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
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.
The Cutting Edge of Discovery
From its very inception on January 21, 1915, the Brady Urological
Institute was designed for discovery, fostering a multidisciplinary
approach combining basic science and clinical investigation
to address problems of the genitourinary system, prostate
cancer in particular.
Research efforts over the past 90 years have covered the
total spectrum of prostate cancer research aimed at finding
better ways to prevent, diagnose, and treat the disease. The
secret to the success of our researchers has been the interaction
of individuals using unique skills to tackle the same enemy
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.
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.