UT Medicine & CTRC: Leading in Each Step of the Cancer Care Journey

Monday, July 1, 2013

As patients walk the path of prostate cancer treatment, an integrated team of medical specialists at UT Medicine helps them find a home for tailored clinical care.

Many patients who are concerned about prostate cancer risk begin their journey with a preventive health visit to Marijan D. Gillard, MD, family medicine physician at UT Medicine San Antonio, the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio.

During these regular visits, Dr. Gillard, who is also Medical Director of the Family Medicine Clinic at the Medical Arts and Research Center (MARC), interviews and examines the patient and obtains any appropriate further testing. Should results suggest other concerns, Dr. Gillard notes, specialist consultations are rapidly arranged.

Marijan Gillard, MD
As one of UT Medicine’s family physicians, Marijan Gillard, MD, coordinates her patients’ healthcare needs from her clinic in the Medical Arts & Research Center on Floyd Curl Drive, which is only half a block from the CTRC.

“The nice thing about the process at the MARC is if we find something abnormal during our examinations, we have a direct gateway to subspecialist urologists who can arrange further testing, counseling or treatment,” she says.

Just upstairs from Dr. Gillard’s clinic is the MARC Urology Clinic, while across the street are a host of other cancer-related services at the Cancer Therapy and Research Center (CTRC) — a National Cancer Institute-designated Cancer Center and an integral part of the services of UT Medicine. No matter her need, Dr. Gillard has a direct link with the appropriate specialists.

“Our cancer specialists and our primary care physicians are on a first-name basis,” she notes. “I feel comfortable calling any specialist for a specific problem. Once I make a referral, I can call the specialist and provide the specific reasons why I’m seeking a consultation.”

Prudent Prostate Screening

In 2012, the U.S. Preventive Services Task Force released its recommendations for eliminating prostate-specific antigen (PSA) screening for prostate cancer. Ian M. Thompson, Jr., MD, Director of the CTRC, is an internationally recognized urologic oncologist with special expertise in prevention, detection and treatment of prostate cancer. He explains that PSA is only a part of the diagnostic process.

“The Task Force recommended against PSA testing because using it unwisely and detecting large numbers of prostate cancers — many of which are inconsequential — and then treating these men without regard for their real cancer risk probably causes a net harm to men who are screened,” Dr. Thompson says.

“Using PSA tests prudently involves an unabridged evaluation of patient risk factors for prostate cancer,” says urologist Ronald Rodriguez, MD, PhD, Professor and Chair of the Department of Urology. Dr. Rodriguez expresses the need to evaluate a myriad of non-cancer causes (prostatitis and prostate enlargement, among others) and says physicians need to include other risk factors in the assessment of whether a prostate biopsy would be helpful.

“The real problem is that treatment of some men can cause more harm than good,” Dr. Rodriguez explains.

A patient with a very low-risk cancer is unlikely to benefit, but the treatments may result in urinary, bowel or sexual side effects. The men whose tumors pose a significant risk are most likely to benefit from treatment.

The Full Spectrum of Treatment Options

Dr. Thompson explains that for most men, especially those whose tumors are detected by PSA testing, the tumor is confined to the prostate. Under these circumstances, the entire range of options is available to men, including surgery, radiation or active surveillance — in which low-risk tumors are monitored and treated later only if there is evidence of growth.

Chul Ha, MD
Chul Ha, MD, Chief of Radiation Oncology (foreground) at the CTRC, reviews a case with Nikos Papanikolaou, PhD, Chief of Medical Physics.

For higher-risk tumors, radiation oncologist Chul Ha, MD, Professor and Chair, Department of Radiation Oncology, explains that surgery and radiation provide similar control of the tumor. Surgical cure of prostate cancer, Dr. Rodriguez says, can be attained with open, laparoscopic or robotic-assisted surgery. Dr. Thompson notes that tumor characteristics, patient preferences and other medical conditions play a major role in the patient’s decision on which of these approaches he prefers. The CTRC’s multidisciplinary team helps patients weigh their options and ultimately decide on a personalized approach to their tumor.

In addition to surgery offered by six urologic oncologists, state-of-the-art radiation technologies are provided at the CTRC. A linear accelerator, equipped with dual capabilities, including precision-targeted intensity-modulated radiation therapy (IMRT) as well as image-guided radiation therapy (IGRT), allows constant monitoring of the daily treatments. Radiation oncology at the CTRC also offers brachytherapy for cancer treatment, in which highly accurate placement of radioactive seeds are implanted into the prostate — a procedure that is accomplished in one day.

Treating Advanced Prostate Cancer

For men whose disease has spread beyond the prostate, a host of new treatments are available from the multidisciplinary team at the CTRC. In addition to the high-profile recent publications of advances from the CTRC associated with improved survival of men with this disease, other therapies are available.

Ian M. Thompson, Jr., MD
CTRC Director and urologic oncologist Ian M. Thompson, Jr., MD, sees patients and conducts studies on prostate cancer at the CTRC.

Devalingham Mahalingam, MD, PhD, Assistant Professor of Medicine and medical oncologist at the CTRC, coordinates many of these new advances.

“When prostate cancer metastases to the lymph nodes or the bone, medical oncology gets involved,” he explains. “If the tumor becomes resistant to hormone treatment, the patient becomes a candidate for the wide variety of new treatments developed in the past decade.”

In addition to agents that are now widely available (abiraterone, docetaxel, enzalutamide), Dr. Mahalingam and colleagues at the CTRC have multiple promising therapies, ranging from simple agents to “trick” the tumor into remaining sensitive to hormone therapy to new agents targeted at specific Achilles’ heels of cancer.

Ronald Rodriguez, MD, PhD
Ronald Rodriguez, MD, PhD, Department Chair and urologist, sees patients not just in the exam rooms at the MARC but also in its operating rooms in the Day Surgery Center on the second floor.

Full Circle

Although the various team members of CTRC specialists coordinate the treatments needed for the patient’s prostate cancer and provide long-term follow-up, the patient’s journey continues with the primary care physician.

“Sometimes, patients follow up with me to coordinate their care for emotional or psychological support,” Dr. Gillard says. “Patients want to come back to a home base where the process started. Many talk about their experiences and don’t need me to do anything but listen to them.”

Call 210-450-1000 to refer a patient for prostate cancer care at the Cancer Therapy & Research Center. Call UT Medicine San Antonio for a family physician or specialist at 210-450-9000.