Sylvester Comprehensive Cancer Center

UM/Sylvester Physicians and Scientists Help “Write the Book” on Bladder Cancer


Urologists and researchers from the University of Miami Sylvester Comprehensive Cancer Center and University of Miami Leonard M. Miller School of Medicine played critical roles in the International Consultation on Bladder Cancer, organized by the World Health Organization and the Société Internationale d’Urologie (SIU). “The goal is to establish guidelines, not only for urologists but all doctors worldwide who deal with bladder cancer,” said Mark S. Soloway, M.D., physician leader, Prostate, Kidney, and Bladder Cancer Site Disease Group, and chairman of the Department of Urology at UM. Dr. Soloway chaired the entire International Consultation.

“I got a call about one year ago from the head of this consultation through the WHO,” said Soloway. The SIU has now taken over the task. “He asked if I would like to chair this consultation. The goal was to set up guidelines for bladder cancer and that’s all the guidance I was given. Then it was my job.”

Soloway divided bladder cancer into 11 disciplines, including epidemiology and diagnosis, molecular tumor markers, several on different tumor types and stages, urinary diversions, radiation therapy, chemotherapy and non-traditional tumors. He selected chairpersons, then the various committees held three meetings over the year-long effort. Each group was tasked with producing one chapter for a book, the final product of the consultation, which promises to become the seminal text on the subject around the world. “This is really a major resource with over 700 pages of reports related to bladder cancer,” said Soloway. “That’s why getting the best people together, with all their collective experience over many years with thousands of patients, was so important. This work sets benchmarks and guidelines.”

“I truly feel that this text will be tremendously valuable to people around the world,” said Vinata B. Lokeshwar, Ph.D., associate professor of urology and cell biology and anatomy at the UM Miller School. Lokeshwar chaired the committee on tumor markers which yielded the longest chapter – a 157-page manuscript with 400 references. “This was a real interaction and people asked difficult questions and that led to us modifying our chapter,” said Lokeshwar. “The whole text is like that because for each panel they brought in experts from around the world.”

Other UM/Sylvester physicians, scientists, and school of medicine faculty members held important roles on various committees, including assistant professors Bruce R. Kava, M.D., Murugesan Manoharan, M.D., F.R.C.S., F.R.A.C.S., and Alan Nieder, M.D. A urology resident at UM, Adrienne Carmack, M.D., offered tremendous help in organizing and editing the text and co-authored the final chapter on non-urothelial carcinoma. “The book is great because it’s really up to date in what the current standards of care are,” said Carmack. “It will help people who aren’t able to keep up with the literature to know what the thinking is among experts in the field, who spend so much of their time studying and writing that literature.” Also, the 100 participants who served on all the panels are world leaders in their disciplines, not just in urology but in oncology, radiology, epidemiology and basic science. More faculty members from the UM Miller School took part than from any other institution, due largely to Soloway’s role as chairman.

“We talked about the guidelines for the treatment of various stages of the tumor,” said Soloway. “There was a beautiful section on the various urinary diversions. In other words, once you remove the bladder, how do you reconstitute the urinary tract? There has been a lot of work in the last 10 to 15 years on reconstructing the bladder.” International leaders also worked – sometimes contentiously – to write definitive chapters on diagnosing and treating this deadly disease. Bladder cancer is overwhelmingly linked to carcinogens in the environment, including tobacco use and, in some cases, parasites. In the United States alone there are more than 63,000 new cases every year and more than 13,000 deaths, according to the American Cancer Society. Among Americans, it is the fifth most common cancer in men, the eighth most common in women. In countries with high tobacco use the risk is greater, and in Egypt, because of an indigenous parasitic infection called schistosomiasis, bladder cancer is the most-diagnosed malignancy.

The reports that were formulated by the 100 or so physicians and scientists who served on the 11 committees will be published in three forms. First, two supplements will appear in the journal Urology, the leading peer-reviewed journal in the field. Then, the entire text will be published in print and on a CD, which will be sent to every member of the SIU worldwide. This work promises to be particularly valuable to people suffering from bladder cancer in less-developed areas. “In a lot of Third World countries this will be their textbook because they don’t have access to standard texts,” said Soloway. Lokeshwar agreed that this work is both comprehensive and convenient. “This can be an easy reference because now they really don’t have to read every single citation.”

The early results of the consultation were presented at the 27th Congress of the Société Internationale d’Urologie, a meeting of more than 3,000 specialists in urology in Hawaii last October. At that meeting, Dr. Soloway touched on the subjective nature of diagnosing and treating bladder cancer, hence the value of reaching a consensus on so many aspects of the disease. Lokeshwar agreed. “It can become a subjective opinion if it is one person writing a review or an article,” she said. “However, this was a panel so I had to take into consideration the opinions of 15 people before I put together this whole chapter.” That philosophy guided the entire text.

The final book and CD should be available in December 2005.

UM/Sylvester was founded in 1992 to provide comprehensive cancer services and today serves as the hub for cancer-related research, diagnosis, and treatment at the University of Miami Leonard M. Miller School of Medicine. UM/Sylvester handles more than 1,300 inpatient admissions annually, performs 2,900 surgical procedures, and treats 3,000 new cancer patients. All UM/Sylvester physicians are on the faculty of the Miller School of Medicine, South Florida’s only academic medical center. In addition, UM/Sylvester physicians and scientists are engaged in more than 150 clinical trials and receive more than $31 million annually in research grants. UM/Sylvester at Deerfield Beach recently opened to better meet the needs of residents of Broward and Palm Beach counties. This 10,000-square-foot facility at I-95 and S.W. 10th Street offers appointments with physicians from six cancer specialties, complementary therapies from the Courtelis Center, and education and outreach events.

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