The Future Of Urologic Oncology: Peril And Promise

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 30 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Paul Lange presented the Ramon Guiteras lecture.

Surgeon-scientists have made great contributions to medicine. However, we might be one generation from ignorance and two from obsolescence, he said. Dr. Linehan has been a great example of the surgeon-scientist, as he identified mechanisms that have advanced the treatment of kidney cancer.

He cited biochemical recurrence after surgery as reflecting recurrent or persistent disease. Dr. Studor's work now shows that we must remove the internal iliac lymph nodes to remove more disease. Intracrine androgens and circulating CaP cells in the bone marrow reflect new understanding on dissemination of CaP. These are examples of biological and physiological processes before our eyes that could have been discovered earlier. But surgical demands are high, and patients seek those with high-volume series. Surgery is more fun than grant writing, he pointed out. But the surgical titans in cardiac surgery are now dancing bears to the cardiologists who have advanced the field. The cognitive arts remain central to our future. There are still unprecedented opportunities for young urologists.

Despite more funding, we need more, he said. The Society of Urologic Oncology has met to address these challenges. We are behind in clinical trials and are now facing the emergence of the new field of interventional oncology. The training of medical oncologists is more conducive to research training. Also, many medical oncologists feel that they should be the primary doctor for prostate cancer patients. The classic principles of physician management mean that those who understand and diagnose the disease and implement primary treatment are best suited to treat the patient. The fact that cardiologists not interventional radiologists perform minimally invasive cardiac procedures is testimony to the classic principle of physician management. Gynecologic oncologists have retained their central role in patient management, while surgeons have let medical oncologists take over the care of breast cancer patients. Cancer care is optimally multi-disciplinary, but the urologist should be at the center of treatment.

The SUO has taken several initiatives to foster the urologists' role in cancer care and he reviewed these to include enhanced fellowship training, support for surgeon-scientists, and conducting clinical trials.

Presented by Paul H. Lange, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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