Genitourinary Cancer Program
The Genitourinary Cancer Program is designed for people who are concerned about cancer risk or are seeking treatment of a genitourinary cancer at any stage. The program builds upon Stanford University's preeminent position of excellence in biomedical research and patient care. The program is based on the philosophy that a multidisciplinary approach to the study and management of genitourinary cancer allows significant insight into the mechanisms of disease initiation and progression, and spurs development of innovative and more effective methods of diagnosis and treatment.
The program focuses on the investigation and management of genitourinary cancers: cancers of the prostate, bladder, kidney, testis and genitalia combining clinical expertise from Urology, Radiation Oncology, Medical Oncology, and basic developments from Immunology, Biochemistry, Pathology, and Molecular Biology. A multidisciplinary approach in the office, operating room and,when appropriate, the laboratory is emphasized. Treatment plans are customized to individual patient needs and may include a variety of modalities (surgical, radiotherapeutic and chemo- or immunotherapeutic) delivered concurrently or consecutively.
There is ongoing application of important new discoveries from the laboratories of researchers who study the epidemiology and basic mechanism of cancer to the management, treatment, and cure of patients. When appropriate, patients are invited to participate in experimental studies to investigate the newest treatments as well as large-scale clinical trials for more established treatments.
An integral part of the program is laparoscopic/minimally invasive surgery. Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Minimally invasive surgery, also often known as laparoscopic or keyhole surgery to patients, has recently been developed in the field of urologic surgery with the advancement of engineering and computer technologies. Using a small telescope with built-in magnification mechanism and a variety of long, thin surgical instruments placed through approximately 3-5 incisions (each of which is usually no larger than a dime in size), the surgeon is able to perform minimally invasive surgery for a variety of urologic diseases and problems. Patients who have undergone these procedures have enjoyed not only the same diagnostic and therapeutic benefits of traditional open surgery but also greatly reduced postoperative pain, shorter hospitalization, faster recovery, and better cosmetic results. Consultations for suitability for laparoscopic/minimally invasive surgery is available through the program.
The program offers associated services to examine the special urologic problems of people who have been treated for cancer such as impotence (erectile dysfunction), infertility, and incontinence (urinary leakage).
The Genitourinary Cancer Program provides a variety of clinical services including:
- Multidisciplinary Genitourinary Cancer Clinic
This clinic provides single visit, patient evaluations by physicians from the three major disciplines of genitourinary oncology (Urology, Medical Oncology, Radiation Oncology). Patients bring all medical records, x-rays and pathology materials to the clinic visit and each case is reviewed and discussed by physicians from all three disciplines. Treatment plans are developed and discussed with patients and family. Treatment plans may be initiated at Stanford.
- Prostate Cancer Diagnostic Clinic
This clinic focuses on the detection of prostate cancer. The Stanford Department of Urology developed techniques for diagnosing prostate cancer that are now used throughout the world. The technique of systematic prostate biopsy was first developed at Stanford in the 1980's and newer biopsy techniques to improve cancer detection rates have recently been described by Stanford urologists. All prostate biopsies performed are reviewed by a world-renowned expert in the field of prostate pathology. A Department of Urology laboratory provides various PSA assays used for prostate cancer detection.
- Genitourinary Cancer Clinic
Patients diagnosed with cancer of the prostate, bladder, kidney or testis who desire further evaluation and possible treatment, or a second opinion regarding proposed treatment, can undergo evaluation by a group of urologists and radiation oncologists who specialize in the management of genitourinary malignancies. For prostate cancer, areas of expertise include:
- nerve-sparing radical prostatectomy (intra-operative evaluation with the Cavermap device is currently undergoing evaluation)
- Robotic radical prostatectomy
- brachytherapy (radioactive seed implantation)
- cryotherapy (freezing of prostate with liquid nitrogen)
- 3-D conformal radiation therapy (state-of-the-art computer guided radiation therapy is used to deliver high doses to the prostate with less side-effects)
- intesity modulated radiation therapy (IMRT, latest advance in 3-D technology which enables even more focused dose to the prostate)
- high dose interstitial radiation therapy (HDR, temporary placement of catheters in prostate which are used to deliver high doses of radiation therapy)
Other areas of expertise include:
- continent urinary diversion (the creation of a new bladder in patients who
require removal of their bladder) - renal-sparing surgery (removal of only a portion of the kidney, rather than the entire kidney for malignancy)
- minimally invasive surgery (use of laparoscopy to remove cancers rather than standard open surgery).
- Laparoscopic / Minimally Invasive Surgery Clinic
Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Minimally invasive surgery, also often known as laparoscopic or keyhole surgery to patients, has recently been developed in the field of urologic surgery to provide greatly reduced postoperative pain, shorter hospitalization, faster recovery, and better cosmetic results. Using a small telescope with built-in magnification mechanism and a variety of long, thin surgical instruments placed through a few puncture sites (each of which is usually no larger than a dime in size), the surgeon is able to perform minimally invasive surgery for a variety of urologic diseases and problems. Laparoscopic surgical management is available for a variety of urologic cancersÑincluding renal cancer (see Pictures 1 and 2 below), prostate cancer, bladder cancer, and testicular cancer.
Picture 1. One method of removing kidney cancer via laparoscopic technique (Transperitoneal laparoscopic radical nephrectomy), which requires only 3 small puncture holes (each ranging from 5 to 12 millimeters in size). Large cut (frequently in excess of 10 centimeters, or 100 milimeters) associated with conventional surgery can be avoided.
Picture 2. One method of removing kidney cancer via laparoscopic technique (Retroperitoneal laparoscopic radical nephrectomy), which requires only 3 small puncture holes (each ranging from 5-12 millimeters in size). Large cut (frequently in excess of 10 centimeters, or 100 milimeters) associated with conventional surgery can be avoided.
- Prostate Cancer Support Group
The importance of support groups and their impact on cancer patient outcomes is well established, and some of this important work has come from the support groups developed at Stanford. Psychiatrists, psychologists and social workers are involved in the development and conduct of cancer support groups within the Genitourinary Cancer Program.
- Pelvic Reconstruction/ Bladder Dysfunction Clinic
Some treatments for malignancies result in significant changes in sexual and urinary function, especially erectile dysfunction and incontinence. Urologists specializing in the evaluation and treatment of these problems are available for evaluation and treatment.
- Benign Prostatic Hyperplasia (BPH) Clinic
BPH, or enlargement of the prostate, is the most common benign tumor in aging men. Approximately 25% of men over the age of 50 will require treatment for this disease in their lifetime. Urologists in this clinic provide several forms of therapy, including medical therapy, minimally invasive therapy (lasers, microwave hyperthermia) and conventional surgical therapy.
- Clinical Trials Open to Accrual:
For more details click on: Clinical Trials
For more information about the Genitourinary Cancer Program, or any of its clinical services and/or clinical trials please call: (650) 725-5544.
Clinical Faculty of Genitourinary Cancer Program
Program Director: Joseph C. Presti, Jr., MD
| PROGRAM MEMBERS | DEPARTMENT | SPECIALTY* |
|---|---|---|
| Rodney Anderson, MD | Urology | Incontinence / BPH |
| James Brooks, MD | Urology | Surgery - P |
| Benjamin I. Chung, MD | Urology | Laparoscopic and Robotic Surgery – P, B, K |
| Harcharan Gill, MD | Urology | Surgery - P, B, K, T |
| Steven Hancock, MD | Radiation Oncology | Radiation - P |
| Thomas Hsu, MD | Urology | Laparoscopy / Minimally Invasive Surgery |
| Robert Kessler, MD | Urology | Infertility / Erectile Dysfunction |
| Chris King, MD, PhD | Radiation Oncology | Radiation - P, B, T |
| Stuart McCallum, MD | Urology | Infertility / Erectile Dysfunction |
| John McNeal, MD | Urology | Pathology |
| Christopher Payne, MD | Urology | Incontinence |
| Joseph Presti, Jr., MD | Urology | Surgery - P, B, K, T |
| David Spiegel, MD | Psychiatry | Support Group - P |
| Sandy Srinivas, MD | Medical Oncology | Medical - P, B, K, T |
* Abbreviations:
P- Prostate cancer; B - Bladder cancer; K - Kidney cancer; T - Testis cancer
