Refining prostate cancer diagnosis
Prostate cancer is the second-leading cause of cancer death in American men, but many prostate cancers grow so slowly they never become a health problem. So for urologists, the diagnosis often poses a dilemma: Which patients need aggressive therapy and which are better served by active surveillance to avoid unwanted side effects of treatment?
“The problem with the PSA test is that it’s often falsely positive in men who do not have cancer and leads to the discovery of nonaggressive cancer more often than aggressive cancer,” says Barnes-Jewish Hospital surgeon Gerald Andriole Jr., MD, the Robert K. Royce Distinguished Professor of Urologic Surgery and chief of the Division of Urology.
Andriole says better markers are needed to distinguish between nonaggressive cancer, which can be treated with a watch-and-see approach, and aggressive cancer that requires immediate treatment. He and colleagues are collaborating with Traxxson, a developer of molecular tests based in St. Louis’ biomedical corridor, to generate a 12-marker panel to diagnose aggressive prostate cancer. So far, using a few hundred serum samples from a Washington University biorepository, they have established a computer algorithm that can detect prostate cancer and distinguish markers that indicate more aggressive vs. low-risk cancer.
“Now that we’ve developed the training algorithm, we will perform a validation study with blinded samples of another couple hundred patients from Washington University and Johns Hopkins University and see how well the algorithm performs,” says Andriole.
Their work — applying basic knowledge of the disease’s mechanisms to develop a new diagnostic method and then performing early proof-of-concept testing — falls in the T1 stage of translational research.
Washington University has consistently been at the epicenter in prostate cancer screening translational research: The first systematic evaluation of the PSA test was conducted by Washington University urologists, and Andriole is chairman of the prostate committee of the NCI’s Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Trial. The study of approximately 80,000 men delineated the limitations of PSA screening for men in their 50s and 60s.
Clinic addresses congenital abnormalities
Urologists Steven Brandes, MD, and Gino Vricella, MD, have opened a multidisciplinary clinic to treat adults with congenital abnormalities of the bladder, kidney and penis.
Conditions treated include urinary complications of spina bifida; congenital defects such as exstrophy, in which the bladder is outside the body; and posterior urethral valves, in which flaps of tissue grow in the urethra and can cause kidney damage. Physicians will address a variety of issues, including those related to sexual function, fertility, pregnancy, incontinence, urinary tract infections and other problems that affect quality of life. Patients with non-urinary problems will be seen by orthopedic surgeons, neurosurgeons, colorectal surgeons and other specialists.
“There are only a handful of multidisciplinary programs like this in the entire country to address transition urology,” says Brandes. “This is a unique program for a very underserved community.”
Highlights
- Washington University urologists and researcher Samuel Achilefu, PhD, are developing a new application for goggles that help surgeons distinguish between cancer cells and healthy cells during surgery. Cancer cells — labeled with a tumor-seeking contrast agent — glow blue when viewed through the goggles. Washington University researchers already have shown the goggles, which Achilefu adapted from military night-vision glasses, to be useful in open surgical procedures. They are now developing an optical system for laparoscopic partial kidney removal and transurethral removal of bladder tumors.
- Robert Figenshau, MD, and Sam Bhayani, MD, co-authored a study reporting that a test measuring the presence of proteins in the urine was more than 95 percent accurate in identifying early-stage kidney cancers. Researchers Evan Kharasch, MD, PhD, and Jeremiah Morrissey, PhD, led the study.
- Erica Traxel, MD, was named program director of the Urology Residency Program. Traxel is a pediatric urologist who completed her urology residency at Washington University and a pediatric urology fellowship at Cincinnati Children’s Hospital.
- The division expanded its outreach in the community by offering services at Christian Hospital in north St. Louis County, Cox Health in Springfield, Missouri, and the Children’s Speciality Care Center in West St. Louis County.