PhD candidate and medical student Tanner Zachem and urologic oncologist Michael Abern, MD. Photo by Eamon Queeney.
An Innovator Sparks Innovation
Published
Walt and Arlene Simmons didn’t just hope for better treatment. They funded it.
Prostate Tumor ID, developed by urologic oncologist Michael Abern (left) and biomedical engineering PhD candidate and medical student Tanner Zachem, promises to help surgeons precisely “see” cancerous prostate tissue in real time. Photo by Eamon Queeney.
Walt Simmons is a seasoned mechanical engineer with an entire wall in his West Virginia home decorated with his patents. Still professionally active in his seventies, he owns and operates a hydro-electric facility that he purchased in a dilapidated condition.
“Even though I knew nothing about dams at the time,” Walt said.
“And even though it was junky, and filthy,” said Arlene.
“So I thought, well, this is a challenge,” said Walt, a playful gleam in his eye.
Walt’s love of a good challenge, and Arlene’s lifelong devotion to supporting her husband’s engineering ventures, soon drew the couple to ask Walt’s oncologist at Duke Cancer Institute, Daniel George, MD, a question. What could they do to advance treatments for the prostate cancer that nearly cost Walt his life?
“When Dr. Dan George pointed out that Duke was uniquely positioned to bring engineers and oncologists together to solve real problems, we knew we wanted to be part of it. I’ve always been fascinated by the process of discovery,” said Walt.
George, co-chair of the DCI’s Center for Prostate and Urologic Cancers, suggested an organic approach to fostering new collaborations: a monthly meeting between prostate cancer clinical researchers and biomedical engineers from Duke’s Pratt School of Engineering to identify and solve prostate cancer challenges. “Bringing biomedical engineers from Pratt to the table is special. That would not have happened without a funding incentive,” George said.
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We wanted to do something that would matter. Not just for Walt, but for other families facing prostate cancer. Supporting this kind of research felt like the right way to give back.
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Arlene Simmons
A Device is Born
A prototype of Prostate Tumor ID. Photo by Eamon Queeney.
The Simmons decided to fund seven “stimulus” awards, each worth $100,000, to kick start collaborative research. One of the first awards sparked the development of a device called Prostate Tumor ID that its inventors hope will improve outcomes for men with prostate cancer who have surgery to remove the prostate.
“Prostate cancer is notoriously hard to visualize during surgery,” said Michael Abern, MD, associate professor of urology at Duke. “Even with laparoscopic cameras, it’s difficult to distinguish cancerous tissue from healthy tissue in real time.”
A surgeon’s ability to successfully make that distinction profoundly impacts a patient’s outcome. If they cut away too little tissue, some cancer could remain. If they take too much, urinary and sexual function could suffer.
Urologists’ dream scenario, said Abern, would be a device designed to enhance a surgeons’ ability to precisely “see” the cancerous prostate tissue in real time — while they are performing a surgery.
Abern and Patrick Codd, MD, associate professor of neurosurgery, proposed to reengineer a tool already in use by Duke neurosurgeons to operate on brain tumors, making it suitable for prostatectomies.
The team assigned Tanner Zachem, a PhD candidate in biomedical engineering, to make a prototype of “Prostate Tumor ID” and test it. Zachem has also begun his first year of medical school at Duke this fall.
Zachem said that the Simmons stimulus grant accelerated the pace of device development
A prototype of Prostate Tumor ID. Photo by Eamon Queeney.
“Within one month of hearing about the stimulus grant, our team presented a prototype to Mr. and Mrs. Simmons. And just weeks later, boxes containing mechanical parts started arriving. And now, we’re generating a significant amount of data,” said Zachem. “I’m so grateful to the Simmons for jumpstarting my career.”
The resulting new tool is a compact, high-tech device that fits inside a 15mm laparoscopic port. It uses advanced imaging and tissue identification technology to instantly detect cancerous cells during surgery, giving surgeons immediate feedback on where to cut — and where to stop.
This past summer, Zachem and Duke’s urologists began testing TumorID. “This pilot funding will allow us to ultimately pursue additional funding to extend this imaging technology to a form that can be used during minimally invasive surgery,” Abern said.
For Walt and Arlene, the journey has been deeply personal — but also profoundly hopeful.
Arlene Simmons summed up the couples’ motivation for funding the stimulus awards. “We wanted to do something that would matter. Not just for Walt, but for other families facing prostate cancer. Supporting this kind of research felt like the right way to give back.”
New research from Duke Cancer Institute (DCI) is helping uncover why some bladder cancer patients are less likely to benefit from a common treatment and how a patient’s cancer history may help guide more personalized care decisions in the future.For more than 50 years, Bacillus Calmette-Guérin (BCG) treatment has been the standard of care for patients with early-stage bladder cancer. It helps reduce the chances that cancer will come back after surgery, and it works well for many patients. But not all bladder cancers behave the same.Bladder cancer is one form of a broader group known as urothelial cancers, which can develop anywhere along the urinary tract. Most cases begin in the bladder itself and are often caught early because patients develop symptoms, such as blood in the urine. These early-stage cancers are typically treated with surgery followed by BCG, which is delivered directly into the bladder to help prevent recurrence.However, about 10 percent of urothelial cancers originate in the upper urinary tract—in the kidneys or ureters. Even after those tumors are treated, cancer can later reappear in the bladder.“Historically, we’ve treated these bladder recurrences the same way we treat primary bladder cancer,” said Yu Guang Tan, MD, a urology fellow at Duke and a collaborator from Duke-NUS Medical School in Singapore. “But the question is, are they really the same disease?”In a recent study published in Urologic Oncology, Tan worked with colleagues including Michael Abern, MD, co-chair of the DCI Center for Prostate and Urologic Cancers, to explore whether bladder cancers that arise after upper tract disease respond differently to BCG than cancers that originate in the bladder.Across both a single-institution study and a larger systematic review and meta-analysis of more than 1,300 patients worldwide, the team found a consistent pattern: patients with a history of upper tract urothelial cancer were significantly more likely to experience recurrence or disease progression after BCG treatment.“In some cases, nearly half of these patients did not respond well to BCG,” Tan said. “That’s a substantial number, and it suggests we may need to think differently about how we treat this group.”BCG has long been the backbone of therapy for non-muscle invasive bladder cancer, but it is not without limitations. In addition to variable effectiveness, the treatment has also faced periodic shortages, particularly in smaller or rural care settings.“This research gives us another piece of the puzzle,” Abern said. “If a patient has a history of upper tract disease, it may shape expectations about how well BCG will work and whether we should consider other options sooner, including clinical trials.”Tan and Abern both emphasize that BCG remains an important and effective therapy for many patients. The goal is not to replace it, but to better match treatments to the patients most likely to benefit.One of the most important implications of the study is its potential role in advancing precision medicine for bladder cancer. The team found that while these cancers may look similar under the microscope, they are likely biologically distinct. That difference may explain why they respond differently to treatment.“We think this history of upper tract cancer may act as a clinical biomarker,” Tan said. “It helps us predict how a patient might respond, but we still need to understand the biology behind it.”To answer that question, the researchers are now conducting whole genome sequencing studies to identify the genetic differences between these tumor types. They are also building a joint database between Duke and Duke-NUS to uncover additional factors that may influence treatment outcomes.“It’s an exciting time in bladder cancer research,” Tan said. “We have many new therapies emerging, and the challenge now is figuring out which treatment is best for which patient.”The research reflects a strong international partnership between Duke University and Duke-NUS Medical School in Singapore. By bringing together data from multiple countries and healthcare systems, the team was able to confirm that these findings are consistent across diverse patient populations.“That global perspective is really important,” Abern said. “It shows that this trend holds true across different regions, which makes the findings more robust and meaningful.”As new therapies, including immunotherapy and targeted treatments, continue to emerge, studies like this one will play a key role in shaping how patients are selected for different treatment approaches.“By better understanding these differences, we can improve how we counsel patients, design clinical trials, and ultimately deliver more personalized care,” Abern said.
New research from Duke Cancer Institute (DCI) is helping uncover why some bladder cancer patients are less likely to benefit from a common treatment and how a patient’s cancer history may help guide more personalized care decisions in the future.For more than 50 years, Bacillus Calmette-Guérin (BCG) treatment has been the standard of care for patients with early-stage bladder cancer. It helps reduce the chances that cancer will come back after surgery, and it works well for many patients. But not all bladder cancers behave the same.Bladder cancer is one form of a broader group known as urothelial cancers, which can develop anywhere along the urinary tract. Most cases begin in the bladder itself and are often caught early because patients develop symptoms, such as blood in the urine. These early-stage cancers are typically treated with surgery followed by BCG, which is delivered directly into the bladder to help prevent recurrence.However, about 10 percent of urothelial cancers originate in the upper urinary tract—in the kidneys or ureters. Even after those tumors are treated, cancer can later reappear in the bladder.“Historically, we’ve treated these bladder recurrences the same way we treat primary bladder cancer,” said Yu Guang Tan, MD, a urology fellow at Duke and a collaborator from Duke-NUS Medical School in Singapore. “But the question is, are they really the same disease?”In a recent study published in Urologic Oncology, Tan worked with colleagues including Michael Abern, MD, co-chair of the DCI Center for Prostate and Urologic Cancers, to explore whether bladder cancers that arise after upper tract disease respond differently to BCG than cancers that originate in the bladder.Across both a single-institution study and a larger systematic review and meta-analysis of more than 1,300 patients worldwide, the team found a consistent pattern: patients with a history of upper tract urothelial cancer were significantly more likely to experience recurrence or disease progression after BCG treatment.“In some cases, nearly half of these patients did not respond well to BCG,” Tan said. “That’s a substantial number, and it suggests we may need to think differently about how we treat this group.”BCG has long been the backbone of therapy for non-muscle invasive bladder cancer, but it is not without limitations. In addition to variable effectiveness, the treatment has also faced periodic shortages, particularly in smaller or rural care settings.“This research gives us another piece of the puzzle,” Abern said. “If a patient has a history of upper tract disease, it may shape expectations about how well BCG will work and whether we should consider other options sooner, including clinical trials.”Tan and Abern both emphasize that BCG remains an important and effective therapy for many patients. The goal is not to replace it, but to better match treatments to the patients most likely to benefit.One of the most important implications of the study is its potential role in advancing precision medicine for bladder cancer. The team found that while these cancers may look similar under the microscope, they are likely biologically distinct. That difference may explain why they respond differently to treatment.“We think this history of upper tract cancer may act as a clinical biomarker,” Tan said. “It helps us predict how a patient might respond, but we still need to understand the biology behind it.”To answer that question, the researchers are now conducting whole genome sequencing studies to identify the genetic differences between these tumor types. They are also building a joint database between Duke and Duke-NUS to uncover additional factors that may influence treatment outcomes.“It’s an exciting time in bladder cancer research,” Tan said. “We have many new therapies emerging, and the challenge now is figuring out which treatment is best for which patient.”The research reflects a strong international partnership between Duke University and Duke-NUS Medical School in Singapore. By bringing together data from multiple countries and healthcare systems, the team was able to confirm that these findings are consistent across diverse patient populations.“That global perspective is really important,” Abern said. “It shows that this trend holds true across different regions, which makes the findings more robust and meaningful.”As new therapies, including immunotherapy and targeted treatments, continue to emerge, studies like this one will play a key role in shaping how patients are selected for different treatment approaches.“By better understanding these differences, we can improve how we counsel patients, design clinical trials, and ultimately deliver more personalized care,” Abern said.
