Urology Cancer Surgery - Present and Future
Continuing the series of Guest Posts by highly regarded Urologists, Benjamin Davies from UPMC answers questions on Urologic Cancer Surgery
Dr. Benjamin Davies is a Urological Surgeon specialising in cancer management. He is an Assistant Professor in Urology at the University of Pittsburgh Medical Centre and the Director of the Urologic Oncology Fellowship. He is a respected clinician scientist and is considered a pioneer for urologists in social media, particularly Twitter.
In this post, Ben Davies answers questions on the current practice and future development of urological cancer surgery
Ben, what was your motivation to concentrate on urology cancers?
I think I was frankly attracted to tumour biology first and then I was introduced to the actual surgery. Once I started being a surgeon I quickly forgot about the basic science biology and become engrossed in large cancer surgeries and robotically enhanced ones as well. I like the direct impactful role that surgery offers to the patient right then and there. No waiting for medication to work or waiting for lab work….it’s operate and hopefully cure. Concrete work.
What is the hardest part of your job?
Sick patients are the absolutely most challenging. It’s simply not a 9-5 job. When I have a patient that is struggling I tend to really take it personally (which of course you shouldn’t) and you can easily become very stressed. Learning to manage the stress is part of becoming a successful physician but is definitely the most challenging.
What have been the biggest developments in urologic cancer in the past few years?
I think two things are the biggest developments:
1. Robotic surgery has significantly aided our surgical approach to prostate cancer care. It has without a doubt decreased the side effect profile of a rather morbid procedure.
2. Genomic testing is finally coming online. We have all been waiting for real genomic testing to help us with our care and the new prostate cancer tests (while still at the beginning of their testing) are promising.
What is the most important preventative measure in urological cancer?
Do not smoke. It is an absolute tragedy to smoke. Just stop it.
Ten years ago, an old boss of mine said to me …”Brook, in years to come you will look back on a holocaust of radical prostatectomies.” Is there is any truth in this?
Of course he was right!! We have done a major disservice in over-treating prostate cancer patients. And as a result our large US screening studies are flawed and we now have to deal with the consequences of bad data. The PSA screening debate has turned against us because we over-treated low volume, low risk prostate cancer without any pause and many times just for money. Hopefully the new generation of urologists has been sufficiently educated to stop the nonsense.
In ten years time, what will prostate cancer treatment look like?
Easy. After your MRI-guided biopsy you will get a genomic profile and risk stratification of your disease. If you are healthy man, then you will be offered a robotic prostatectomy at a centre of excellence.
Prostate cancer receives a huge amount of publicity and funding. Which urology cancer gets a rough deal, and what can be done to improve this?
The absolute worst is bladder cancer! The patient population that is affected is older, sicker, and has lower socioeconomic means. What to do?? The Bladder Cancer Advocacy Network is beginning to generate better lobbying efforts and academics certainly need to bring this issue to the fore more often.