standardizing treatment pathways using evidence-based guidelines, so every patient is treated according to their stage and risk,” Jang explains, “reduces unnecessary imaging and procedures, avoids treatment-related complications, and lowers total system costs.”

That philosophy shows up across the program. RWJBH has invested in five Da Vinci 5 robotic surgical systems – the newest generation – plus a single-port platform, giving its New Brunswick campus six total robotic systems. The precision these tools enable translates directly to the bottom line: most prostatectomy (when all or part of the prostate gland is removed) patients are now discharged the same day or within 24 hours, reducing bed utilization, nursing costs, and inpatient complications.

Lowering costs

Smarter diagnosis is generating savings, too. MRI (magnetic resonance imaging)-ultrasound fusion guided targeted biopsy technology allows clinicians to more precisely identify which cancers are clinically significant — and which aren’t. A substantial share of men diagnosed via PSA screening have low-risk disease that warrants careful monitoring or active surveillance, not intervention. “By avoiding overtreatment of those patients, the program eliminates unnecessary procedures and downstream complications that drive up costs for the entire system,” explained Jang.

On the technology side, RWJBH operates one of roughly 100 MRI-Linac radiation systems in the world. The device delivers real-time, MRI-guided precision radiation. The system also offers HIFU focal therapy, a minimally invasive, targeted treatment that uses high-intensity focused ultrasound waves to destroy diseased tissue while sparing healthy surrounding areas.

Research investment rounds out the model. Jang and his team at RCI recently closed enrollment on a seminal clinical trial. The SIMCAP (Surgery in Metastatic Carcinoma of Prostate) study examined surgery’s role in metastatic prostate cancer. Numerous other trials at RCI actively explore novel therapies and treatment sequences that may improve the longevity for men with prostate cancer. In addition to therapeutics, Jang’s team collaborates with RCI’s cancer epidemiology team to study whether exposure to PFAS (per- and polyfluoroalkyl substances, also known as synthetic “forever chemicals”) exacerbates negative outcomes and partners with national collaborators to examine the health-related outcomes of imaging and biomarker testing for prostate cancer early detection — the kind of upstream research that shapes tomorrow’s standard of care.

As healthcare reimbursement shifts from fee-for-service to value-based models, Jang says the program is built for exactly that: better outcomes, fewer complications, and lower costs.

Other institutions are also making inroads. Atlantic Health, for example, is set to launch an innovative proton radiation system in the fourth quarter of 2026, bringing one of oncology’s most precise and effective treatment technologies to the local community. For Dr. Yana Goldberg, a radiation oncologist who has been with the institution for 17 years, the milestone is profound.

“Patients used to think they needed to go to New York to access this life-saving treatment, but now they can stay in New Jersey, close to home, close to their families,” Goldberg said.

Why proton therapy?

Traditional radiation therapy kills cancer cells but can also damage surrounding healthy tissue. For prostate cancer, that means nearby structures – the bladder, rectum, and other organs – are often caught in the crossfire, leading to side effects that can negatively affect quality of life.

Proton therapy changes that equation. It lets physicians control the precise depth at which the proton beam releases its energy — typically within a range of two to three centimeters. That delivers a concentrated dose directly to the tumor with minimal collateral radiation. Healthy tissue beyond the target receives little to no exposure.

“Tighter targeting means fewer side effects, and that matters enormously to patients,” Goldberg noted.

Historically, proton therapy centers were massive, expensive undertakings requiring enormous,  specially constructed facilities. But Atlantic Health’s new system is compact enough to fit in a standard “vault” or 1,200-square-foot room. Traditional systems require up to a football field of space. The latest generation of machines are also a fraction of the cost of previous models, which could easily top $150 million once vault-construction costs factored in.

The MEVION S-250 FIT is an advanced proton therapy system that also introduces an innovation in patient experience: instead of lying on a rotating table while the machine moves around them, patients sit in a chair while treatment is delivered. It is, Goldberg said, the first time in New Jersey that this approach has been used for proton therapy.

Atlantic Health plans to begin with head and neck, prostate and pediatric cancer cases. A second machine may follow as patient volumes grow, and costs are spread across a larger base.

Evolving field

Beyond proton therapy, Goldberg sees the broader field of prostate cancer treatment evolving rapidly. Treatment courses that once required nine weeks of daily low-dose radiation have already been compressed — first to six weeks, then shorter still. Today, some protocols deliver treatment in as few as five days at higher doses, and studies are exploring three-day and even single-day regimens.

“The machines are getting more precise, which is what makes shorter, higher-dose treatment possible,” she said.

The machines are getting more precise, which is what makes shorter, higher-dose treatment possible.
– Dr. Yana Goldberg, radiation oncologist, Atlantic Health

Genetic profiling of tumors is also reshaping how treatment decisions are made, moving the field toward genuinely personalized care. With new prostate cancer diagnoses expected to double over the next 20 years as the population ages, that precision will matter more than ever.

Like all health systems, Atlantic Health faces the dual challenge of rising costs and tightening reimbursements. Insurance company delays in prior authorizations are a friction point, Goldberg acknowledged — but not one that changes the clinical calculus.

“If we continue to follow medical guidelines, we can justify what we’re doing and advocate for our patients, she said.”

Pushing boundaries

Hackensack University Medical Center is also making substantial investments in prostate cancer detection and treatment — and measuring the payoff in both financial returns and patient outcomes. Dr. Nitin Yerram, co-director of urologic oncology at HUMC’s John Theurer Cancer Center, outlined four key areas where the hospital is pushing boundaries.

Gone are the days of an elevated PSA test leading automatically to a “blind” biopsy, where a tissue sample is taken from an area that the doctor cannot directly see. At HUMC, patients with elevated PSA levels first receive a high-resolution MRI of the prostate. That image is overlaid onto a real-time ultrasound during biopsy – a technique known as MRI fusion biopsy – allowing physicians to target suspicious lesions with far greater precision. “This has been proven to increase detection and accuracy of significant prostate cancer,” Yerram said.

For patients who meet certain medical criteria, HUMC offers high intensity focused ultrasound (HIFU), a 90-minute outpatient procedure that destroys cancerous cells without removing the prostate. “Our hospital was the first in New Jersey to offer the technology and remains one of only two or three facilities in the state providing it,” Yerram noted.

HUMC is also one of just two sites nationally offering the PRELUDE clinical trial, which administers the drug Pluvicto before surgery to reduce cancer recurrence in newly diagnosed patients.

And to enhance surgical precision, the hospital operates as many as 12 robotic systems, including three da Vinci platforms: the XI robot uses four to five small incisions for laparoscopic surgery, while the newer DV5 incorporates integrated AI and advanced performance metrics. The crown jewel, however, is the SP – or single-port – robot, which performs surgery through a lone two-centimeter incision. Hackensack claims to be the highest-volume single-port urological surgery center in the world, with close to 3,000 cases performed.

High price tags

These advances don’t come cheap, though. “Each robotic system runs between $2 million and $3 million, while a HIFU machine costs approximately $1 million,” said Yerram.

Philanthropy plays a crucial role in sustaining these investments, particularly for a nonprofit hospital system. Yet the hospital measures return on investment beyond dollars: mortality rates for robotic prostatectomy are well below 1%, as are blood transfusion and 30-day readmission rates. “We measure our return on investment not only financially, but also based on our outcomes,” Yerram said.

These and other breakthroughs are impressive. But behind every technological or medical advance is a patient – often a husband, father, or brother – facing one of the most frightening diagnoses in medicine. New Jersey’s hospitals are betting that investing in the best available prostate cancer tools and talent is the surest path to giving those patients more time, better quality of life, and in many cases, a cure. As expert physicians suggest, the math works when patients do well. Clinical excellence and fiscal sustainability are not competing goals — they are, ultimately, one and the same.

New approaches

Elsewhere at Atlantic Health, Dr. James Cassuto – a diagnostic and nuclear radiologist with who serves as associate system medical director of nuclear medicine for Atlantic Medical Group and section chief at Atlantic Health Overlook Medical Center – is focused on radioligand therapy (RLT), an intravenous radiation treatment that is reshaping how physicians approach advanced prostate cancer.

Unlike conventional radiation, which precisely aims therapy from outside the body to target local disease or specific areas of concern, radioligand therapy works by attaching a radioactive molecule to a substance that cancer cells naturally absorb. Once injected, the molecule circulates through the bloodstream, seeks out cancer cells, and delivers a concentrated radiation dose to many sites of disease at the same time — while largely sparing surrounding healthy tissue.

What makes the approach especially powerful is that certain agents can also be imaged, allowing physicians to see exactly where the therapy travels before and after treatment. Cassuto can calculate radiation doses delivered to tumors, monitor patient response in real time, and adjust treatment schedules accordingly.

“We’ve had patients with such a good upfront response that we delayed their next dose by a couple of months,” he said. Conversely, when imaging shows a patient isn’t responding, physicians can pivot quickly rather than continuing a treatment unlikely to succeed.

AI support

Cassuto frames radioligand therapy within the broader promise of precision medicine — tailoring treatment not just to a diagnosis, but to the specific biology of each patient’s cancer. That means combining imaging data, genetic markers, tumor pathology, and treatment history to determine the right therapy at the right time.

Artificial intelligence supports that process. Cassuto currently uses AI to model how radiation distributes after a radioligand is administered and expects machine learning to play a growing role in building predictive models that guide treatment decisions across the full course of cancer care.

The therapy is often effective, but it does carry significant costs. Individual doses of radioligand agents – including primary prostate cancer treatments – run roughly $40,000 to $50,000 per dose, with patients potentially receiving multiple doses over time.

That said, administrative overhead for delivering the therapy is relatively low. Each infusion takes approximately 1 minute. Essential post-treatment imaging and dosimetry calculations generate additional billable services that help offset acquisition costs. And pharmaceutical companies in the space have been supportive of patients who cannot afford treatment, Cassuto noted, helping institutions at minimum break even on challenging cases.