Clinical Centers of Excellence - Prostate Cancer: Cleveland Clinic

April 1, 2009

Cleveland Clinic has a history of pioneering innovation and leading-edge research in urology. Prostate cancer is no exception.

In the 1920s, William Lower, MD, the Clinic's first urologist and one of its four founders, was among the first surgeons to perform a suprapubic prostatectomy. In 2008, Jihad Kaouk, MD, performed the world's first robotic single-port prostatectomy.

"Our philosophy for prostate cancer is that there isn't one single best treatment," said Eric Klein, MD, chairman of the Glickman Urological & Kidney Institute at Cleveland Clinic. "We offer all available therapies: open surgery, laparoscopic surgery, robotic surgery, brachytherapy, and cryotherapy. And we have one of the world's largest comparative databases of cure rates for all of those treatments since 1987."

"That allows us to reassure the vast, vast, vast majority who are cured by surgery that they are cured. They don't need to worry about it, and they don't need additional treatment," Dr. Klein explained. "And it allows us to identify the relatively small number of patients who-even though they had surgery-had microscopic metastatic disease outside the prostate, and give them additional treatment. It's one of the best tools that's ever been developed."

Dr. Stephenson and Cleveland Clinic re-searcher Michael Kattan, PhD, are now at work mapping out a similar nomogram to help predict prostate brachytherapy outcomes.

Although that nomogram also will look at data from other institutions, the Clinic boasts one of the largest brachytherapy programs in the country. Since the treatment became routine in 1996, Cleveland Clinic urologists have used brachytherapy to treat more than 2,000 men.

Richard Nord, MD, a partner in Advanced Urology, Inc., with offices in the Youngstown, OH, area, diagnoses and treats men with prostate cancer. His group of four urologists offers patients almost all of the same treatments available at a larger medical center. Still, he often sends patients to Cleveland Clinic.

"We actively encourage it because with a cancer like prostate cancer, there's certainly different ways to approach it," Dr. Nord said. "Many, many times, particularly in early prostate cancer-which we see so much more nowadays-there are different approaches in managing it, different options for the patient. And, as part of their due diligence, many patients wish to go to a tertiary center like Cleveland Clinic."

Another type of patient Dr. Nord sends to Cleveland Clinic is the younger man with high-risk prostate cancer who might need a multimodal treatment approach.

"Those patients really should be enrolled in a clinical study, if they're willing to, and that's something we have the ability to offer them through the Clinic that's not going to be ongoing on a local basis," Dr. Nord explained.

In addition to comprehensive treatment protocols, Cleveland Clinic is involved in cutting-edge research and drug trials for the treatment of prostate cancer. It receives more than $9 million annually in funding from the National Institutes of Health alone.

In tracking down the cause of prostate cancer, Dr. Klein and researcher Robert Silverman, PhD, of the Clinic's Lerner Research Institute, have identified the xenotropic murine leukemia-related virus (XMRV), a gamma retrovirus that can be found in the prostate gland. Since 2006, Clinic researchers have been studying whether prostate cancer might be caused by the virus.