Clinical Centers of Excellence - Prostate Cancer: Johns Hopkins University

Through innovative clinical trials, aggressive research programs, and a focus on solid prevention methods, Johns Hopkins is pushing prostate cancer medicine to a higher level.

Alan Partin, MD, PhD, urologist-in-chief and chairman of the Brady Urological Institute, said the department is at the forefront of prostate cancer medicine because of its research.

Discoveries are being sought in advanced segments of prostate cancer research, including biomarker research, expectant management, a pilot program of temperature-enhanced metastatic therapy (TEMT), robotics, immunology, and genetics.

Efforts in improving detection

A recognized researcher, Dr. Partin is perhaps best known for his role in the development of the Partin tables in the 1990s. The tables were constructed to use PSA test results to predict the probability that prostate cancer had spread to the lymph nodes, or seminal vesicles, or remained localized.

PSA tests are now recommended to screen for prostate cancer; however, the test is not as precise as researchers and physicians would like. Researchers at Johns Hopkins are moving rapidly to validate a test for early prostate cancer antigen-2 (EPCA-2), a more specific biomarker for the disease.

In freezers on the Johns Hopkins campus in Baltimore are about 18,000 samples from men with all stages of prostate cancer-neatly categorized, bar-coded, and computerized, with demographic information, including family history, and readily available to investigators throughout the world. Dr. Partin said the samples are valuable in many areas of research, including the development of the EPCA-2 biomarker test, which some researchers predict will eventually replace the PSA test as a cancer screening tool.

According to Robert Getzenberg, PhD, professor of urology and director of research at the Brady Urological Institute, the development of the test for EPCA-2 would be a major breakthrough because it would allow physicians to see not only whether prostate cancer is present, but also to determine whether a particular case is aggressive enough to warrant treatment.

Whether to treat is another question that Brady researchers are exploring. Citing his department's work in expectant management, Dr. Partin explained that many cases of prostate cancer could be managed without surgery or radiation therapy.

It's Johns Hopkins' overall excellence in surgical care that impressed Robert Pickens, MD, a urologist in Princeton, NJ.

Dr. Pickens said he has referred numerous patients to Johns Hopkins over the last 36 years. Those referrals were based partially on Johns Hopkins' reputation, but mostly on the quality of available care there.

"The patients that have gone there have come back quite pleased," he said.

Johns Hopkins' urologic and surgical programs have garnered worldwide attention in part because of Patrick Walsh, MD, the University Distinguished Service Professor of Urology at Johns Hopkins Medical Institutions who took the helm of the Brady Urological Institute in 1974. Dr. Walsh has helped in reshaping the radical prostatectomy procedure, which was first performed at Johns Hopkins in 1904 by surgeon Hugh Hampton Young, MD. Dr. Walsh is a pioneer in the development of the anatomic approach to radical prostatectomy, which incorporates nerve-sparing techniques.