New center focuses on multidisciplinary, collaborative approach
Tim Culbert had never been sick—had never been admitted to a hospital—until he was diagnosed with prostate cancer last August. The news came as a complete surprise: Just 46 years old and otherwise in good health, he had no family history of the disease.
His journey began at his annual physical exam, when his doctor discovered that his PSA (prostate-specific antigen) levels were slightly elevated. After a regimen of antibiotics to rule out an inflammation in his prostate gland, a biopsy confirmed the diagnosis.
Culbert immediately began investigating various treatments with his wife, Heidi. Unlike most people facing such a diagnosis, the Culberts brought some medical knowledge to the task: Tim is a developmental and behavioral pediatrician, and Heidi is a nurse. Even so, they wanted to consult with specialists about the risks and benefits of all their options.
That’s when Tim made an appointment with Kenneth Koeneman, M.D., a urologic surgeon who brings an additional dimension of expertise: He directs the University’s new Center for Prostate Cancer and holds the Dougherty Family Chair in Uro-Oncology in addition to serving as associate professor in the Medical School’s Department of Urologic Surgery.
“The first thing that amazed Heidi and me was the amount of time Dr. Koeneman spent with us,” says Culbert. “He took well over an hour going over all the treatment possibilities—from surgery to radioactive seed implants and other nonsurgical options. He answered all of our questions and drew pictures while he was explaining. The session was very educational, which I appreciated because even though I’m a physician, I’m not a urologist. I’m a pediatrician. I don’t know much about the prostate gland.”
For those without medical training, this kind of expertise and communication is especially helpful when considering the range of treatment options. For them, the center’s collaborative approach provides consultations from a team of specialists focusing on each patient’s unique medical history and the progression of the disease.
Koeneman introduced the Culberts to program coordinator Karina DiLuzio, who loaned them books from the center’s resource library and gave them information about diet, exercise, and stress-management techniques. After their consultation, the Culberts decided that laparoscopic robotic surgery was the right choice for them, and the procedure was scheduled.
Before surgery, program manager Allie Briley, R.N., arranged for Culbert to talk to a patient who had recently had the same procedure. “This man’s issues of erectile function recovery and so on confirmed for me what I had already read,” says Culbert. “But it was so helpful to hear from someone who had recently had the surgery.”
The surgery took place in early October, and it went well. “A holistic approach to medicine is what I believe in and what I do for a living, and I think the Center for Prostate Cancer is going at this the right way,” says Culbert. “The people there aren’t just talking about it but are actually delivering on it, and I think they’re doing a very good job. I was really pleased with the care I received.”
A new model
The Center for Prostate Cancer is the brainchild of two people who know a lot about living with prostate cancer: Mike and Kathy Dougherty. Mike, a prominent Minneapolis investment banker, had his prostate gland surgically removed after his first diagnosis in 1999. When the cancer reappeared a few years later, Mike and Kathy crisscrossed the country in search of the very best treatment options.
After visiting more than a dozen highly regarded cancer institutions, they returned home feeling frustrated. None of the major centers they visited offered multidisciplinary care; for example, some places focused on radiation, others on surgery. As a result, the Doughertys felt it was impossible to get a complete understanding of the range of treatment modalities available to prostate cancer patients. They were also discouraged that Kathy Dougherty wasn’t included in many of the consultations. In their minds, an ideal cancer center would involve the patient’s family in discussions and decision-making.
Mike is now in remission and focusing his efforts squarely on behalf of other prostate cancer patients who experience similar frustrations. The Doughertys are collaborating closely with the University and the Cancer Center to develop the Center for Prostate Cancer into the ideal place for patient care and research.
“The multidisciplinary approach involves basic research, clinical research, and patient care, and it includes specialists in surgery as well as radiation oncology,” says John Kersey, M.D., director of the University of Minnesota Cancer Center and holder of the Children’s Cancer Research Fund Chair in Pediatric Cancer Research.
“We all agreed that we wanted to build a strong prostate cancer program, so we set out to recruit a leader and a strong team,” he says. “We were very fortunate to be able to recruit Ken Koeneman, who was at the University of Texas in Dallas. He’s an outstanding urologic surgeon—the best we found in the country—and he was enthusiastic and willing to take this broader approach.”
Kersey points out that the program extends beyond the beautiful new physical facility, which includes a patient resource library and other amenities.
“It is our plan to develop an outstanding prostate cancer program with the word center attached to it. The patients are seen in the new clinic, but there is also important research taking place in labs in adjacent buildings, and some of the people doing that research are part of this program.”
Kersey cites developing objectivity and eliminating bias among the goals for the center. “We hope to do this through daily communication between nurses and patients, between surgeons and radiation therapists, and so on,” he says. “And we also hope to develop innovative randomized clinical trials to help develop objectivity when it comes to patient treatment options.”
This collaborative, multidisciplinary approach was one of the things that attracted Koeneman to the position. “We want this center to offer not only the best physicians and the best technology but also a holistic approach for the patient and his family,” says Koeneman. The center currently includes 12 physicians (surgeons, radiation oncologists, and medical oncologists); 4 nurses; and a nutritionist in addition to staff members. And there are plans to hire more.
“At the University of Minnesota we’ve always emphasized multidisciplinary care, but in this case the team actually sees patients in the same physical space, in the same clinic,” says Kathryn Dusenbery, M.D., associate professor and head of the Department of Therapeutic Radiology/Radiation Oncology. “From the patient’s perspective, it’s so much easier to go to just one clinic instead of two or three.
“The potential for better commu-nication is another advantage,” she adds. “With prostate cancer there are differences of opinion about the right treatment, and there are lots of options for the patient. We hope to be able to better serve the patients by addressing some of that ambiguity up front.”
Number of cases on the rise
Despite recent treatment advancements, prostate cancer remains a significant disease. It’s the most common solid tumor in men, and the second most common cause of tumor death in men. (Only lung cancer is more deadly.) The good news is that 98 percent of prostate cancer patients live at least five years after diagnosis. Unfortunately, though, the risk for prostate cancer increases with age.
“As baby boomers get older, we’re going to see a relative epidemic in prostate cancer,” says Koeneman, “with anywhere from 3 to 8 million new cases expected in the U.S. over the next 10 to 15 years.”
Koeneman thinks the greatest advances will come from using a combination of treatments more effectively, which should also lead to fewer side effects, particularly for intermediate- and high-risk cancers.
“The reality is that most low-risk prostate cancers can be cured by multiple modalities,” he says, “and while prostate cancer is a big problem, it’s not the only one. If we develop the model at this center and recruit the best physician-scientists, then in two or three or five years we can translate what we learn to other areas, like orphan diseases and rare childhood tumors.”
Research is key
James McCarthy, Ph.D., is one of the prostate cancer researchers Koeneman and his colleagues meet with in regular Friday meetings to discuss their work. With 20 years of experience in cancer research and 10 years studying prostate cancer, McCarthy is the program leader for cancer progression and metastasis at the Cancer Center as well as a professor in the Medical School’s Department of Laboratory Medicine and Pathology. A basic scientist who studies how tumor cells change the composition of tissues, McCarthy says the Center for Prostate Cancer is critical to developing a better understanding of how cancer cells develop and spread.
“This new program gives us access to the patient tumor samples that are so important to our work,” he says. “Dr. Koeneman understands the clinical issues, so he’s able to guide those of us doing research. Basic scientists can ask a lot of questions, but the challenge is knowing which questions are the most important. This program helps us develop meaningful studies that will allow us to make predictions about prostate cancer.”
Working together with a talented research team, McCarthy and Koeneman are confident that the Center for Prostate Cancer will make important contributions to prostate cancer research over the next several years.
“We want to be able to cure or control the lethal or aggressive
types of cancer in the 50-year-old man—even if he has to live with
prostate cancer for 30 years, just like someone lives with diabetes or
hypertension,” says Koeneman. “And that’s realistic. I want to be a
part of this, and I want this center to be a part of this. If we
continue to recruit the very best people, the rest will follow.”
By Faith Adams