Optimizing Care for Every Patient With Genitourinary Cancer

Masked doctor and patient

Based on clinical expertise and patient volume, the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) is one of the top programs in the country for the treatment of genitourinary cancers. The integrated center draws on the expertise of a multidisciplinary team of specialists to provide exceptional patient care.

“The GU program at DF/BWCC is a national leader in clinical trials and patient care,” said Adam Stuart Kibel, MD, chief of urology. “Our multidisciplinary team is focused on innovation to improve care and quality of life for all of our patients.”

This year, DF/BWCC placed sixth nationally, and first in New England, for cancer care in U.S. News & World Report‘s Best Hospitals rankings.

Subspecialized Expertise

Each week, the Lank Center for Genitourinary Oncology at DF/BWCC hosts about 70 new patient consults in medical oncology, urology and radiation oncology, according to clinical director Bradley McGregor, MD. He added that over 20 medical oncologists, seven urologists and seven radiation oncologists see patients in the clinic for genitourinary cancers only.

“With so many physicians, you really get an opportunity to specialize. Within GU, a lot of us have a specific niche we know very well,” Dr. McGregor said. “Drs. Toni Choueiri and Steven Chang are world experts in kidney cancer. Drs. Mary-Ellen Taplin, Christopher Sweeney, Anthony D’Amico, Paul Nguyen, Adam Kibel and Quoc-Dien Trinh are world experts in prostate cancer, as are Drs. Guru Sonpavde, Mark Preston, Matthew Mossanen and Kent Mouw in bladder cancer.”

Medical Oncology Cases at DF/BWCC

Cancer FY18 FY19 Total
Kidney 1,803 2,219 4,022
Bladder 1,633 1,771 3,404
Prostate 8,471 9,765 18,236

Dr. McGregor noted that the expertise, volume and collaborative environment enable DF/BWCC to offer patients access to the latest medical therapies through clinical trials. One example is the NeoVax trial, which is investigating a personalized vaccine for patients with kidney cancer and being run exclusively at DF/BWCC. Another is the phase 3 Proteus trial, which is looking at using hormone therapy with surgery in patients with prostate cancer and is based on Dr. Taplin’s phase 2 trials.

“Trials like these are establishing new standards of care, not just building on standards of care,” Dr. McGregor said.

Equipped to Treat Difficult Cases

The DF/BWCC team includes 40 radiation oncologists, seven of whom focus solely on genitourinary cancers. Among the clinicians are Anthony Victor D’Amico, MD, PhD, genitourinary radiation oncology chief, and Paul L. Nguyen, MD, Genitourinary Disease Center leader for radiation oncology. They are ranked respectively as the #1 and #2 radiation oncology experts in prostate cancer in the United States by Expertscape.

As with medical oncology, the large team in radiation oncology allows for a high degree of specialization. Dr. Nguyen said that one radiation oncologist focuses exclusively on bladder preservation therapies, for instance. The group also includes a rapidly growing practice that specializes in oligometastatic bone disease, bone recurrences that are a major issue with prostate cancer.

Another growing practice, Dr. Nguyen said, specializes in renal cell carcinomas. “We were the first in New England to have an MRI linear accelerator, which allows us to treat renal cell carcinomas as well as really difficult cases of lymph node recurrences — even in patients who received prior radiation,” he explained. “That really gets at our being able to treat unique cases that many other centers cannot.”

Dr. Nguyen added that another important technology available at DF/BWCC is an MRI simulator, which enables exceptionally precise planning for all new patients with prostate cancer. “We are one of the few, if not the only, radiation oncology group in New England with this device,” he said.

Expertise in Complex Surgical Procedures

DF/BWCC performs thousands of urologic surgeries a year. Steven Lee Chang, MD, MS, section chief of urologic oncology, said that upon joining the Brigham’s Division of Urology a decade ago, he was one of only three surgeons specializing in urological oncology. The group is now recruiting its eighth such surgeon, and he anticipates further growth in the coming years.

According to Dr. Chang, DF/BWCC has one of the busiest robotic urologic surgery programs in New England. The robotic approach, he noted, “allows us to achieve the goals of caring for both simple and advanced disease with as little trauma as possible to patients. And because we’re a high-volume center, we are more capable of managing more complex procedures.”

Urologic Oncology Surgeries at DF/BWCC

Procedure FY18 FY19 Total
Cystectomy 136 110 246
Prostatectomy 573 597 1,170
Nephrectomy 226 231 457

Dr. Chang also cited DF/BWCC’s high-volume expertise in:

  • Retroperitoneal lymph node dissections for testicular cancer
  • Complex kidney cancer surgeries, some of which involve stopping the heart with cardiopulmonary bypass to remove tumors that extend through blood vessels into the heart
  • Open, complex and minimally invasive bladder surgery, including the less common neobladder or continent catheterizable stoma, to create avenues for urine to exit the body

In the area of prostate surgery, meanwhile, Dr. Chang and his colleagues are skilled in minimally invasive robotic surgery for salvage procedures.

Dr. Chang said that with cancers of the urinary system, patients benefit from being able to tailor their care by selecting the optimal treatment among multiple options and, particularly for more advanced disease, to receive surgery in concert with systemic therapy and radiation therapy to achieve the best outcome.

“Having the opportunity to collaborate with colleagues at the Brigham and Dana-Farber who are at the top of their game on an international level gives us the best chance to match patients with the best care — surgical or nonsurgical — they can possibly have,” Dr. Chang concluded.