The University of Michigan Comprehensive Cancer Center has recognized Urologic Oncology as a program of excellence within the institution. The strength of this program is derived from the collaboration of highly trained, nationally recognized individuals working in the fields of urologic oncology, radiation oncology, medical oncology, and pathology. Together these people provide a broad range of specialized clinical expertise and research experience.
The clinical focus of the Urologic Oncology Program is the Multidisciplinary Urologic Oncology Clinic (MDUC). MDUC is designed for patients with newly diagnosed genitourinary cancers who are exploring treatment options. MDUC provides a patient with the opportunity to see experts from different specialties during one outpatient visit. A management strategy for each patient is discussed by the personnel participating in the clinic. Written communication is provided to the patient and the referring physician. MDUC is held on Thursday afternoons in the Cancer Center. New patients may schedule an MDUC appointment by calling (734) 647-8903.
The treatment of patients in the clinic is further enhanced by a weekly Genitourinary Oncology Conference wherein interesting cases are presented to a team of physicians and researchers. Current projects in clinical and basic research are also discussed. This conference is held on Tuesday mornings at 7:00 am and is organized by Sharon Drew.
Fields of Expertise of MDUC Personnel
James E. Montie, M.D. Area of Expertise: bladder, renal, prostate, and testes cancers. Dr. Montie completed his surgery training at The Cleveland Clinic Foundation and was on the staff of The Cleveland Clinic Foundation for thirteen years. He was previously a Professor of Urology at Wayne State University School of Medicine. In 1995 he joined the faculty at The University of Michigan as a Professor of Surgery in the Section of Urology. He is now Chairman of the Department of Urology. He is a founding member and former president of The Society of Urologic Oncology; an Editor of Seminars in Urologic Oncology; a member of The American College of Surgeons Commission on Cancer, American Joint Committee on Cancer, The American Urology Association Practice Parameters Committee on Bladder Cancer, and the National Comprehensive Cancer Center Guidelines Panel. He has authored 149 articles in peer-reviewed medical publications and 73 book chapters.
Martin Sanda, M.D. pioneered the application of gene-targeted immunotherapy in prostate cancer, and his prior studies at Johns Hopkins University are the basis for a Phase I/II clinical study at that institution using genetically modified, autologous prostate cancer vaccine cells secreting recombinant GM-CSF for the treatment of advanced prostate cancer. He completed research fellowships at the NCI in tumor immunology and at Johns Hopkins in prostate cancer animal models; his work has been recognized by clinical and basic science research awards from the American Urological Association and the American Cancer Society. His post-doctoral training at the NIH and Johns Hopkins led to a broad range of experience both in research regarding prostate cancer, tumor immunology, and gene therapy as well as in clinical urology regarding surgical management of bladder cancer and prostate cancer.
Cheryl Lee, M.D. had dedicated her clinical practice to the treatment of urologic cancers. She has broad surgical experience and performs innovative operations including the construction of bladder replacements after cystectomy; nerve-sparing prostatectomy; nerve grafts after removal of the neurovascular bundle during prostatectomy; and kidney-sparing surgery for small to medium tumors. She was trained in performing radical prostatectomy and in the use of sural nerve grafts under Dr. Peter Scardino at the Memorial Sloan Kettering Cancer Center, who is a pioneer of this technique. She has clinical appointments at the University Hospital and at the Veterans Administration Medical Center.
David Wood, M.D.
Howard M. Sandler, M.D. Area of Expertise: prostate and bladder cancer. Dr. Howard Sandler received his radiation oncology training at the Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania. He has been on the staff at The University of Michigan since 1989 and is currently an Associate Professor. He has particular expertise in prostate cancer and is the principle investigator of a national protocol studying dose escalation and conformal radiation therapy for prostate cancer. He is the author of over thirty peer reviewed publications and three book chapters.
Michael E. Ray, M.D., Ph.D. Area of expertise: prostate and bladder cancer. Dr. Michael Ray received his M.D. and Ph.D. from the University of Michigan in 1998. His Ph.D. studies were conducted in the Laboratory of Cancer Genetics at the National Human Genome Research Institute at the National Institutes of Health. His laboratory research has focused on genetic alterations in human cancers including melanoma, prostate cancer and breast cancer. He completed his radiation oncology training at the University of Michigan and then joined the faculty in 2003. His laboratory currently is focusing on prostate and bladder cancer. He has authored over a dozen peer reviewed scientific publications.
David Smith, M.D. Area of Expertise: bladder, kidney, prostate and testicular cancers. Dr. David Smith joined The University of Michigan Division of Hematology/Oncology in January, 1996. He did his hematology/oncology training at Duke University and was then on the faculty at The University of Pittsburgh and Pittsburgh Cancer Institute until 1996 when he joined The University of Michigan. Throughout his career, he has had a particular interest in urologic oncology and has twelve peer reviewed publications in this area. His particular area of interest is in the evaluation of new drugs for use in bladder, prostate, and kidney cancers.
Kenneth Pienta, M.D. Area of Expertise: prostate cancer. Dr. Kenneth Pienta is the Director of the Urologic Oncology Research Program in the Comprehensive Cancer Center. Dr. Pienta did his medical oncology training at Johns Hopkins University and was a Special Fellow in Oncology, specializing in urologic oncology. He was previously Assistant Professor of Medicine at Wayne State University School of Medicine and joined The University of Michigan as an Associate Professor of Medicine and Surgery in 1994. Dr. Pienta has international expertise in the development of novel chemotherapeutic programs for prostate cancer and is the principal investigator on The University of Michigan's SPORE (Specialized Program of Research Excellence) in prostate cancer awarded from The National Cancer Institute. Dr. Pienta is the author of more than one hundred peer reviewed articles and twenty book chapters.
Maha Hussain, M.D., FACP
Dr. Maha Hussain graduated from Baghdad University Medical School and completed an internal medicine residency and oncology fellowship at Wayne State University in Detroit. Prior to joining the University of Michigan faculty in 2002, Dr. Hussain had served as the genitourinary oncology section chief in the Division of Hematology/Oncology and the team leader for the Mulidisciplinary Genitourinary Oncology Program at the Barbara Ann Karmanos Cancer Institute and Wayne State University. She is a national expert and leader in the management of prostate and bladder cancer and chairs the Advanced Prostate Cancer subcommittee at the Southwest Oncology Group. Dr. Hussain is the author of more than 60 articles and book chapters.
The Multidisciplinary Clinic provides a patient the opportunity to see an expert from different specialties at one outpatient visit. This is particularly appropriate for a patient with uncertainty about treatment options or who has a complicated or unusual cancer. A management strategy for each patient is discussed by the personnel participating in the clinic. Written communication is provided to the patient and referring physician.
Clinical Research Projects
An additional strength of the Urologic Oncology Program is participation in innovative clinical trials or state-of-the-art therapies. Many of the unique studies available in urologic oncology are listed below.
Protocols are available for both metastatic disease and locally advanced bladder cancer using chemotherapy or a combination of chemotherapy, radiation therapy and surgery. A collaborative study is being performed with the Hematology Oncology Department at Wayne State University School of Medicine evaluating the combination of paclitaxel, carboplatin and gemcitabine. This may have substantially less toxicity than the traditional combination most widely used, MVAC.
From a surgical standpoint, Dr. Montie has one of the largest experiences in the country with orthotopic bladder replacement (neobladders). Of particular excitement is the opportunity to provide this neobladder to most women who are undergoing cystectomy for bladder cancer. With more than twelve years of experience in almost 100 patients, he has seen the operation refined and improved substantially to the current level of excellent results.
An innovative research program is underway under the direction of Dr. Martin Sanda, Associate Professor of Urology at the University of Michigan Medical School. In an animal model, Dr. Sanda is using an adenoviral vector for gene therapy for superficial carcinoma of the bladder. While not ready for clinical use at this time, there is hope that within the next 12 to 24 months, a clinical trial will be available.
Renal cell carcinoma (RCC or kidney cancer) has been of long-standing interest to members of the urologic oncology group. In urologic oncology, Dr. Montie has written a book on renal cell carcinoma (The Clinical Management of Renal Cell Carcinoma, Yearbook Medical Publishers, Chicago, 1990) and has published considerably on the surgical aspects of partial nephrectomy and inferior vena cava tumor thrombectomy. Both Drs. Bruce Redman and David Smith have experience in many institutional and national studies using biologic response modifiers to treat this cancer.
There are multiple trials available for patients with RCC. As part of the national Cytokine Working Group, Drs. Montie and Redman are evaluating the role of adjuvant interleukin-2 (IL-2) in patients with resected RCC at high risk of relapse. There is also a NCI-funded UM study under the direction of Dr. Alfred Chang evaluating adoptive immunotherapy with activated lymph node cells primed with autologous tumor cells which have been transduced with the GM-CSF gene. This trial requires that the patient have metastatic disease with a resectable metastatic lesion performed at the UM.
The institution has recently received a National Cancer Institute SPORE grant for the study of prostate cancer diagnosis and therapy and is one of only three institutions to receive this award. There is recognized special surgical expertise by Drs. Montie and Sanda for radical prostatectomy, using either traditional methods or nerve-sparing dissections in selected patients. Conformal radiation therapy at The University of Michigan is nationally recognized for quality and is one of a very limited number of institutions participating in a National Cancer Institute-sponsored trial investigating the benefit of this type of treatment. Dr. Kenneth Pienta has developed one of the most effective protocols for systemic chemotherapy for hormone refractory prostate cancer (Emcyt/VP-16) and is pursuing new approaches as well.
There is considerable clinical experience in the management of testicular cancer cases by Drs. Montie and David Smith. Also available is an aggressive treatment protocol for patients with recurrent disease after previous chemotherapy using autologous bone marrow transplantation. For patients with localized cancer, expertise in the nerve-sparing retroperitoneal lymph node dissection, designed to preserve normal ejaculation, is available.