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Mark Soloway | |
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Born | Cleveland, Ohio |
Education | MD (1970) |
Alma mater | Northwestern University, Case Western Reserve |
Occupation | Urologic Oncology |
Mark S. Soloway is a leading authority in urologic cancer, [1] researcher, former departmental chair, medical professor and invitational lecturer. He served as chairman of the University of Miami Miller School of Medicine Department of Urology [2] and is currently a professor at the Miller School of Medicine. Born in Cleveland, Soloway received his B.Sc. from Northwestern University in Chicago (1961–1964). He completed his M.D. and residency at Case Western Reserve University School of Medicine in Cleveland, Ohio (1964–1970). He completed a fellowship at the National Cancer Institute of the National Institute of Health in Bethesda, MD (1970–1972). Soloway has received numerous awards for his work as a researcher and teacher, These awards are American Urological Association's Gold Cystoscope award, Mosby Scholarship for Scholastic Excellence award (1967), North Central Section of American Urological Association Traveling Fellowship award (1972) [3] and many others. These are outstanding achievements for an individual who has contributed most to the field of urology within ten years of completion of his residency program” (1984). [4]
Soloway has received numerous honors and awards. These include the Gold Cystoscope Award from the American Urological Association in 1984, and the Presidential Citation of 2008 [5] from the American Urological Association for his contributions to clinical urology and his educational innovations. Soloway was honored with a corresponding membership in the German Urology Association and the Dutch Urologic Society. [6] Soloway has been the visiting professor in over 50 academic programs both nationally and internationally and a guest speaker at national meetings in over 30 countries. [7] [8] [9] He was one of the founding members of the International Urologic Research Society. In 2004–2005 Soloway served the chair of the first International Panel on Cancer, [10] a project that included fourteen individual panels and over one hundred experts in different aspects of bladder cancer. The Societe Internationale de Urologie (the governing body of the International Panel on Bladder Cancer) [11] and the International Consultation of Urologic Diseases have jointly commissioned him again to chair the second International Panel on Bladder Cancer. [12]
Soloway's contribution to the field of bladder cancer began when he was a Clinical Associate at the National Cancer Institute of the National Institutes of Health. [13] While working at the NCI, Soloway was instrumental in developing a unique carcinogen-induced animal model for urothelial carcinoma. [14] This FANFT-induced primary and transplantable tumor model allowed him to investigate the efficacy of several investigational chemotherapeutic drugs for the treatment of bladder cancer. [15] [16] [17] Today, even after more than thirty years, this transplantable tumor model, now established as the MBT-2 tumor and its more malignant derivative MBT-9, are still being used by researchers all over the world to test experimental and targeted therapeutic agents. Soloway's research was supported by NIH funding throughout his residency in Urology at Case Western Reserve University and as faculty at the University of Tennessee Center for the Health Sciences.
At the same time, Soloway was studying the usefulness of different investigational drugs in the animal model, he was also testing the hypothesis that the high rate of local recurrence of urothelial tumors may be the result of implantation of tumor cells on the urothelial surface following endoscopic resection of bladder tumors. [18] By developing an orthotopic bladder implantation animal tumor model, Soloway was able to establish that an injury to the urothelium created the necessary environment for tumor implantation and the scientific evidence in support of early intravesical chemotherapy following transurethral resection of a bladder tumor. [19] [20] [21] Twenty years later, a series of prospective randomized clinical trials have firmly established the benefit of post-TURBT intravesical chemotherapy. [22] It is also noteworthy that the orthotopic tumor model developed by Soloway is still the only tumor model that recapitulates the development of muscle-invasive bladder cancer in patients.
Soloway was one of the first urologic oncologists to use flexible cystoscopy as an integral part of his office practice; today, the majority of the world uses it. [23]
In contrast to Soloway's work in bladder cancer, which was largely initiated by laboratory work using his animal model, his research on prostate cancer is clinically oriented and has focused in six different areas: the use of transrectal ultrasonography for the diagnosis of prostate cancer; the development of the periprostatic nerve block to decrease pain during biopsy; the evaluation of the role of androgen deprivation prior to radical prostatectomy for locally advanced prostate cancer; the importance of quality of life in treatment decision-making; the recognition of active surveillance as a management strategy for low-risk prostate cancer; and surgical techniques for total prostatectomy.
Always fascinated with new technology, very early on Soloway saw the potential of ultrasound guided biopsies over the digitally guided biopsies and soon he began promoting the TRUS biopsy method to urologists for their outpatient clinics. [24] [25] [26] In an effort to minimize the discomfort from biopsies, he also popularized the use of the periprostatic nerve block. [27] [28] This procedure is used to minimize the pain associated with a prostate biopsy and is used in over 500,000 procedures annually in the US alone.
During the 1980s and early 1990s, a high percentage of patients with prostate cancer were diagnosed with locally advanced disease. Anecdotally, many of these patients were given the newly developed LHRH analogs as initial treatment for their disease. Since their initial responses were impressive, it seemed reasonable to give androgen deprivation prior to prostatectomy with the hope of improving progression free and overall survival. [29] [30] Enlisting the cooperation of a multi-institutional group, Soloway initiated a prospective randomized trial to test the efficacy of neoadjuvant androgen deprivation therapy. This randomized trial showed that although the surgical margin rate was lower for men who had received androgen deprivation prior to prostatectomy, there was no improvement in progression free or overall survival. [31] [32] Other groups who later performed similar studies have substantiated these results.
Another focus of Soloway's clinical research has been on the relationship between positive surgical margins and the preservation of the bladder neck and approach to the seminal vesicles. His first publication in 1996 on this topic detailed pathological analysis of the location and consequences of positive surgical margins. [33] In a more recent paper published in the Journal of Urology, he reported that the recurrence rate was only 20% in his patient cohort with a positive surgical margin and therefore, the routine adjuvant radiation therapy would over treat 80% of the patients. [34] [35] On the subject of urinary continence, for over 20 years, Soloway has been a proponent of bladder neck preservation for enhancing urinary continence without compromising cancer control for patients undergoing radical prostatectomy. [36] [37] Soloway and M. Manoharan have worked together to minimize the side effects of a radical prostatectomy. They have popularized the lower abdominal transverse incision to minimize pain and enhance recovery as well as providing a smaller, less obvious scar. [38] They have shown that most patients do not require a drain [39] [40] [41] and an inguinal hernia can be easily be repaired at the same operation of a radical prostatectomy using this transverse incision. [42] [43]
With the advent of PSA and early detection of prostate cancer, Soloway, concerned about the risk of overtreatment, has been an advocate of active surveillance for patients with low-risk, low volume Gleason 6 prostate cancer who are compliant with careful monitoring. In 2000 he published his first series of patients including those eligible for watchful waiting, as well as active surveillance and reported that only a few of these patients went on to have treatment. [44] Using a tighter definition for active surveillance, Soloway's group reported that less than 15% of these prostate cancer patients went on to treatment. [45] This series was updated recently in European Urology with the addition of quality of life parameters and a constant of 15% progressing to treatment.
Over the last two decades, Soloway has worked closely in tandem with a former resident and co-faculty member, Gaetano Ciancio on kidney cancer. Together they have revolutionized the surgical approach for large renal tumors, particularly those in which the tumor extends into the vena cava. Ciancio is a urologist, who is fellowship trained in renal and liver transplantation. More than 10 years ago, Soloway and Ciancio worked as a team to reduce the perioperative morbidity and mortality associated with these large tumor masses. Their idea was to incorporate surgical techniques from liver transplantation to increase the exposure of the vena cava with the anticipation that this would reduce blood loss and obviate circulatory arrest. Together they have published over 35 articles beginning with their first description of this technique in 2000. [46] Their most recent publication [47] is an update of their step-by-step approach toward minimizing complications related to renal cell carcinoma with vena cava thrombus. This series emphasizes the improvements in safety and reduction in operative mortality and morbidity related to their technique. Since most tertiary medical centers where these procedures are likely to be performed now have liver transplant surgeons, this technique can easily be duplicated.
Despite his busy clinical practice and research programs in the mid-1980s, Soloway recognized the need to address quality of life issues associated with the treatments for prostate cancer. He developed one of the first prostate cancer support groups in the country in Memphis, Tennessee. In 1992, he co-authored one of the first QOL studies [48] examining patient preference related to LHRH versus orchiectomy for patients with advanced disease. In 1995 Soloway and his colleagues reported on a study that looked at patients with localized prostate cancer and the QOL implications of surgical management vs. radiation therapy. [49] Recognizing that prostate cancer is a couple's disease, Soloway also studied the psychosocial and sexual implications of this disease on patients and their partners. [50]
Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.
The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue, as well as connective tissue.
Prostate cancer is the uncontrolled growth of cells in the prostate, a gland in the male reproductive system just below the bladder. Early prostate cancer usually causes no symptoms. As the cancer develops, one or more tumors can damage nearby organs causing erectile dysfunction, blood in the urine or semen, and trouble urinating. For some patients, the cancer eventually spread to other areas of the body, particularly the bones and lymph nodes. There, tumors cause severe bone pain, leg weakness or paralysis, and eventually death.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems.
Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become malignant.
Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.
Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under general, spinal, or epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence, but these outcomes are related to a combination of individual patient anatomy, surgical technique, and the experience and skill of the surgeon.
Radical perineal prostatectomy is a surgical procedure wherein the entire prostate gland is removed through an incision in the area between the anus and the scrotum (perineum).
Laparoscopic radical prostatectomy (LRP) is a form of radical prostatectomy, an operation for prostate cancer. Contrasted with the original open form of the surgery, it does not make a large incision but instead uses fiber optics and miniaturization.
Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are affected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred.
Mani Menon, born 9 July 1948 in Trichur, India, is an American surgeon whose work has helped to lay the foundation for modern Robotic Cancer Surgery. He is the founding director and the Raj and Padma Vattikuti Distinguished Chair of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, MI, where he established the first cancer-oriented robotics program in the world. Menon is widely regarded for his role in the development of robotic surgery techniques for the treatment of patients with prostate, kidney, and bladder cancers, as well as for the development of robotic kidney transplantation.
Menon is the recipient of the Gold Cystoscope award, Hugh Hampton Young award, the Keyes Medal, the prestigious B.C. Roy award.
Douglas S. Scherr, M.D. is an American surgeon and specialist in Urologic Oncology. He is currently the Clinical Director of Urologic Oncology at Weill Cornell Medicine. He also holds an appointment at the Rockefeller University as a Visiting Associate Physician. Scherr was the first physician at Cornell to perform a robotic prostatectomy as well as a robotic cystectomy.
Treatment for prostate cancer may involve active surveillance, surgery, radiation therapy – including brachytherapy and external-beam radiation therapy, proton therapy, high-intensity focused ultrasound (HIFU), cryosurgery, hormonal therapy, chemotherapy, or some combination. Treatments also extend to survivorship based interventions. These interventions are focused on five domains including: physical symptoms, psychological symptoms, surveillance, health promotion and care coordination. However, a published review has found only high levels of evidence for interventions that target physical and psychological symptom management and health promotion, with no reviews of interventions for either care coordination or surveillance. The favored treatment option depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors include the man's age, his general health, and his feelings about potential treatments and their possible side-effects. Because all treatments can have significant side-effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.
Simon J. Hall is an American researcher who is the Associate Professor and Kyung Hyun Kim, M.D. Chair of Urology and Assistant Professor, Department of Gene and Cell Medicine at The Mount Sinai School of Medicine, as well as the Director of the Barbara and Maurice Deane Prostate Health and Research Center at The Mount Sinai Medical Center, both in New York City.
Dr. Michael A. Palese, is an American urologist specializing in robotic, laparoscopic and endoscopic surgery, with a special emphasis on robotic surgeries relating to kidney cancer and kidney stone disease.
Roger Sinclair Kirby FRCS(Urol), FEBU is a British retired prostate surgeon and professor of urology, researcher, writer on men's health and prostate disease, founding editor of the journal Prostate Cancer and Prostatic Diseases and Trends in Urology and Men's Health and a fundraiser for prostate disease charities, best known for his use of the da Vinci surgical robot for laparoscopic prostatectomy in the treatment of prostate cancer. He is a co-founder and president of the charity The Urology Foundation (TUF), vice-president of the charity Prostate Cancer UK, trustee of the King Edward VII's Hospital and as of 2020 is president of the Royal Society of Medicine (RSM), London.
Michael D. Stifelman Michael D. Stifelman, M.D., is Chair of Urology at Hackensack University Medical Center, Director of Robotic Surgery at Hackensack Meridian Health, and Professor and Inaugural Chair of Urology at Hackensack Meridian School of Medicine.
Vipul R. Patel, FACS is the founder and Medical Director of the Florida Hospital Global Robotics Institute, founder and Vice President of the Society of Robotic Surgery, and founder and Editor Emeritus of The Journal of Robotic Surgery. He is board certified by the American Urological Association and specializes in robotic surgery for prostate cancer. As of June, 2023 he performed his 17,000th robotic-assisted prostatectomy. The large volume of prostatectomies he has performed has enabled him to amass a large amount of statistical evidence regarding the efficacy of robotic techniques which has been used in developing and refining techniques. Patel credits the use of robotic assisted surgery with helping surgeons achieve better surgical outcomes with the "trifecta" of cancer control, continence and sexual function. In the course of his career Patel has led and participated in studies that have resulted in developing improved outcomes for robotic surgery and urologic treatment.
Terence John MillinFRCSI FRCS LRCP was a British-born Irish urological surgeon, who in 1945, introduced a surgical treatment of benign large prostates using the retropubic prostatectomy, later known as the Millin's prostatectomy, where he approached the prostate from behind the pubic bone and through the prostatic capsule, removing the prostate through the retropubic space and hence avoided cutting into the bladder. It superseded the technique of transvesical prostatectomy used by Peter Freyer, where the prostate was removed through the bladder.
Gaetano Ciancio is an Italian American surgeon at the University of Miami who specializes in kidney transplant. He is the chief medical and academic officer of the Miami Transplant Institute and the director of its Kidney & Kidney-Pancreas Programs. His most significant contributions to medicine are related to surgically treating kidney cancer once it has spread to the inferior vena cava and in optimizing the immunosuppression protocol after kidney transplant.
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