CCE Prostate Cancer: Johns Hopkins

Johns

Hopkins University
Baltimore

, Maryland

In laboratories and surgical suites, urologists at Johns Hopkins University are breaking new ground in prostate cancer research as well as setting improved quality standards in patient care.

Through innovative clinical trials, aggressive research programs, and a focus on solid prevention methods, Johns Hopkins is pushing prostate cancer medicine to a higher level.

Alan Partin, MD, PhD, urologist-in-chief and chairman of the Brady Urological Institute, says the department is positioned at the forefront of prostate cancer medicine because of its research.

“We prefer the word discovery,” he says.

Discoveries are being sought in advanced segments of prostate cancer research, including biomarker research, expectant management (the close monitoring of prostate cancer instead of immediate treatment), a pilot program of temperature-enhanced metastatic therapy (TEMT), robotics, immunology, and genetics.

A recognized researcher, Partin is perhaps most known for his role in the development of the Partin tables in the 1990s. The tables were constructed to use prostate-specific antigen test results to predict the probability that prostate cancer had spread to the lymph nodes, seminal vesicles, or remained localized.

PSA tests are now recommended to screen for prostate cancer; however, the test is not as precise as researchers and physicians would like. Researchers at Johns Hopkins are moving rapidly to validate a test for early prostate cancer antigen-2 (EPCA-2), a more specific biomarker for the disease.

In freezers on the Johns Hopkins’ campus in Baltimore are about 18,000 samples from men with all stages of prostate cancer – neatly categorized, bar-coded, and computerized, with demographic information, including family history, and readily available to investigators throughout the world. Partin says the samples are valuable in many areas of research, including the development of the EPCA-2 biomarker test, which some researchers predict will eventually replace the PSA test as a cancer screening tool.

According to Robert Getzenberg, PhD, professor of urology and director of research at the Brady Urological Institute, the development of the test for EPCA-2 would be a major breakthrough because it would allow doctors to see not only whether prostate cancer is present, but also to determine whether a particular case is aggressive enough to warrant treatment.

Whether to treat is another question that Brady researchers are exploring. Citing his department’s work in expectant management, Partin says that many cases can be managed without surgery or radiation therapy.

It’s Johns Hopkins’ overall excellence in surgical care that impresses Robert Pickens, MD, a Princeton, New Jersey, urologist.

Pickens says he has referred numerous patients to Johns Hopkins over the last 36 years. Those referrals were based partially on Johns Hopkins’ reputation, but mostly on the quality of available care there.

“The patients that have gone there have come back quite pleased,” he says.

Johns Hopkins’ urologic and surgical programs have garnered world-wide attention in part because of Patrick Walsh, MD, the University Distinguished Service Professor of Urology at Johns Hopkins Medical Institutions who took the helm of the Brady Urological Institute in 1974. He helped reshape radical prostatectomy, which was first performed at Johns Hopkins in 1904, by surgeon Hugh Hampton Young, MD. Walsh is a pioneer in the development of the anatomic approach to radical prostatectomy, which incorporates nerve-sparing techniques.

Surgeons at Johns Hopkins perform about 1,200 radical prostatectomies annually. Of those, about 25 percent were done robotically. The fellowship program in urologic oncology at Johns Hopkins provides comprehensive multidisciplinary training in all aspects of urologic cancer surgery, including open, laparoscopic, and robotic-assisted techniques. Another program that is gaining considerable attention from the oncology community is Brady’s TEMT program.

Conceptually, TEMT was inspired by Tour de France champion Lance Armstrong and his successful battle over advanced testicular cancer, according to Partin. Researchers hypothesized that Armstrong’s clinical victory was linked to heat.

“The testes do hang outside the body and they are somewhat colder tissue. When these cancer cells (were warmed), they were more sensitive to the chemotherapy and that’s why they die,” Partin says.

The idea was that you can take these prostate cancer cells and heat them up through some external method, and then treat them with a form of radiation and have a better chance for a cure, Partin says.

The program’s goal, Partin says, is to figure out the best way to use heat selectively-aiming at the cancer cells only, but leaving adjacent healthy tissue unscathed. One way to do this may involve nanoparticles, which are attracted to specific proteins on cancer cells.

“It will be a new therapy for prostate cancer if it works,” Partin says. “It’s probably the hottest thing we’re doing here.”

TEMT was funded with a $3 million grant from food retailer Safeway Inc. The Prostate Cancer Foundation developed the collaborative research partnership and provided a matching $3 million grant for the special program. The TEMT program brings together an interdisciplinary team of investigators from Johns Hopkins, which serves as the project coordinator, Massachusetts Institute of Technology, the University of Michigan Cancer Center, and University of British Columbia.

In other efforts, immunology researchers at Johns Hopkins are studying the relationship between regulatory T cells and prostate cancer.

Partin says that Johns Hopkins, for more than 100 years, has taken a leadership role in advances in prostate cancer medicine. He predicts Johns Hopkins will be closely linked with success when a cure for prostate cancer is found.

“The ice is thin with prostate cancer and it’s going to break, and I think it’s going to break at Johns Hopkins,” Partin says. “That’s what makes us go.”