Six Advances in Urology Pioneered at MSK

By Jennifer Castoro,

Monday, November 9, 2015

Doctors and nurses in an operating room during the early 20th century.

MSK’s Urology Service marks its centennial this year. Our clinicians and researchers have pioneered many treatments throughout the service’s 100 years that have changed the face of care for people with urologic cancers.

  • MSK’s Urology Service marks its centennial this year.
  • Among the advances pioneered here are chemotherapy and surgical treatments.
  • Our doctors have long been among the top urologic cancer experts in the country.

Memorial Sloan Kettering’s Urology Service, founded in 1915, has cared for countless patients and pioneered many vital discoveries throughout its 100 years. These are six of the most practice-changing treatments and tools from the world-renowned urologists at MSK.

MVAC Chemotherapy

At MSK, our surgeons save patients’ lives in many ways. Alan Yagoda proved this in the 1980s, when he developed the
 first and most effective combination chemotherapy for metastatic bladder cancer, known as MVAC (methotrexate, vinblastine, doxorubicin — or adriamycin, the A in MVAC — and cisplatin). At the time, nationwide studies demonstrated that this regimen followed by surgery led to better cancer control and survival rates than surgery alone for invasive bladder cancer. The combination has yet to be surpassed in terms of efficacy.

MSK’s Urology Service also pioneered incorporating surgery for patients with locally advanced, unresectable (not able to be removed through surgery), or metastatic bladder cancer that responded to MVAC chemotherapy but who still had residual disease. Through surgery to remove metastatic disease and cystectomy to remove the remaining cancer in the bladder, a third of patients who would have been likely to die of recurrent disease survived disease-free for five years or longer.

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Partial Nephrectomy

Sometimes less is more when it comes to cancer care, as shown by kidney cancer specialist Paul Russo in 2006. He conducted studies comparing partial nephrectomy, in which a portion of the kidney is removed, with total nephrectomy, in which the entire organ is taken out. His findings established that partial nephrectomy is equally likely to cure the cancer and less likely to lead to chronic kidney disease and premature death than total or radical nephrectomy.

Today, partial nephrectomy is currently used in 35 percent of eligible patients with kidney cancer nationwide, up from less than 10 percent five years ago. That figure is expected to continue to rise to 50 to 60 percent of eligible patients.

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BCG Therapy

MSK’s Lloyd Old, an internationally acclaimed immunologist known as the founder and standard-bearer of immunotherapy, set the stage for modern immunology. One of Dr. Old’s biggest contributions was the introduction of Bacillus Calmette-Guérin (BCG), a vaccine that had proven effective against the scourge of tuberculosis, into experimental cancer research as a way to stimulate nonspecific resistance to tumor growth.

Harry Herr, a urologic surgeon at MSK, conducted the crucial randomized clinical trial in 1983 that demonstrated long-term control of carcinoma in situ (CIS) of the bladder with BCG. This led to FDA approval of the treatment in 1991. BCG remains a standard therapy for high-grade, non-muscle-invasive bladder cancer.

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Michael Kattan, who arrived at MSK in 1998, used his expertise in statistics and predictive models to create nomograms — online tools that can estimate the extent, level of aggressiveness, and outcomes of prostate and other cancers. Most nomograms apply to patients who will have – or have had— surgery for their cancer. For example, many of the nomograms predict the likelihood a patient will survive five years after surgery, or the likelihood that the cancer will return during that same period. The nomograms can help doctors make treatment decisions for patients, such as whether to give chemotherapy before or after surgery.

Dr. Kattan’s nomograms gained rapid acceptance in oncology. The prediction tools page is among the most frequently visited on MSK’s website, with more than 650,000 page views per year.

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PSA and 4K

A man’s PSA, or prostate-specific antigen, level in midlife strongly predicts his risk of eventually developing advanced prostate cancer or dying of the disease.

Two MSK researchers, Hans Lilja and Andrew Vickers, took that discovery to an even more precise level with the development of the 4-kallikrein panel. Often called a 4Kscore, the test is more accurate than PSA alone in detecting high-grade, potentially lethal prostate cancers and also in predicting lifelong risk of death from the disease. Today, the new 4Kscore test is used in 2,000 cases per month, and this number is rising steadily.

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Value of Surgical Expertise

From minimally invasive techniques to specialized robots, surgical technology continues to evolve at a rapid pace. But despite these valuable tools, the skill of the surgeon is absolutely vital to good outcomes for patients.

Dr. Vickers and Peter Scardino, the fifth chair of the Urology Service, proved this through a series of epidemiological studies and randomized clinical trials. They found that the outcomes of surgery for patients with prostate or bladder cancer — both the chances of cure and the risk of complications — depend on the skill and experience of the surgeon, rather than the method they use to perform the surgery. This confirmed that the power of surgery to control cancer depends upon the surgeon’s ability and judgment to perform the right operation for the right patient at the right time.

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These people are simply phenomenal.

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