Urologic Cancer Program

INCIDENCE AND PREVALENCE

About one in nine men will be diagnosed with prostate cancer during their lifetime. It is the second leading cause of cancer death in men in the U.S. It is estimated that 65,340 individuals will be diagnosed with kidney cancer, and 81,190 individuals will be diagnosed with bladder cancer in 2018, according to the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. In total, prostate, testicular, kidney and bladder cancers account for 18.05% of all new cancer cases.

PROGRAM OVERVIEW

From advanced diagnostics to multidisciplinary treatment and clinical research, Hoag’s Urologic Cancer Program offers comprehensive, coordinated care for patients with prostate, bladder, kidney, or testicular cancer. Jeffrey Yoshida, M.D., Benjamin & Carmela Du Endowed Chair in Urologic Oncology is the Urologic Cancer Program director. Dr. Yoshida is fellowship-trained in urologic oncology and robotic surgery and board-certified in urology. He leads the team of specialists in surgery, medical oncology, urology, radiation oncology, radiology, and pathology.

DIAGNOSTICS

Hoag’s is one of the first programs in Orange County to routinely offer multiparametric prostate MRI, a significant advancement in prostate imaging that is improving prostate cancer diagnosis.All prostate MRIs at Hoag are done with 3 Tesla MRI scanning. Images show the prostate gland in its entirety, allowing for improved cancer detection, ability to detect prostate cancers earlier, and enhanced images to guide treatment planning. Implemented in 2015, the Prostate MRI program at Hoag has seen significant increase in both volume and cancer detection and currently maintains the highest volume in the county.

Hoag is also among the first in Orange County to offer targeted prostate biopsies, or MRI Ultrasound Fusion Prostate Biopsies for select patients, which combines pre-biopsy 3T MRI images with ultrasound-guided biopsy imaging. The technology, offered at both Hoag Hospital Newport Beach and Hoag Health Center Irvine - Sand Canyon, allows for accurate target biopsy of the suspicious MRI finding. MRI Ultrasound Fusion Prostate Biopsy can help distinguish between cancers that need treatment and low-grade cancers that can be watched. Hoag’s volume of MRI Ultrasound Fusion Prostate Biopsies is the highest in Orange County.

Ultrasound-guided MR fusion biopsy of suspicious targeted lesion identified on multiparametric prostate MRI exam

PET/MR is available at Hoag for prostate cancer diagnosis and management. A small number of centers have access to the new technology; Hoag is the first on the West Coast to offer PET/MR to patients. The hybrid imaging modality’s ability to combine structural, metabolic, and functional images is particularly beneficial for prostate cancer diagnosis and staging. In 2017, Hoag Radiology implemented Axumin (18F-Fluciclovine), a new radiotracer that can be used with PET CT and PET/MR to detect early prostate cancer recurrence on a molecular level in patients after surgery, including those with PSA levels less than one.

PET/CT with Axumin in patient with history of prostate cancer with rising PSA of 5.4 demonstrates Axumin avid left internal iliac chain lymph node compatible with recurrent nodal disease.

Comprehensive tumor profiling through Hoag’s partnership with Caris Life Sciences is available for prostate, kidney, and bladder cancer patients and is being used to guide clinical decision making.

TREATMENT

Tumor Board

The multidisciplinary Urologic Tumor Board brings together surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, urologists, precision medicine specialists, the nurse navigator, and the patient support team to discuss prostate, kidney, and bladder cases. The Urologic Tumor Board meets on the 3RD Tuesday of every month at 7:30 a.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by Jeffrey Yoshida, M.D., Benjamin & Carmela Du Endowed Chair in Urologic Oncology To submit a case for the Urologic Tumor Board, contact the Urologic Cancer Nurse Navigator, Sandy Southerland, B.S.N., R.N., O.C.N., at 949-764-1804 or S[email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

Surgery

Robotic-assisted surgery is a cornerstone of the Urologic Cancer Program. Hoag maintains the highest volume of robotic radical prostatectomies in Orange County and the highest volume of urologic robotic-assisted surgeries in the state. In addition to less blood loss and less pain, patients have a lower rate of complications like incontinence and sexual dysfunction than with open surgery. The program also maintains a high volume of robotic radical and partial nephrectomies, and Hoag’s urologic surgeons are skilled in the surgical treatment of bladder cancer including robotic-assisted bladder removal and neobladder reconstruction. Hoag’s total volume of urologic cancer robotic-assisted surgeries is about equally distributed between its Irvine and Newport Beach campuses.

Hoag is the fourth highest volume provider of total roboticassisted surgeries in the nation and offers state-of-the-art robotic surgical technology at its Newport Beach and Irvine campuses. The Surgical Review Corporation named Hoag a Center of Excellence in Robotic Surgery (COERS), which recognizes health care institutions that consistently deliver the safest, highest-quality care in robotics. Intuitive Surgical selected Hoag as one of only two sites in the U.S. for their Executive Enrichment Program, which provides physicians and hospital administrators the opportunity to visit Hoag to learn about robotic surgery from our OR team, robotic surgeons, and administrators.

Medical Oncology

A medical oncologist specializing in urologic cancers is integrated with the program and adds up to date knowledge and expertise in the newest agents. Through Hoag Family Cancer Institute’s alliance with USC Norris Comprehensive Cancer Center, eligible patients also have access to novel agents through phase I and II clinical trials.

Radiation Oncology

Hoag’s Radiation Oncology team is skilled in the treatment of low risk, high risk, regionally advanced, and metastatic prostate and bladder cancers with radiation therapy. Treatment modalities include image guided Intensity Modulated Radiation Therapy (IMRT) by TomoTherapy® and Stereotactic Body Radiation Therapy (SBRT).

For select patient clinical situations, Hoag offers stereotactic body radiation therapy (SBRT) for the treatment of prostate cancer under an IRB protocol on the Elekta Versa HD™, one of the most advanced linear accelerators available, at Hoag Cancer Center Irvine. With SBRT on the Versa, the typical nine-week treatment course is reduced to just five treatments of higher dose that can each be delivered in about five minutes. The higher dose levels require even greater accuracy – fiducial markers help delineate the targets, and CT and pre-treatment MRI scans allow for accurate delivery. The Versa accounts for movement of the prostate and repositions accordingly.

After CT planning, patient external and internal positioning is checked daily with IMRT treatments directed toward the prostate only or prostate and pelvic lymph nodes.

Hoag is the first hospital west of the Mississippi to offer SpaceOAR® Hydrogel, the first FDA cleared spacing device to protect the rectum in men undergoing radiation therapy for prostate cancer.

Interventional Radiology

Cryoablation is often a viable treatment option for patients with kidney cancer who are not candidates for open surgery. Using CT or ultrasound to steer cryoprobes to the tumor, argon gas creates an ice bulb that encompasses and freezes the tumor at -150 degrees Celsius. For patients with T1 kidney cancer, greater than 90% tumor response rates at five years can be achieved with cryoablation. Hoag’s interventional radiologists maintain a high volume of cryoablations and are skilled in microwave ablation for the treatment of kidney tumors.

CLINICAL RESEARCH

Access to early phase clinical trials and other progressive research protocols including a Prostate Cancer Active Surveillance registry and a prostate cancer vaccine trial for low risk prostate cancer further distinguish Hoag’s Urologic Cancer Program. The following clinical trials have opened for patients with prostate, bladder, kidney, and testicular cancers. For a list of trials currently open, please contact Leila Andres, M.S., at 888-862-5318.

(181-17) 0C-14-2: An Open-label, Multicenter, Multinational, Phase 2 Study Exploring the Efficacy and Safety of Neratinib Therapy in Patients With Solid Tumors With Activating HER2, HER3 or EGFR Mutations or With EGFR Gene Amplification (Phase 2 clinical trial, appropriate for patients with solid tumors of the bladder.)

(208-17) 0C-17-15: A multicenter, open-label, phase 1b/2 study to evaluate safety and efficacy of avelumab (MSB0010718C) in combination with chemotherapy with or without other anti-cancer immunotherapies as first-line treatment in patients with advanced malignancies (Phase 1b/2 clinical trial, appropriate for patients with bladder and lung cancers.)

187-17/0C-17-11 Phase 1 Trial of ZW25 in patients with locally advanced (unresectable) and/or metastatic HER2- expressing cancers

157-17/0C-18-2: A Phase I Study of FID-007 in Patients with Advanced Solid Tumors

(155-17) 0C 17-1: Phase 1 Multi-center Study of the Safety Pharmacokinetics and Preliminary Efficacy of CBT- 101 in Subjects with Advanced Solid Tumors and C-Met Dysregulation (Phase 1 clinical trial, appropriate for patients with advanced solid malignancies.

(214-17) 0C-17-17: A Phase 1/2 First-in-human Study of BMS-986258 Alone and in Combination with Nivolumab in Advanced Malignant Tumors (Phase 1/2 clinical trial, appropriate for patients with advanced malignant tumors.)

(117-16) Prostate Cancer Active Surveillance: Data Registry for Active Surveillance Management of Prostate Cancer: Prospective Data Collection and Analysis

115-16: Stereotactic Body Radiation Therapy (Sbrt) For The Management Of Carcinoma Of The Prostate: Quality Of Life Data After Primary Stereotactic Body Radiation Therapy For Localized Prostate Cancer

113-16: Data Registry for Pancreatic Cancer Early Detection: Prospective Data Collection and Analysis

181-17/0C-14-2: An Open-label, Multicenter, Multinational, Phase 2 Study Exploring the Efficacy and Safety of Neratinib Therapy in Patients With Solid Tumors With Activating HER2, HER3 or EGFR Mutations or With EGFR Gene Amplification (Phase 2 clinical trial, appropriate for patients with solid
tumors of the bladder.

157-17/0C-18-2: 157-17/0C-18-2: A Phase I Study of FID- 007 in Patients with Advanced Solid Tumors

211-17/0C-17-14; An Open-Label, Non-Randomized, Multicenter Study to Determine the Pharmacokinetics and Safety of Niraparib Following a Single Oral Dose in Patients with Advanced Solid Tumors and Either Normal Hepatic Function or Moderate Hepatic Impairment (Phase 1 Clinical trial appropriate for patients with advanced solid tumors)

SCREENING AND HIGH RISK SERVICES

The recently launched Active Surveillance Program is available to men with low-grade low stage prostate cancer not requiring treatment (Gleason 6 or less). Men enrolled undergo regular screening utilizing state-of-the-art imaging, targeted biopsies, and molecular cancer profiling. Built into the program are all the components for successful lifestyle modification to reduce the risk of cancer progression including nutrition support under the guidance of a certified oncologic dietitian, exercise and weight management with a personal trainer, and smoking cessation. The Active Surveillance program includes a data registry to an IRB protocol to better understand the impact of lifestyle modification on prostate cancer progression.

For patients with a personal or family history of prostate or kidney cancer, genetic counseling and testing is available through Hoag’s Hereditary Cancer Program.

SUPPORT AND EDUCATION

The Urologic Cancer Program Nurse Navigator Sandy Southerland B.S.N., R.N., O.C.N., guides patients through multimodality treatment plans and navigates them through the healthcare system, providing education and emotional support to patients and their families along the way.

Sandy leads the Bladder Cancer Support Group, which meets every other month at the Patty & George Hoag Cancer Center in Newport Beach, the Kidney Cancer Support Group, which meets every other month at Hoag Cancer Center Irvine, and the Prostate Cancer Support Group, which meets every other month in both Newport Beach and Irvine.

Hoag’s Ostomy Care Program is available to help patients who have had surgery for bladder cancer manage their ostomies while optimizing quality of life. An Ostomy Support Group is offered monthly.

Hoag’s Pelvic Health Program offers specialized pelvic floor physical therapy at Hoag Health Center Irvine – Sand Canyon as well as Hoag Health Center Newport Beach. A team of physical therapists who have their doctorates and advanced certifications in pelvic floor physical therapy provide preoperative education and pelvic floor muscle uptraining and strengthening to patients prior to prostate removal as well as physical therapy post-surgery with the goal of facilitating recovery time and continence. Physical therapy before and after neobladder reconstruction is also important to assist with continence strength after surgery. Anecdotal evidence suggests 75% of patients who do physical therapy are dry after catheter removal and 95% are dry within six weeks.

For more information call: 949-722-6237