My career has been devoted to clinical excellence, education and research. I have trained and mentored over 130 residents and post graduate fellows. I am interested in prostate disease management, both cancer and benign and successfully lead a multi institutional group in investigation of one of the first minimally invasive therapies for benign prostatic hyperplasia, microwave thermal therapy which is now an FDA approved device for alleviating symptoms related to bladder outlet obstruction from benign prostatic hyperplasia. The ability to merge outcome reporting with interrogation of radical prostatectomy specimens lead to a number of program projects put in place by our team which subsequently resulted in achieving the first institutional NIH SPORE grant award for prostate cancer ($6 million per year) in 1999. This was renewed in 2005. With the development of the renal cancer interdisciplinary working group we challenged standard practice of radical nephrectomy in renal mass management that it represented “over treatment” for a significant number of patients with small renal masses. This lead to many articles impacting national and international guidelines to recommend kidney preserving surgery for small renal masses, a significant paradigm shift in the last decade of kidney cancer management. In addition, I was co-investigator in a biospecimen procurement protocol that lead to direct identification of renal cancer biomarkers, ie, B7-H family of ligands in the management and outcome of patients with renal cancer. This work has spawned approximately 7 patent applications, 20 peer review publications including Cancer, Cancer Research, Clinical Cancer Research, Proceedings for the National Academy of Science and the execution of two Mayo-to-Pharma (Medarex) therapeutic licenses. I was also co-developer of a molecular signature prognostic assay (bio-SSIGN) to predict outcome (cancer recurrence and survival) for patients who have undergone radical nephrectomy for renal carcinoma. The kidney cancer disease working group helped champion the bench to clinic translation of CTLA-4 blockade (Ipilimumab) as an immunotherapeutic approach to prevent immune cell down regulation in order to treat malignancy. I was co-investigator for a federally funded DOD-sponsored CTLA-4 blockade study entitled, “A Phase II Immunotherapeutic Trial: Combination Androgen Ablative Therapy and CTLA-4 Blockade as a Treatment for Advanced Prostate Cancer.” This approach has greatly bolstered interest in prostate cancer as a premier target for immunotherapy.
In terms of surgical excellence, I lead a prospective evaluation of retroperiotoneal lymph node dissection in the management of patient with high risk renal cell carcinoma. We identified important prognostic variables based on frozen section (real time) evaluation of radical nephrectomy specimens which would trigger a retroperitoneal lymph node dissection to improve staging and control a resistant site of metastatic spread. In a prospective analysis of over 400 patients we performed tumor mapping studies to identify pathways of spread of renal malignancy to the ipsilateral and contralateral vessels in the retroperitoneum. This tumor mapping approach will lead to a standardized template for dissection of the retroperitoneum in patients with advanced renal malignancy who are candidates for attempts at cure.
I was an early surgical leader with others in performing intestinal neobladder reconstruction after surgical removal of the bladder for malignancy. In addition, I was the first at an institutional level to perform this procedure in women, therefore, avoiding the use of an external urinary collecting device and allowing volitional voiding and urinary control. This operation has significantly enhanced the quality of life for many bladder cancer patients over the last 20 years.
I became chair of one of the largest departments of urology in the country at Mayo Clinic in 1999. I established a strong committee system for practice, education and research, secured ACGME accreditation for the largest urology residency program in the United States and achieved a resident board pass rate of 100%. Education was a daily activity in that the residency training was based on preceptorship model. In 2006 I was offered a position at the highest level of governance at the Mayo Clinic in Rochester, Minnesota to serve on the twelve member executive board which governs the clinical, research and educational activity of 3,300 staff physicians, medical scientists, clinical and research associates and also 3,200 residents, fellows and students.
In my current role as Chair of Urology at MGH, my clinical and research activity will involve urologic oncology and reconstructive urology. In recognition of my professional work the American Urologic Association awarded me the Career Contribution Award for 2010.