CCE Prostate Cancer: Mayo Clinic

Mayo Clinic
Rochester

, Minnesota

Experienced clinicians, a broad range of treatment options, extensive and well-funded research, a large and comprehensive patient database, and a strong emphasis on collaboration combine to make the Mayo Clinic Department of Urology a Clinical Center of Excellence for the treatment of prostate cancer.

Treatment Tailored to Individuals

Mayo’s reputation in the field begins with its approach to surgery. “We have a full-spectrum practice in terms of all the available options for men with prostate cancer,” says Michael Blute, MD, emeritus chair of the urology department and executive board member of Mayo Clinic Rochester. “Our surgeons have extensive experience performing radical prostatectomies using either open surgical or robotic-assisted laparoscopic techniques. That allows us to tailor each patient’s treatment to his individual needs, and utilize the procedure best suited to achieving cancer control and preserving the patient’s quality of life.” In 2008 Mayo surgeons performed 700 open radical prostatectomies and 500 using robotic-assisted laparoscopic techniques.

Along with surgery, Mayo offers prostate cancer patients external radiation therapy, brachytherapy, hormone therapy, and cyrotherapy. Mayo surgeons have also developed an extensive practice in treating benign prostatic hyperplasia, Blute says. That is partially because of the groundbreaking work of Reza Malek, MD, in development of the potassium titanyl phosphate (KTP) laser for photoselective vaporization of the prostate, a far less invasive method than transurethral resection.

Registry a Key Research Tool

Underlying much of Mayo’s approach to prostate cancer treatment and research is information gleaned from its patient registry. Begun in 1966, the registry includes detailed histories and outcome and follow-up information on more than 20,000 prostatectomy patients.

Among its other uses, Blute explains, the registry is a tool for quality improvement. “The information we get has enabled us to standardize many of our procedures, eliminate waste, shorten lengths of hospital stay and decrease transfusion rates. It’s been a way to improve the quality of our practice clinically, in addition to the basic and translational research aspects of it.”

According to Mayo data, the percentage of prostate cancer patients requiring transfusions declined from 78.7 in the years 1966–86 to 17.1 in the years 1997–2004. The percentage requiring hospital stays of 14 days or longer dropped from 28.1 to 0.3.

R.J. Karnes, MD, a surgeon in the urology department, says that as a result of studying follow-up patient data, Mayo surgeons have changed thinking among urologists about management of patients with high-risk prostate cancer. “Previously a lot of men with high Gleason scores and high-grade tumors were denied surgery because the thinking was it was not potentially curative. Our reporting on that cohort has shown that radical prostatectomies can play a role in management of their cancers,” he says.

Collaborative research approach

Research on prostate cancer causes and takes place under the auspices of the Prostate Cancer Program, part of the Mayo Clinic Cancer Center, a National Cancer Institute-recognized comprehensive program. Started in 1989, the program brings together 50 researchers and experts from 15 departments ranging from pathology to radiation oncology to pharmacology.

Its $4.3 million budget is funded primarily with grants to individual researchers and a Specialized Program of Research Excellence (SPORE) grant from the National Institutes of Health, and a grant from the U.S. Department of Defense’s Prostate Cancer Research Program.

“We place a lot of emphasis on collaboration between our clinicians and basic scientists, which enables us to more easily move things from a research lab into the clinic,” says Donald Tindall, PhD, professor of biochemistry/molecular biology, and professor of urology.

As an example, he cites the noted Mayo endocrinologist John Morris, MD, who suggested that his research in the use of radioactive iodine to detect and kill thyroid cancer cells might apply to prostate cancer as well. The seeds planted by that conversation have since blossomed into a phase 1 clinical trial investigating the effectiveness of sodium iodide symporter gene therapy in combination with radioiodine to treat locally recurrent prostate cancer.

Eugene Kwon, MD, the center’s co-director of cancer immunology and immunotherapy, participated in preclinical research testing whether combining immunotherapy with ipilimumab, an investigational human monoclonal antibody, and standard hormone treatment for advanced prostate cancer can improve patient outcomes. A phase 2 clinical trial is under way at Mayo.

“We are very excited about this study, as are many people out in the field,” says Kwon, the study’s principal investigator. “It’s a very interesting question as to whether hormone therapy can be used to start a response that can then be ramped up through the use of immunotherapy.”

Kwon says Mayo research scientists find the patient registry an invaluable tool in their work. “The registry allows us to get accurate, validated data that can be tied to outcomes, without selection bias,” he explains. Information pulled from the registry helped Mayo researchers quickly demonstrate links between B7-H3 ligand expression by prostate cancer cells and the likelihood of cancer recurring in patients following surgery.

Inter-campus video conferencing

Highly integrated communications and videoconferencing systems enable researchers and physicians at Mayo campuses in Minnesota, Florida, and Arizona to communicate with each other. “I can sit at my computer and share a CT scan in real time with my colleague in Arizona,” Blute says. “Our pathologists can transmit images by satellite to any of our sites and discuss what they see with colleagues there. It’s almost as though we’re all in the same place.”

Physicians who refer patients to the Mayo Clinic for prostate cancer treatment praise its doctors for their helpfulness. “They’ve always been great,” says Chris Adducci, MD, a urologist in Bismarck, North Dakota. “They are an outstanding institution and do high-quality work. If I need to talk to any of their doctors they are always open and responsive.”

Karnes, who completed his residency at Mayo before practicing for three years at another academic center, says he jumped at the opportunity to return. “Patients are cared for here in a very efficient manner,” he says. “We see a patient and operate on him the next day so as to minimize stays. It’s also very easy for us to call on colleagues in other disciplines for advice. That easy exchange of knowledge helps afford us the ability to provide the highest level of care for our patients and ensure the best outcomes.”