The Brady Urological Institute is recognized internationally for its leadership in diagnosing and treating cancer of the prostate. Under the guidance of Alan W. Partin, M.D., Ph.D., the Chairman of the Brady Urological Institute, our diagnostic and screening programs are continually refined to detect prostate cancer early, when it is most treatable and curable. Surgical removal of the prostate with the anatomic nervesparing retropubic prostatectomy, which was developed by Dr. Patrick C. Walsh, the internationally recognized authority in prostate cancer treatment, not only cures prostate cancer but also preserves urinary continence, sexual function, and quality of life. Men from all over the world have been treated at the Brady Urological Institute for localized prostate cancer, which is the most common inpatient surgical procedure performed at Johns Hopkins Hospital.

For men diagnosed with prostate cancer, Johns Hopkins offers effective surgical treatment by a dozen experts who perform a combined total of more than 1,200 radical prostatectomies annually with excellent cure rates. The majority of our patients maintain continence and potency and are discharged within two days after surgery. In addition to the standard approach to radical prostatectomy performed through an open incision in the lower abdomen, some procedures are now performed using laparoscopic and robotic techniques. (See page 30 for more information on this topic). For carefully selected candidates, brachytherapy is offered through collaboration with physicians from the Department of Radiation Oncology.

When it comes to radical prostatectomy surgery, the published results of the Brady Urological Institute surgeons in terms of continence, potency, surgical complications, need for blood transfusion, and duration of hospitalization are among the best in the world. Largely due to our expertise in treating prostate cancer, the Brady Urological Institute has been honored as the top department of urology in the country for more than 16 years by U.S. News & World Report.

In both the laboratory and clinic, our specialists are working on ways to improve the outcomes of patients with advanced disease. Johns Hopkins offers the latest and most sophisticated care for late-stage prostate cancer. Working closely with our colleagues in medical oncology, pathology, and radiation therapy, we offer out patients intensity-modulated radiation therapy as well as the latest chemotherapeutic interventions.

Over the course of its illustrious history, the Brady Urological Institute has led the global field with its urological research efforts. Dr. Walsh's development of the surgical technique for total prostatectomy that preserves sexual function with fewer side effects is now considered the gold standard in prostate surgery.

The Partin Tables, developed by Drs. Partin and Walsh, based on accumulated data from thousands of patients treated at Johns Hopkins for prostate cancer, have become the international criterion for estimating the likelihood that cancer has remained in the prostate or else spread out of the prostatic capsule to the seminal vesicles or the pelvic lymph nodes. These simple tables are used to help men and their doctors predict the definitive pathological stage and the best course of action before any treatment has been provided. These tables are updated at regular intervals.

The PSA test was approved by the FDA in 1987, so today most men have long PSA histories. Interpreting this information correctly can mean the difference between an early or delayed diagnosis of prostate cancer. Working with the Baltimore Longitudinal Study of Aging, H. Ballentine Carter, M.D., the Director of the Division of Adult Urology at the Brady Urological Institute, has evaluated upwards of three decades of PSA measurement using frozen serum samples from men who were diagnosed with cancer and those who were not. This led to the development of the concept of -PSA velocity,- which is used today to alert men (even men with low PSA levels) that prostate cancer may be present.

Although the Brady Urological Institute has achieved world renown for improvements in the surgical treatment of prostate cancer, there are many men who are diagnosed with prostate cancer that is considered very low risk (determined by age, general health, PSA density, tumor grade, Gleason score, and extent of core involvement at biopsy). Dr. Carter and Jonathan I. Epstein, M.D, the Rose-Lee and Keith Reinhard Professor of Urological Pathology, now coordinate the expectant management program. This special program is offered to appropriate patients who are comfortable delaying immediate prostate therapy with the reassurance of frequent monitoring. At present, more than 350 men are being monitored who are thought to have tumors that can be safely managed without immediate treatment.

With the aging of the post-WW II baby boomers, it is estimated that the number of new cases and deaths from prostate cancer may triple over the next 40 years. To lessen the burden of the most common cancer in men, major inroads must be made in prevention, diagnosis, and treatment. At the Brady Urological Institute, research efforts cover the total spectrum of prostate cancer research as scientists try to discover and unravel the biology and genetics of prostate cancer. Their efforts, individually and in combination, have led to the identification of molecular, biochemical, genetic, and immunological factors that regulate the initiation and progression of prostate cancer.

William B. Isaacs, Ph.D., professor of oncology and urology, has, along with Dr. Walsh, conducted large family studies and started a genome-wide search to define the areas of the genome that might contain aberrant genes relevant to prostate cancer. Dr. Isaacs' International Consortium for Prostate Cancer Genetics, a collaborative effort of more than 25 groups and multiple investigators pursuing research on the epidemiology of prostate cancer, now has more than 3,000 multiplex (multiple-affected) families in its registry.

Brady Urological Institute researchers are very interested in understanding the etiology of prostate cancer in an effort to develop new approaches to prevention. William G. Nelson, M.D., Ph.D., is currently studying the molecular pathogenesis of prostate cancer. Dr. Nelson, along with Dr. William Isaacs and Angelo DeMarzo, M.D., Ph.D., has put together compelling evidence that inflammation may play a major role in the genesis of prostate cancer. The team has cloned two susceptibility genes for prostate cancer- MSR1 (macrophage scavenger receptor one) and RNASEL- that are involved in the host defense mechanisms against infections. This raises the tantalizing possibility that infections may, in some way, be responsible for this inflammation.

The Brady Urological Institute has achieved world renown for
discoveries that led to improvements in the surgical treatment of prostate cancer

Mario Eisenberger, M.D. is the R. Dale Hughes Professor of Oncology and Urology. Working with Michael A. Carducci, M.D., he continues to study new forms of treatment for patients with high-risk, locally advanced, and metastatic prostate cancers. These include studies of molecularly-targeted small molecules and antibodies-the latest in drugs that are able to target the genetic changes in an individual's tumors while sparing healthy tissues.

The war on prostate cancer requires a multidisciplinary approach. One of the outstanding distinctions of the Brady Urological Institute is that scientists and clinicians from just about every department at Johns Hopkins-pathologists, radiation oncologists, medical oncologists, surgeons, and basic scientists- are all working on this disease. This multi-faceted approach will eventually bring to light the winning formula in defeating prostate cancer.