A Surgeon’s View: Why Genetics? Why Now?

“Genetics is going to revolutionize the practice of medicine.”

In a brief look back at his career, surgeon William Catalona answers the question of why genetics is the next tool for researching the causes of and treatments for prostate cancer.

When Dr. Catalona began his medical career, his goal was to improve surgery for men who had prostate cancer.

“Surgery was the most effective treatment for prostate cancer at that time but the risk of impotence and incontinence was so great that men not only avoided the treatment but also the diagnostic rectal exam,”Catalona pointed out.

Catalona was instrumental in refining and teaching the technique of nerve sparing surgery, originally described by his mentor, Patrick Walsh M.D. at Johns Hopkins, to diminish the risks of impotence and incontinence.

That goal accomplished, he confronted the next problem. The rectal exam, which was the only diagnostic method available then, found the cancer too late – when it had spread beyond the prostate in 70% of the patients.

“Prostate cancer had to be detected in a more curable stage,” Catalona said.

The PSA test existed but was used only to monitor men already in treatment. Clinical studies, which Catalona began in St. Louis, showed that the PSA test was effective in the early diagnosis and screening for prostate cancer.

That finding helped reverse the death rate in prostate cancer. With early diagnosis and effective treatment, 75 to 85% of prostate cancer patients can be cured.

Having accomplished the goal of early detection, attention could be directed to finding out what caused prostate cancer and how it could be prevented.

“The answers to those questions are going to come from genetic studies,” Catalona said.

Fifteen years ago, Catalona began collecting blood samples and tumor samples from men who appeared to have a family history of prostate cancer.

“I knew that we’d need those samples when technology caught up with our visions,” he said.

In fact, the blood and tumor samples from the sib-pairs (brothers’) study, initiated by Dr. Catalona and supported by the Urological Research Foundation, produced the first samples used by many prostate cancer researchers across the country. They helped scientists find out where to look for the possible chromosomes and then the genes involved in the development of prostate cancer. Researchers have discovered several new regions statistically associated with prostate cancer.

“If we can find out which genes are involved in the development of prostate cancer and then figure out what goes wrong – then they are mutated – then we can direct our attention to the cure and prevention of prostate cancer.

“We don’t have practical applications for prostate cancer yet, but we’re so very close,” Catalona said.