Combined Harvard Urologic Oncology Fellowship Program

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1 Combined Harvard Urologic Oncology Fellowship Program 1

2 Goal: Department of Urology To reduce the disease burden for patients with urologic issues by improving: Clinical Care Teaching Research 2

3 History of Fellowship Program Urologic Oncology Fellowship at MGH 2005 SUO Accreditation at MGH 2011 Brigham & Women s Hospital as Affiliate member 2013 First combined fellows entered July 2014 SUO Accredited Combined Harvard Urologic Oncology Fellowship between MGH & BWH

4 SUO Fellowship Curriculum Year 1: Summer Program Clinical Effectiveness Course at Harvard School of Public Health Development of research projects Clinical responsibilities will be limited one half-day session of clinic per week. During this clinic session, the fellow will be responsible for clinical care and surgical management of his/her own patients. Participate in one half-day GU Oncology Multidisciplinary Clinic Fellow will share weekend call with Urology Cabot Attending at Mass General or attending call at Brigham & Women s During first year, there will be some surgical exposure (approximately once per week) after completion of the Clinical Effectiveness Course 4

5 SUO Fellowship Curriculum Year 2 Equal time is spent at Mass General and BWH during 2 nd year. GU Medical Oncology Rotation: one month session with GU Medical Oncologists at MGH or BWH/Dana Farber Cancer Institute GU Radiation Oncology Rotation: will spend one month with our GU Radiation Oncologists at MGH or BWH/Dana Farber Cancer Institute. Surgical exposure in the operating room will increase during second year with attention to specific urologic oncologic cases. Fellow will continue to maintain and manage his/her own clinic session for a one half-day session per week. Fellow will continue to share in the weekend on-call at MGH or weekly attending call at BWH. 5

6 MGH Urologic Oncology Faculty Dr. Michael Blute (Chair Department of Urology) Dr. Aria Olumi (Director Urologic Oncology Fellowship Program) Dr. Douglas Dahl Dr. Adam Feldman Dr. Niall Heney Dr. Francis McGovern Dr. Shahin Tabatabaei Dr. Matthew Wszolek 6

7 BWH Urologic Oncology Faculty Dr. Adam Kibel (Chair Division of Urologic Surgery) Dr. Steven Chang (Associate Director of Urologic Oncology Fellowship Program) Dr. Kevin Loughlin Dr. Mark Preston Dr. Jerome P. Richie Dr. Graeme Steele Dr. Quoc-Dien Trinh 7

8 Residency Format 3 residents/yr at MGH and 3 residents/yr at BWH 1 year general surgery 0, 4 mos, 8 mos research or general surgery 4 years urology At MGH an additional: 4-6 months attending position: Cabot Service Chief 8

9 Urology Residency Training Urology Residency 5 year program 3 residents per year Junior resident on O Neil, Leadbetter or Kerr Service MGH Junior at Children's: 2 mos Senior, Clinical Senior MGH Senior Children's: 3 mos Research / Outpatient: 6 mos Chief Outpatient: MGH, Danvers Chief Resident: One year 9

10 MGH Clinical Volume: FY 2014 Outpatient Visits 29,100 7% increase FY 12 FY 14 Outpatient Office Procedures: 5,370 (4% increase compared to FY 2012) Cystoscopy, laser fulguration bladder tumors, vasectomies, stent placement and removal, minor surgical procedures, periurethral injections, prostate biopsies, urodynamics Main OR Procedures (six operating rooms): 3,360 cases 2% increase FY 12 FY 14 Inpatient Admission 1,425 8% decrease FY 12 FY 14 10

11 BWH Clinical Volume: FY 2014 Outpatient Visits: ~18,000 9% growth FY 14 9% growth FY 13 2% growth FY 12 Outpatient Office Procedures: 8,055 Cystoscopy, laser fulguration bladder tumors, vasectomies, stent placement and removal, minor surgical procedures, periurethral injections, prostate biopsies BWH + Faulkner + Foxboro OR Procedures: 14,357 cases 2% growth FY 14 1% growth FY 13 4% growth FY 12 11

12 Academic Productivity-MGH >150 publications per year between the two institutions Many externally funded research grants Refer to document for details 12

13 Urologic Oncology-MGH Kidney Cancer A comparison of nephron sparing techniques: percutaneous radiofrequency ablation (RFA) vs. open and laparoscopic partial nephrectomy (Feldman) Renal Biopsy for Suspicious Renal Masses: The MGH Cohort of 900 patients (Feldman) Molecular pathogenesis of angiomyolipoma and other TSC related neoplasm (Wu funded by NIH/Program Project) 13

14 Urologic Oncology-MGH Bladder Cancer Multi-Institutional Bladder Cancer Quality Care Initiative for nonmetastatic muscle invasive transitional cell carcinoma of the bladder (Feldman) RTOG 0926: Phase II -- Aggressive Forms of Stage T1 Bladder Management of Trimodality therapy (TURBT, Chemo- & Radiotherapy) (Dahl) RTOG 0524: Paclitaxel and Radiation Therapy With or Without Trastuzumab in Treating Patients Who Have Undergone Surgery for Bladder Cancer (Dahl) Genetic signatures in T1 G3 bladder cancer (McDougal) 14

15 Urologic Oncology-MGH Prostate Cancer 5-alpha reductase 2 expression in adult prostate tissue (Olumi funded by NIH/R01 Biomarkers for Active Surveillance in Prostate Cancer (Feldman funded by DOD & Prostate Cancer Foundation) Circulating Tumor Cell analysis in Prostate Cancer (Dahl) Molecular Mechanisms of Resistance to Pro-Apoptotic Therapies (Olumi funded by New York Academy of Medicine) Molecular pathogenesis of angiomyolipoma and other TSC related neoplasm (Wu funded Program Project Grant from NIH) 15

16 Urologic Oncology-MGH Prostate Cancer (Cont.) Metabolic state of Prostate Cancer Cells determines sensitivity to Metformin in Prostate Cancer Cells (Olumi) Genetic signatures in prostate cancer (McDougal & Wu) Template biopsy in patients who are highly suspicious for having prostate cancer but have had negative biopsies (McDougal) Metabolomics of prostate cancer in prostate biopsy specimens (McDougal & Wu funded by NIH) 16

17 GU Tissue Pathology Tissue Bank Fresh frozen tissue (Wu & McDougal Funded by MGH Bertucci Research Fund) Prostate: 3547 Kidney: 1091 Bladder : 244 Testis: 140 Adrenal:

18 BWH Clinical Trials Prostate Cancer Diet to Alter Disease Progression in Prostate Cancer (Kibel) Prospective Study of Impact of Decipher on Treatment Consideration and Decision Following Pro-Impact (Kibel) The Men s Eating and Living Study (MEAL) CALGB (Kibel) Energy Balance and Post-Radical Prostatectomy Urinary & Sexual Function (Kibel) Neoadjuvant Enzolutamide for High Risk Prostate Cancer (Kibel) Genetic Risk Profiling for Prostate Cancer (Kibel) 18

19 BWH Clinical Trials Prostate Cancer - continued Open Registry to Measure the Impact of Adding Genomic Testing on Treatment Decisions (Kibel) Germline Sequencing Study for Aggressive Prostate Cancer (Kibel) High Throughput Sequencing in Prostate Cancer (Kibel) Image Overlay for Robot-Assisted Laparoscopic Radical Prostatectomy (Kibel) Financial Well-Being Following Prostate Cancer Diagnosis (Trinh) 19

20 BWH Clinical Trials Prostate Cancer - continued Tumor-Specific Fingerprinting by Urinary MMP Analysis (Loughlin) Validation of Novel Biomarkers for Early Detection of Prostate Cancer (Loughlin) PCORI funded project to develop guidelines for prostate cancer screening in collaboration with Umass (O Leary) 20

21 BWH Clinical Trials Kidney Cancer Prospective Trial Evaluating Novel Biomarkers for Renal Function (Chang) Prospective Trial Evaluating Novel Biomarkers for RCC (Chang) Identification of Vascular Progenitor Cells From Human Renal Artery (Chang) Identification of Myofibroblasts in Kidney Fibrosis at the time of Nephrectomy (Chang) Health Related Quality of Life and Overall Patient Satisfaction with Health Care Following Urologic Surgery of Active Surveillance (Chang) 21

22 BWH Clinical Trials Bladder Cancer Tumor-Specific Fingerprinting by Urinary MMP Analysis (Loughlin) SWOG 1011 SLND vs. ELND for bladder cancer (Kibel) RAndomiZed Open versus Robotic cystectomy trial RAZOR (Kibel) 22

23 MGH & BWH at Forefront of Progress First successful human organ transplant Joseph Murray, MD 1990 Nobel Laureate in Physiology / Medicine BWH Jack W. Szostak, PhD 2009 Nobel Laureate in Physiology / Medicine MGH 23

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