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INTERVIEW…
With Dr. Peter T. Scardino
Chief of the Urology Service and head of its
Prostate Cancer Program
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Memorial Sloan-Kettering has a highly talented pool of specialists who
are developing better ways to understand, diagnose, and treat genitourinary
cancers – such as prostate, testicular, bladder, and kidney cancers – which
account for more than 15 percent of the cancers we see here. This
institution has made a major commitment to expanding our facilities and
resources to meet the needs of these patients.
We have an extraordinary research program in this area, including the
investigation of biochemical markers that predict which treatments might
best benefit a patient, and the exploration of gene therapy and cancer
vaccines.
Prostate cancer has been considered a disease that men die “with” not
“of.” In fact, there is a 42 percent chance that a man will develop
cancer cells in his prostate during his lifetime, but only a 10 percent
chance that he will actually be diagnosed with prostate cancer, and only
a 3 percent chance that he will die of the disease. For years, that
fooled people into thinking that prostate cancer was essentially a toothless
lion, a harmless disease. But we’ve learned that while there are
forms that behave that way, many types of prostate cancer are potentially
lethal.
Characterizing the exact nature of those cancers is a very important
part of our task. When I came here from Baylor College of Medicine,
my colleague Dr Michael Kattan joined me. His background is in medical
informatics – the use of artificial-intelligence techniques to predict
what will happen in complex systems. Using data from the patients
I’ve treated, Dr. Kattan developed a “nomogram” – a mathematical formula
that predicts tumor behavior based on several clinical features. We enter
the stage and grade of the patient’s cancer into the formula, as well as
the level of prostate-specific antigen, or PSA, in his blood. The
nomogram then calculates the probability that the cancer will be cured
– that is, if the patient will be free of cancer five years after treatment.
This information helps us decide whether we need to treat a patient
or just monitor him, and—if treatment is necessary – how aggressive it
needs to be. For example, will the patient do well with surgery or
radiation therapy alone, or should chemotherapy and/or hormone therapy
e added? The nomogram also helps us enroll patients in clinical trials
that are most likely to help them and it enables us to match patients in
different treatment groups by identifying each person’s cancer as high-risk
or low-risk.
We’d also like to include in the nomogram data about what’s important
for the patient. One patient may say, “If I have to live with a cancer,
I just can’t sleep at night,” while another patient might say, “I don’t
mind living with a cancer, but I don’t like that I might not be able to
control my bladder or have sex.” We’re developing ways to measure
such personal values so we can enter them into the formula, helping patients
make wise decisions that maintain their optimal quality of life.
We’re using this nomogram now as part of our everyday proactive for
prostate-cancer patients. We also think nomograms can be developed
for other cancers, such as bladder, testicular, and breast cancers – basically
any cancer where there are multiple treatment options.
On other fronts, we plan to expand our screening and early detection
of prostate cancer. We’re recruiting experts in prostate biopsy and
ultrasound. In addition, we want to bring in specialists in urinary
reconstruction. We’re also very concerned about how treatment for
genitourinary cancers can alter urinary function as well as sexual function,
so we’re recruiting experts I these areas, too.
While we continue to improve the diagnosis and treatment of genitourinary
cancers, we want to pay full attention to each patient’s quality of life,
using the most modern techniques available to accomplish this.
Reprinted with permission: From Center News, published
by Memorial Sloan-Kettering Cancer Center:
Copyright 1999
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