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techniques we use for these surgeries and develop a niche here in which we can do complex vascular work and have remarkably good outcomes. In many cases, patients have no evidence of residual cancer, or they have minimal cancer that we can then treat with chemotherapy. Ten years ago, these cases wouldn't have even been attempted." Treating the Full Spectrum of Bladder Cancer Multidisciplinary collaboration is also a key theme in the treatment of bladder cancer. Fellowship-trained urologic oncolo- gist Robert Svatek, MD, MSCI, leads the department in treating patients with both superficial and invasive bladder cancers. "On the superficial side, we're special- ists in deciding what combination and sequence of therapies to put into the blad- der," Dr. Svatek says. "On the invasive side, we perform a specialized operation called REFINING PROSTATE CANCER DETECTION AND RISK STR ATIFICATION JAVIER HERNANDEZ, MD, MSCI, Associate Professor in the Department of Urology at the UT School of Medicine, developed an interest in prostate cancer detec- tion while completing a fellowship under the mentorship of another faculty member, Ian Thompson, MD. Dr. Hernandez is the principal investigator for the Finasteride Challenge Study, a randomized clinical trial seeking to determine whether treating men with mild prostate-specific antigen (PSA) elevation with finasteride instead of antibiotics could help clinicians determine which patients truly need a biopsy of the prostate, a procedure that carries significant risk of infection. "We know that, in most men who have mild PSA elevation, benign prostatic hyperplasia [BPH], not cancer, is the culprit," Dr. Hernandez says. "Many providers in the community think, 'OK, we can bring PSA levels down with antibiotics and avoid biopsy.' The problem with this approach is that part of the reason why we're seeing increasing instances of infection after biopsies is that we're selecting out more antibiotic-resistant organisms. This approach also presumes that mild PSA elevation is due to infection, which is much less common than BPH. "We know from multiple studies that finasteride can lower PSA by roughly 50 percent within six months or so of treatment, with most of the decrease happening within the first few months," Dr. Hernandez continues. "If you have someone with a mild PSA elevation, and you were to challenge that patient's PSA with a short course of finaste- ride instead of antibiotics, could that help us determine — assuming there's a predicted drop in PSA — whether this man truly needs a biopsy or not? This is what we're trying to find out." Dr. Hernandez also collaborates with the Prostate Biopsy Collaborative Group, an international team of investigators seeking to determine the PSA threshold for prostate biopsy in patient popula- tions around the world. "Within this group, there's a substudy I lead here locally that seeks to better integrate family history information into prostate cancer risk assessment," Dr. Hernandez explains. "The widely used Prostate Cancer Prevention Trial risk calculator only accounts for whether a man has a first-degree relative with the cancer to assess his risk vis-à-vis family history. Studies suggest the number of first-degree relatives who've had cancer, prostate or otherwise, the number of second-degree relatives who've had prostate cancer, and the ages at which both first- and second-degree relatives were diagnosed all matter in determining prostate cancer risk. We're collecting extended family histories on our patients and submitting them to the Prostate Biopsy Collaborative Group to assess the impact of detailed family history on prostate cancer risk assessment." M D N E W S . CO M ■ MD NEWS San Antonio | 9