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cystectomy, which is sometimes necessary for advanced cases. The challenge with advanced bladder cancer is that it's a disease of older individuals, and many of these patients suffer from comorbid illnesses. We are putting them through a pretty advanced operation. Therefore, we integrate closely with cardiologists, pulmonologists and medical oncologists to minimize risks and avoid complications." Dr. Svatek and colleagues perform bladder cancer surgeries using both open and robotic techniques using the da Vinci Surgical System. They also per- form extended lymph node dissections and offer a variety of urinary diversion options. Many patients undergoing a bladder removal are candidates for construction of a neobladder — a new bladder made from a portion of the small intestines. It's a proce- dure Dr. Svatek's team performs routinely. Bladder cancer surgery — a procedure that, historically, has had high complication and readmission rates — requires coor- dinated, integrated care to give patients the greatest chance of enjoying a success- ful outcome. "We've created a preoperative, intraopera- tive and postoperative continuum-of-care plan for these patients that has allowed us to decrease readmissions and overall com- plications substantially," Dr. Svatek says. "It's been demonstrated that patients enrolled in clinical trials experience improved care, and many of our patients have come to us because of an interest in participating in one of our active clinical trials." Liberating Young Lives from Testis Cancer After completing a urologic oncology fellowship at the UT Health Science Center San Antonio, Javier Hernandez, MD, MSCI, worked for many years at Brooke Army Medical Center in San Antonio before moving to UT Medicine. During his time at Brooke Army Medical Center, Dr. Hernandez came to specialize in per- forming surgery for testis cancer. "Caring for these patients is rewarding because testis cancer is curable when treated correctly and caught in time, and I feel I can make a huge difference for these patients because they're young men with full lives ahead of them," Dr. Hernandez says. "The challenge with these patients is that, quite frequently, initial presentation is delayed for several reasons, including patient denial, and so they already have metastatic disease when they present. "When this is the case, depending on the extent and subtype of disease, patients go through orchiectomy to establish tissue diagnosis, and then we have to decide, based on stage and histology, if they'll need chemotherapy or retroperitoneal lymph node dissection," Dr. Hernandez continues. "In some cases, we put patients on surveillance. In selected cases, radio- therapy may be necessary." Dr. Hernandez completes 15 to 20 retroperitoneal lymph node dissections per year, a high number for most urolo- gists. When treating certain testis cancer cases — open surgery is the standard approach — Dr. Hernandez works closely with vascular surgeons, who may be needed to repair blood vessel damage following tumor removal if malignancy has spread into the vasculature of the abdomen. "The infrastructure we have here in vascular surgery, anesthesiology, medical oncology and radiation oncology allows us to handle the most difficult cases," Dr. Hernandez says. "We can cure these patients, thanks to the efforts of the entire team." To learn more about the Department of Urology, visit UTMedicine.org/urology. ■ DEVELOPING NOVEL PROSTATE CANCER THERAPIES IMPROVING DETECTION METHODS isn't the only area of prostate cancer research taking place at the UT School of Medicine. Ronald Rodriguez, MD, PhD, Chair of the Department of Urology, and colleagues are devising new ways to treat the disease. "We've been co-developing the use of a drug to administer intraoperatively that binds to prostate cancer cells and fluoresces in the near-infrared spectrum when it's been induced and excited by a laser," Dr. Rodriguez says. "We developed the light source, optics and imaging, and tested this approach in animal studies. We're now actively pursuing clinical translation of this with a company to get this treatment to patients in the next year or two. The premise is that clinicians will be able to see prostate cancer as they operate robotically and identify lymph nodes that need to be removed. They will also be able to see whether cancer extends beyond the edges of the prostate to be sure all malignancy is removed, so there's minimal chance of recurrence." Dr. Rodriguez is also actively involved in gene therapy and viral development. "Recently, we developed a virus that could be turned on by the nonsteroidal anti- androgen bicalutamide," he says. "We've demonstrated in animal models that we can combine this virus with radiation and get a synergistic effect of cell death in prostate cancer cells. Patients with high-grade, high-risk prostate cancer are usually treated with hormone therapy and radiation therapy. This treatment is designed for them." 1 0 | San Antonio MD NEWS ■ M D N E W S . CO M

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