The Holden Comprehensive Cancer Center located in University of Iowa Hospitals and Clinics has been named by Urology Times as one of 15 Clinical Centers of Excellence for prostate cancer. Magazine editors say The Holden Comprehensive Cancer Center “rises above the pack” bringing something extra to the specialty through research, patient care, and community outreach.
Richard Williams, MD, professor and head of the UI Department of Urology and this year's recipient of the Hugh Hampton Young Award from the American Urological Association, talks about treatment for prostate cancer:
How common is prostate cancer?
Quite common; it’s the most common cancer, that is not skin cancer, in American men—and this is men over the age of 50. We start looking at the age of 40 so we don’t miss it. It depends on the history (background) of the patient. But it is the most common cancer in this age group.
Are some men at more risk than others to get prostate cancer and are you able to determine why?
African-Americans are the highest risk in the world for prostate cancer. Recently, we learned Hispanics and Latinos in America are at higher risk and their risk is growing rapidly.
We're aware family history makes a difference—primary relatives in particular (a father or a brother). There are definitely reasons we should look at selected groups of patients. The reason they have prostate cancer at a higher rate is not entirely known. A guess is that it relates to genetics in some way, particularly in patients who are African-American versus Caucasians. They both have high incidence, but you'd predict there's something in their genes that might make it higher in the African-American.
There's also relationship to diet. High fat diets—particularly countries that have high fat diets have higher risks of prostate cancer. And the opposite—Asian countries, as an example, have a lower rate of prostate cancer in the past.
Are all prostate cancers alike—with one method of treatment?
They are quite different from the standpoint some are more aggressive than others. It depends on the grade. A pathologist looks at the tumor and says it is high grade or low grade. The low grade ones are not as aggressive.
It also depends on how advanced it is at the time that we diagnose it. Is it already out of the prostate? Is it into lymph nodes nearby? All of these things change what kind of treatment the man might get.
I'm also going to talk about age. Older men tend to have a higher incidence of prostate cancer. If we took a group of men that are over 70, almost 70 percent of them will have prostate cancer. They tend to have low grade, low volume, less aggressive cancer. I said tend to—not all of them have that. Some of them have higher grade and higher aggressive tumors, but we have to figure that out.
Once we determine what the stage and grade is, then we can determine what the best treatment will be for that individual. It could be a variety of things including removal of the prostate, radiation therapy to the prostate, all manner of different things, hormone therapy, etc., etc.
Does the age of the man when he develops prostate cancer help determine his treatment plan?
It's usually the other way around. The older fellows have the weaker immune system, just naturally. But this particular tumor and immune system doesn't appear to be quite the big risk, so it really doesn't relate so much to the immune system, although we have ways to enhance the immune system that can treat the tumor that we're studying in our own institution.
The Holden Comprehensive Cancer Center is also recognized by the National Cancer Institute as an NCI-designated cancer center. Does that designation also help bring prostate cancer studies to UI Hospitals and Clinics that are not available at other medical centers?
Absolutely! Part of the recognition comes with some money, as well, so some of the money that comes from the NCI and also the American Cancer Society and others are used for;
- New studies
- Enhancing the ability for young investigators to try something new
- Learning something new
National trials or national groups look at us as a good area to bring their protocols to because we have this designation.
In your opinion, how is prostate cancer treated at UI Hospitals and Clinics that makes it “rise above the pack” in reference to patient care?
We were most fortunate and really were pleased to get this designation from the Urology Times. It means they've looked at us from the standpoint of how we treat patients.
We have medical oncologists, radiation therapists, and urologic oncologists, meaning surgeons, who work together for the best treatment of the patient.
It doesn't mean when you see a surgeon that the only thing that is going to happen is surgery. Depending on your stage and grade of tumor, you may be a better candidate for radiation. The radiation here is image-guided, which means they can look with a CT and tell where the prostate is specifically and aim directly at the prostate. The surgery we have—we have a robot—and many of our urologic oncologists use the robot to remove the prostate. It works really, really well.
Medical oncology—we have the ability to give the most recent approaches to treatment of cancers that are beyond just removal directly or radiating just the area of the prostate. All of those things work together and the doctors in different disciplines work together for the betterment of the patient.
How does a ranking in a publication like Urology Times reflect on the prostate cancer program at UI Hospitals and Clinics?
Well, as I've already said, it makes us very proud. But I think it also makes us want to be even better. It makes us want to be sure we are providing the most up-to-date, best therapy we can. We already have some of our own therapies, like a vaccine trial that we're doing at the moment for prostate cancer patients that have disease that has recurred after initial treatment. It gives us impetus to do even more—try to bring from the laboratory directly to the patient some new kinds of treatment.
If an individual needs your services, is a referral necessary? What advice would you give men to use your services?
They have multiple ways they can see us. As an example, if they don't have a diagnosis but they want to be sure they don't or do have prostate cancer, they could make an appointment directly with our urology clinic.
If they already know they have cancer, then they can make an appointment with the Holden Cancer Center for urology as the first step and the urologist will help decide whether they need to radiation or they need to see the medical oncologist.
If they are already being treated, they could see the medical oncologist or the radiation therapist first, it depends on what their needs and wants are. |
