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 make the Mayo Clinic's department of urology a Clinical Center of Excellence for the treatment of prostate cancer.
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," said Michael Blute, MD, chair emeritus of the department of urology and executive board member of Mayo Clinic, Rochester, MN. "Our surgeons have extensive experience performing radical prostatectomies using either open surgical or robot-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."
Along with surgery, Mayo offers prostate cancer patients external beam radiation therapy, brachytherapy, hormone therapy, and cryotherapy. Mayo surgeons have also developed an extensive practice in treating BPH, says Dr. Blute. That is due in part to the groundbreaking work of Reza Malek, MD, in the development of the potassium titanyl phosphate laser for photoselective vaporization of the prostate, a far less invasive treatment method than transurethral resection.
Underlying much of Mayo's approach to prostate cancer treatment and research is information gleaned from its extensive patient registry.
Begun in 1966, the registry includes detailed histories and outcomes as well as follow-up information on more than 20,000 prostatectomy patients. Among its other uses, Dr. Blute explains, the registry is a practical 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 has 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 the 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 that it was not potentially curative. However, our reporting on that cohort has shown that radical prostatectomies can play a role in management of their cancers," Dr. Karnes explained.
Research on the causes ofprostate cancer 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 through grants to individual researchers, a Specialized Program of Research Excellence (SPORE) grant from the National Institutes of Health, and a grant from the U.S. Department of Defense 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," said Donald Tindall, PhD, professor of biochemistry/molecular biology and professor of urology at the Mayo Clinic.
Dr. Tindall cites as an example of this collaborative effort 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 I clinical trial investigating the effectiveness of sodium iodide symporter gene therapy in combination with radioiodine to treat locally recurrent prostate cancer.