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
[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