The DCI Center for Prostate and Urologic Cancers is a multidisciplinary team of physicians and researchers who are leaders in screening, diagnosing, and treating prostate and urologic cancers. The center is a major referral center and specializes in difficult-to-treat prostate cancers. We are also nationally recognized leaders in clinical, translational, and population research in the areas of health disparities, immunotherapy, population sciences, and RNA targets and therapeutics. Our overall goal is to improve survival rates and quality of life in patients with testicular cancer, bladder cancer, kidney cancer, and prostate cancer.
Visit DukeHealth.org for more information about prostate cancer treatment.
The DCI Prostate & Urologic Cancer Center provides comprehensive care, education, and training, and conducts clinical, translational, and population research. Our team includes urologists, medical oncologists, radiation oncologists, a dedicated genitourinary (GU) radiology group, nurse practitioners, physician assistants, scientists, and pathologists. The Center’s priorities are to:
Advanced first-in-human prostate cancer clinical trials
Lead studies to better understand the biology of health disparities and the most aggressive forms of prostate cancer
Develop new strategies to target the immune system
Conduct population studies in prostate cancer screening to further our understanding of the biology and symptom burden of stage 4 disease
Cultivate junior faculty and trainees to become the next generation of clinical and research leaders in the field.
At Duke Prostate and Urologic Cancer Center, we’ve put together a team of rising stars and world-renowned physicians specializing in detecting and treating all types of urologic cancers — from rare to common — including complex urologic cancer cases.
Active Surveillance Registry and Clinical Program for Prostate Cancer
We are strong advocates of active surveillance for small, nonaggressive prostate cancer. Our active surveillance registry and clinical program incorporates molecular testing of tumor tissue, prostate MRI, and lifestyle and dietary approaches to identify men who will benefit from treatment and those who can safely defer therapy. We aim to keep men on active surveillance until treatment is necessary and believe surveillance is a safe and important course for certain men with low-risk prostate cancer. Some men are candidates for watchful waiting. Patients who are not candidates for surgery or radiation are carefully observed until treatment is needed.
Personalized Medicine Approach
We understand that each patient's cancer possesses unique characteristics that can manifest in a variety of behaviors and outcomes. We utilize precision medicine to examine a patient’s urine or blood-based biomarkers, tissue-based biomarkers, and imaging biomarkers. We use this information to optimize and tailor treatment while minimizing risks. Our multi-disciplinary team-based approach includes patient counseling, risk stratification, and therapy based on individual patient’s health conditions, prostate and urologic cancer subtypes, and preferences.
Visit DukeHealth.org for more information about prostate cancer treatment.
Clinical research is critical to our collective mission to reduce the burden of prostate and urologic cancer. Our research focuses on prevention and screening, early diagnosis, and the development of new treatments, including targeted treatments and individualized care. We are making meaningful strides in tackling metastasis and aggressive cancer behavior. Each year, the DCI Center for Prostate and Urologic Cancers team presents pioneering data and practice-changing results at national and international conferences for cancer care.
As the recipient of millions of dollars in research funding annually, we offer patients access to clinical trials studying new therapies and advances in technologies and techniques, long before they become routinely available.
We are one of the few institutions participating in the Prostate Cancer Clinical Trials Consortium. This clinical research group is sponsored by the Prostate Cancer Foundation and the Department of Defense Prostate Cancer Research Program. It facilitates patient enrollment in phase I and phase II clinical trials and improves drug development for prostate cancer. Our physicians work with pharmaceutical companies to design clinical trials that allow us to study all phases of prostate and urologic cancers. We also provide access to phase 3 clinical trials, registries, biomarker studies, and genetic testing and counseling for men with prostate cancer.
As a result of these collaborations, we can offer a broader selection of medical, surgical, and minimally invasive options to more people, including those who are not considered candidates for treatment elsewhere.
Prostate Cancer Research
As leaders in the field of prostate cancer research, we work on the development of new therapies to improve survival, quality of life, and optimize care for patients most likely to benefit. Trials include:
Precision medicine approaches
Genetic sequencing (germline and tumor)
Immunotherapies
Molecularly targeted therapies based on a personalized genetic test
Circulating tumor cell biology studies
Radiopharmaceuticals
Combination approaches across all stages of prostate cancer.
Health Disparities Biology/Therapy
There are substantially higher rates of prostate cancer among African American men than men of other racial/ethnic groups. Our group studies how the biology of cancer is different between groups. We are committed to finding whether certain therapies work better in one group or the other.
Novel Immunotherapies
Our immune systems can recognize and fight cancer, but sometimes the cancer develops ways to trick our immune systems. Immunotherapies target our immune system to help fight the cancer. We are committed to developing, identifying, and testing new immunotherapies to improve how we treat prostate cancer.
Precision/Predictive Medicine and Biomarkers of Aggressive Disease
Our genes, lifestyles and environment can affect the way prostate cancer develops and responds to certain treatments. We study DNA and other molecules in cancer cells to tailor prostate cancer treatments. We work to identify biomarkers or biological differences between aggressive and less aggressive prostate cancers and use this information when making treatment decisions.
Lifestyle and Survivorship Studies
Our lifestyle and survivorship research aims to help patients and their families recover from the stress and long-term effects of prostate cancer diagnosis and treatment. Our studies hope to:
Bridge the gaps in knowledge about the relationships between physical activity, sedentary behavior, nutrition, and cancer
Optimize lifestyle factors to improve health, quality of life, and cancer outcomes
Examine how exercise testing may improve the assessment of functional status and drug toxicity
Investigate how exercise training may mitigate fatigue and other treatment-related adverse events and modulate the immune system to synergize with targeted therapies and immunotherapy.
Pre-Clinical and Translational Research
The Duke Prostate & Urologic Cancer Center seeks to translate cutting-edge basic science research into improvements in the prevention, diagnosis, and treatment of kidney cancer. Our Kidney Cancer Translational Research Program studies:
Molecular Mechanisms and Biomarkers for Kidney Cancer
CTC Immune biomarkers with microbiome and urine cfDNA
Development of perioperative treatment for kidney cancer
Prosper
Merck Keynote 564
Development of Novel Treatments and Combinations for Aggressive Kidney Cancer
Agensys
PDIGREE (likely start in late 2018)
Studying non-clear cell renal cell carcinomas
PAPMET/S1500
Treatment-related Toxicities (cardio-oncology) and Overall Outcomes/Treatment Sequencing
Angelo Moore, PhD, MSN, RN, NE-BC, director of the DCI Community Outreach, Engagement, and Equity program Office of Health Equity, has been named a Fellow of the American Academy of Nursing (AAN). Moore, along with four other nurses at Duke, is among 253 new fellows selected from across 40 states, the District of Columbia, and 13 countries.
Beyond one's achievements within the nursing profession, fellows are recognized for "engaging with health leaders nationally and globally to improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science."
As a U.S. Army Non-Commissioned Officer, Moore served during three Gulf War campaigns. After subsequently attending, then graduating from Winston-Salem State University, he joined the U.S. Army Nurse Corps. All told, he served more than 25 years on active duty in multiple leadership roles from Germany to Hawaii — earning several service medals, commendation medals, service ribbons, and three bronze service stars. During this time Moore also completed a master’s degree and a doctorate degree in nursing.
Moore retired from the U.S. Army in 2015 as a Lieutenant Colonel, but his service continued in civilian life with his commitment to serve historically underserved communities in the U.S.
Moore joined DCI in May 2019. He oversees, coordinates, and helps design DCI's community impact-projects to reduce disparities in cancer outcomes for patients across North Carolina and beyond.
⇒LEARN MORE about OHE's latest projects
⇒ Read this 2020 profile of Moore: "In Service to Others: On the Battlefield & In the Community."
The Academy will induct the new class of fellows during its annual Health Policy Conference in October. With this honor comes the Fellow of the American Academy of Nursing "FAAN" credential.
The other Duke inductees are: Mariam Kayle, PhD, RN, CCNs ; Mitchell Knisely, PhD, RN, ACNS-BC, PMGT-BC;Staci Reynolds, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN, CPHQ; Ryan Shaw, PhD, RN, ACHIP.
A drug combination that shows little overall survival benefit in white men with advanced prostate cancer has a far greater effect in Black men with the disease, according to interim results from a study led by the Duke Cancer Institute.
The study, called PANTHER and funded by Janssen Pharmaceuticals, administered the hormone therapies apalutamide and abiraterone acetate plus prednisone to parallel groups of Black and white participants with metastatic prostate cancer.
Read the press release.
A biomarker developed with digitalized pathology and artificial intelligence demonstrated it was able to identify which men treated with radiation for high-risk localized prostate cancer could be spared long-term hormone therapy and its potential side effects.
Presenting their findings on June 4 at the American Society of Clinical Oncology meeting, Duke Cancer Institute researchers reported results from a phase 3 trial involving the National Cancer Institute Cooperative Group NRG/RTOG 9202 of thesuccessful AI-derived digital pathology tool.
Read the press release.
part of a Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report (pdf)
Oncologists today have a wider range of anti-cancer drugs to reach for, many of which target the molecular alterations believed to contribute to the cancer’s development.
Comprehensive genomic profiling, also known as next-generation sequencing (NGS), is used to identify these molecular alterations. Duke Cancer Institute (DCI) oncologists partner with Duke University Health System (DUHS) Clinical Labs and private diagnostics companies to test patients at diagnosis and/or after the cancer grows or spreads.
While it can vary across cancer types, increasingly, targeted therapies that can save patients from needing toxic chemotherapy are becoming available at multiple points in a patient’s cancer treatment, from first line standard of care to subsequent treatment after progression on conventional therapies.
Test results are entered into a Molecular Registry of Tumors known as Frameshift MRT. This centralized informatics tool — designed, built, and coded at Duke byMichael Datto, MD, PhD, (currently the medical director of DUHS Clinical Labs and vice chair for Clinical Pathology) and Christopher Hubbard (DUHS clinical informatics architect) — helps oncologists identify if anything in their patient’s mutational profile, even extremely rare targets, can be treated with any existing targeted therapies or immunotherapies.
Duke Cancer Institute has been offering its patients NGS testing since 2014. Developing Frameshift MRT three years later to organize and optimize the growing volume and complexity of data, and the subsequent formation, in early 2018, of a weekly multidisciplinary Molecular Tumor Board to review complex patient cases was a perfectly timed great leap forward.
The Precision Cancer Medicine Initiative — launched in 2017 by DCI, the BioRepository & Precision Pathology Center (BRPC), and the Clinical Labs — was the critical push behind it.
“It had become increasingly clear that the needs of sophisticated cancer researchers were changing across all cancer types; moving away from generic, archived, cancer-tissue samples, to fresh samples, to samples with a specific molecular abnormality,” explains Shannon McCall, MD, director of the BRPC, a DCI and Duke University School of Medicine Shared Resource housed in the Department of Pathology. “This coincided with clinical advances. Providers, including at DCI, were utilizing these broad molecular profiling assays to direct the care of cancer patients. There was a need to harness all this molecular profiling data to support both cancer research and treatment. I was totally on fire to get this started. We have so many big thinkers at Duke who said, ‘Let’s think about data and what’s possible.’”
In mid-2018, Executive Director of DCI Michael Kastan, MD, PhD, a noted cancer biologist, and Chair of the Department of Pathology Jiaoti Huang, MD, PhD, a prostate cancer researcher, signed a memorandum of understanding to co-fund the staffing necessary to further support the Molecular Tumor Board — co-directed by oncologists John Strickler, MD (for solid tumor cancers), and Matthew McKinney, MD (for blood cancers) — and to manage the Frameshift MRT database. This included hiring a bioinformatician/ data analyst (Jonathan Bell, PhD) and a savvy genetics scientist (Michelle Green, PhD).
Green, fresh from a position in the molecular diagnostic testing industry, joined the Duke Pathology (with salary support from DCI) in the spring of 2019 as senior research program leader of the Molecular Tumor Board and main user and manager of Frameshift MRT. She tracks promising clinical trials and new FDA drug approvals and has configured Frameshift MRT to automatically send therapy alerts to providers when their patients' molecular profiles match any known anti-cancer drug(s). This match could include drugs that are already FDA-approved, drugs that are “emerging” with strong clinical evidence, drugs that are being tested in clinical trials, or drugs that are approved or being trialed in another cancer type.
Over the course of the COVID-19 pandemic, Green has made several significant changes to Frameshift MRT that make it more user-friendly, interactive, and accessible for clinicians and researchers, who can access the Frameshift MRT dashboard when logged into the Duke VPN. Green is available to train and advise.
On a bright clear day last month, a group of cyclists hit the road in support of Duke Cancer Institute (DCI) and the Ride Hard Breathe Easy Foundation (RHBE) to raise awareness about and funds for lung cancer screening.
While the DCI team participated in a 26-mile out-and-back course starting at Duke campus, other RHBE riders continued on a 600-mile seven-day route to Fox Chase Cancer Center in Philadelphia.
The 2022 6th Annual Ride Hard Breathe Easy Classic raised $15,000 for the Duke Lung Cancer Screening Program Patient Support Fund — administered by the DCI Supportive Care & Survivorship Center — which provides financial assistance for lung CT cancer screening at Duke for the uninsured. Support is being offered for up to 100% of the patient’s out-of-pocket costs, based on Duke’s financial assistance sliding scale.
Among the riders was DCI thoracic surgical oncologist Betty Tong, MD, MHS, MS, a fierce advocate for lung screening, which is estimated to have saved more than 10,000 American lives since 2013 when low-dose screening CT scans were first introduced for high-risk people over 55 with a history of smoking.
The U.S. Preventive Services Task Force currently recommends annual lung cancer screening for adults between the ages of 50 and 80 who are either current smokers or quit within the past 15 years AND who have a 20 “pack-year” or greater smoking history; that’s at minimum one pack-a-day for 20 years or two packs-a-day for 10 years. Tong says that to qualify for lung cancer screening at Duke, these criteria must be met. Patients must also be asymptomatic and well enough to undergo potential treatment for lung cancer.
Unlike mammography or colon cancer screening, lung cancer screening requires a shared decision-making visit in advance. Prior to the scan, an advanced practice provider speaks to the patient about the risks and benefits of screening and is also available to discuss tobacco cessation options at Duke.
Should patients discover they do have lung cancer, Tong says, they will find themselves in good hands at DCI.
“From the surgical side, Duke is a pioneer in minimally invasive surgery for lung cancer, which gets people back and recovered much faster with less pain and better quality of life than traditional surgery,” Tong assures. “In addition, there are a range of therapies newly available to treat more advanced lung cancers.”
To date, Ride Hard Breathe Easy has raised more than $600,000 in support of its mission to raise awareness about lung screening and early detection of cancer, provide direct financial assistance to patients and their caregivers, and end the stigma associated with a lung cancer diagnosis. The charity’s partner hospitals include Duke Cancer Institute, Fox Chase Cancer Center, Temple Lung Center, Einstein Medical Center, Lung Health Services, and Crozer Health.
David Gira, his wife, two daughters and son enjoy the beach. When he was diagnosed with lung cancer his oldest was just starting college. In 2021 she’ll graduate and pursue a master’s degree. His other daughter is also in college.
This holiday season, two stage 4 lung cancer survivors share their inspirational stories of healing and passing on the gift
David Gira, 49, and Phuong Huynh, 46, come from different family and professional backgrounds.
They’ve never met, but they have many things in common. Each has been married more than 20 years. Him, 23. Her, 24. Each is a parent of more than one child. Each has a daughter in her final year of college. Both live in cities in North Carolina’s Research Triangle. Each has a family member who works in healthcare at Duke. And both have become unexpected advocates for a cause they never thought much about before September 2017.
Gira, a father-of-three, is an ordained elder of the United Methodist Church of North Carolina with nearly 20 years of pastoral and church leadership experience. Born in Michigan, he’s lived in North Carolina since the late 1970s; in Charlotte, Locust, Boone (for college), Greensboro, and Wilson. After earning a Master of Divinity with honors from Duke in 2005, he went on to live and serve (as pastor) in Graham, Fayetteville, Raleigh and Chapel Hill.
Gira and his wife Amy (anurse at the Duke University Hospital birthingcenter)and family live in Raleigh.
Huynh, a mother-of-two, is a research scientist with 17 years of experience in drug development. Born in Vietnam, she was eight years old when she and her family arrived in the U.S. as immigrants. Huynh’s father, in the volatile restaurant business, moved the family where the work was — from Harford, Connecticut, to Worcester, Massachusettes, to Orlando, Florida, to Buffalo, New York.
After graduating from the University of Buffalo, Huynh spent the first six years of her professional life with Pfizer Inc. in Groton, Connecticut, before moving south for warmer climes and plentiful job prospects, including an eight- year stint in the labs of GlaxoSmithKline. She and her husband Lance Schado (with GE Aviation) and family live in Cary.
In September 2017, the pastor and the scientist were each shocked by a diagnosis ofnon-small cell lung cancer— the most common type of lung cancer.Neither Gira, nor Huynh, had ever used tobacco — the leading risk factor for lung cancer. Their cases weren’t entirely unusual.According to the American Cancer Society,as many as 20%of people with lung cancer have never smoked or used any other form of tobacco. (Patients in this group may have been predisposed to lung cancer due to radon gas, second-hand smoke, cancer-causing agents in the workplace, air pollution, and/or genetic mutations, or no apparent cause at all)
They would each seek and receive treatment from Duke Cancer Institute’s thoracic oncology team and radiation oncology team. They would each experience lung cancer’s spread to the brain and other setbacks. And, as they celebrated Christmas this year, each of their families would rejoice in the greatest gift — no evidence of disease.
Christopher Hoimes, DO, PhD, joined the genitourinary oncology program at Duke Cancer Institute as Associate Professor of Medicine where he will serve as clinical investigator with a focus on GU cancers, experimental therapeutics, and early phase trials.
Hoimes has expertise in immunotherapy and biomedical engineering to advance cancer treatment and diagnostics. As director of GU malignancies at the Case Comprehensive Cancer Center at Seidman in Cleveland, OH, he built research teams that integrated radiologists, pathologists, and urologists with experts in biomedical engineering for novel imaging and drug development approaches. He has particular interest in clinical and preclinical applications of nanomaterials for drug delivery and imaging, antibody-drug conjugates, and immunoengineering. As a clinical investigator in Phase I and genitourinary malignancies, Hoimes serves as principal investigator of over 12 active Phase I, II and III trials. He served on the NCCN guidelines panel for bladder and penile cancers, serves on the SITC expert consensus panel for immunotherapy in bladder cancer, and was a founding member of the NCCN panel on cancer immunotherapy and related complications.
“We are excited to bring Chris’s tremendous knowledge and experience and collaborative approach in genitourinary cancers, and bladder cancer in particular, to our group,” said Daniel George, MD, director of genitourinary oncology at Duke Cancer Institute. “As an international expert in bladder cancer clinical research, Chris led early trials that supported the first indication of immune-conjugated therapy in bladder cancer. He is currently co-leading a Phase III trial of neoadjuvant chemotherapy immunotherapy in invasive bladder cancer, as well as studying several novel approaches to combining these strategies in unmet needs for patients with advanced bladder cancer. His research will increase the treatment options for patients at Duke and our region. Additionally, he is also well trained in cancer immunology and provides another interface for us with our DCI Center for Cancer Immunotherapy, as well as with our School of Engineering.”
Recognized as a global leader in genitourinary cancers, Hoimes was recently nominated for the Master Clinician Award (2019), awarded the ECOG Symposium Young Investigator Award, and received the Department of Defense Prostate Cancer Young Investigator Award. He presented abstracts at the European Society of Medical Oncology (ESMO) Annual Meetings, American Society of Clinical Oncology (ASCO) Annual Meetings and the American Urological Association (AUA) Annual Meetings. Additionally, he also authored multiple articles published in the Journal of Clinical Oncology, the Journal of Urology and the New England Journal of Medicine.
Hoimes is board certified in Medical Oncology and Internal Medicine and was previously on faculty at Case Western Reserve University and Yale University. He received his medical degree from New York College of Osteopathic Medicine and completed Internal Medicine Residency and Chief at Penn State University and fellowship in Medical Oncology at Yale University School of Medicine.
Sound waves may become the next effective tool to help doctors diagnose cancer and develop more personalized diagnostics and treatments.
A new study conducted by researchers from Duke University, MIT and Singapore's Nanyang Technological University shows that sound waves are capable of rapidly and efficiently separating circulating tumor cells (CTCs) from blood. CTCs are small pieces of tumor that break away and flow through the bloodstream. They contain a wealth of information including tumor type, physical characteristics and genetic mutations.
So the ability to quickly harvest and grow these cells from blood samples would enable doctors to collect "liquid biopsies"that could diagnose patients and suggest more individualized treatment options. Sound waves might even eventually supplant biopsies, which are painful, invasive and often not administered until late in the cancer's development.
With our circulating tumor cell separation technology, we could potentially help find out, in a non-invasive manner, whether the patient has cancer, where the cancer is located, what stage it's in, and what drugs would work best," saidTony Jun Huang, William Bevan professor of mechanical engineering and materials science at Duke. "All from a small sample of blood drawn from the patient."
One of the big challenges is that CTCs are rare —typically only a few for every billion blood cells —and difficult to catch. While technologies already exist to separate tumor cells from normal blood cells, they tend to damage or kill the cells in the process. And they aren't efficient, only work on specific types of cancer, or are too slow to be used in many situations.
The sound wave method is fast and effective enough for clinical use, processing a 7.5 mL (1 1/2teaspoon) vial of blood in less than an hour with 86 percent efficiency. But its biggest asset is that "it'svery gentle on the circulating tumor cells,"said Andrew Armstrong, associate professor of medicine, surgery, and pharmacology and cancer biology at the Duke University School of Medicine. "The cancer cells remain viableand can be characterized, cultured or profiled, which allows us to do genotyping or phenotyping to better understand how to kill them."
He said the idea is to develop more personalized treatments for patients based on their cancer biology. Researchers hope the platform will lay the groundwork for a new test using an inexpensive, disposable chip.
Huang continues to work on improving the technology to increase both its speed and efficiency, while Armstrong determines its potential for clinical use in a number of culturing and profiling projects. They also plan to deploy the platform in a variety of research projects, such as examining how CTCs survive in the bloodstream and spread through the body.
The results of the sound wave study (Circulating Tumor Cell Phenotyping via High-Throughput Acoustic Separation) appear in the July 3 issue of the journalSmall. The National Institutes of Health and the National Science Foundation supported the research.
This is another example of the transformative precision health sector that contributes to North Carolina's global life science leadership. Significantly, Duke is a partner in the North Carolina Biotechnology Center-ledNC Precision Health Collaborative.
