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outcomes. Prostate cancer specialists treat each patient based on their needs, creating specialized plans for each individualized patient. Specialists work with various disciplines, including medical oncology, radiation oncology, pathology, radiology and other surgical specialties, to provide the highest level of care. Within the department the program also has a Urinary Tract and Pelvic Reconstruction Program to manage pelvic conditions that affect genitourinary function, as a result of cancer treatment or non-urologic cancer therapies. The prostate cancer program provides services to evaluate, diagnose and monitor patients at risk for cancer. Its diagnostic services use innovative imaging techniques such as transrectal ultrasound-guided prostate biopsy, Artemis (Eigen) MRI-Fusion biopsy, UroNav TRUS guided fusion biopsy, and transperineal stereotactic ultrasound to find cancer in its earliest stages. When prostate cancer is discovered, patient counseling is of utmost importance. When surgery is considered, the best-tailored treatment option is identified based on clinical study results. Surgeons in Urology use the latest technologies to treat patients with prostate cancer. In fact, MD Anderson treats the highest volume of patients in Houston with robotic-assisted prostatectomy and is in the top 10% of robotic prostate surgery nationally. We have also established techniques in extended template pelvic lymph node dissection, a procedure to improve the staging of the tumor and increase curative outcomes. The prostate cancer program has pioneered the approach of active surveillance in the management of early-stage and low-grade prostate cancer. This is a method of close monitoring of prostate cancer with intervention only in those men whose disease demonstrates the ability to progress and/or put the patient at risk of metastases or prostate cancer-related mortality. This approach has lowered the rates of men receiving therapy in the absence of a clear benefit from the treatment, and has successfully identified men who could avoid treatment altogether. Outreach Urology has supported outreach and clinical care in underserved minority populations including African American, Hispanic and Asian men for over 15 years, starting with the community-based Prostate Outreach Project (POP) that fostered prostate cancer education and early detection throughout the Harris County area. Our goal has been to improve prostate cancer outcomes among African Americans and the underserved by studying both clinical and biologic correlates of aggressive disease. Under the leadership of Curtis Pettaway, M.D., Urology professor and POP medical director, POP has educated and screened over 44,000 men. Working with our Pathology colleagues, we have a database over 500 African American men who have undergone radical prostatectomy at our center to study pathologic correlates of aggressive disease. The Urology department supports Pettaway’s National Cancer Institute-funded cooperative grant (U54) along with investigators from the University of Puerto Rico evaluating the influence of West African Ancestry on the incidence and aggressiveness of prostate cancer among African American (AA) and Puerto Rican populations (POPCAP study). As a result of our experience, we offer state-of-theart personalized care to the underserved in addition to novel clinical trials targeting this patient population. A targeted approach Our Urology faculty also pioneered focal therapy and targeted prostate biopsy more than a decade ago, under the direction of John Ward, M.D. and Louis Pisters, M.D., both Urology professors. Developing better prostate cancer imaging through MRIs and fusion biopsy allows MD Anderson urologists to better diagnose and risk stratify prostate cancer so we can tailor therapy to the individual. Using technologies such as cryoablation, high-intensity focused ultrasound and interstitial laser ablation, MD Anderson is studying the potential for prostate organ preservation while still treating clinically significant prostate cancer. With nearly 2,000 targeted biopsies now completed, we are prepared to reach beyond standard prostate cancer therapies to develop innovative approaches to each man’s disease state. Integrated prostate cancer management The group is also leading the way in establishing new treatment paradigms for men with advanced disease. MD Anderson is a premiere center for clinical trials, Division of Surgery | Surgical Outcomes FY18 49 incorporating multimodality approaches such as systemic therapy (neoadjuvant, presugical and adjuvant) in combination with radiation and surgery to treat the most aggressive cancers. These approaches are establishing new options for men with advanced prostate cancers, informing physician scientists about direct action of drug therapies on prostate cancer and advancing the field by translating these findings to newer therapies. Davis and Brian Chapin, M.D., an associate professor of Urology are the principal investigators on several trials incorporating this treatment strategy. With the recent advances in immunotherapeutic strategies, this platform is being used to investigate new immune-enhancing drugs in prostate cancer, in collaboration with a major pharmaceutical company. The goal is to provide rapid exploration of newer agents with short measures of
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