Yair Lotan, M.D. Answers Questions On: Urologic Conditions and Care

I perform surgical procedures for general urologic conditions such as kidney stones and vasectomies, but the majority of my patients have bladder, prostate, or kidney cancer.

Surgery and radiation therapy are the most common treatment options. Surgically, I use either the laparoscopic, robotic, or open method. Most patients prefer minimally invasive procedures if they are candidates for it. For radiation therapy, we’d send the patient to a radiation oncologist.

Most important is a surgeon with vast experience. We routinely treat patients with advanced urologic cancers, rather than just seeing one or two per year.

It’s also important to find a hospital that can deal with complex problems and that has coordinated, multimodal care with medical oncologists, radiation oncologists, and other medical professionals. We have specialists in every field at UT Southwestern, so patients who come here expect the best all-around care.

Additionally, doctors at academic institutions like UT Southwestern spend a lot of time thinking about how to move the field forward. We’re always evaluating new therapies and trying to stay ahead of the curve with clinical trials.

We see a lot of cancer patients who want second opinions about their diagnoses or about their course of treatment.

I had a bladder cancer patient – he had been seen elsewhere – who was told he had only a short time to live and would not do well in surgery. His bladder cancer actually was bad, but things weren’t as pessimistic as they had been portrayed. He received chemotherapy, had his bladder removed and a kidney transplant at UT Southwestern. That was almost seven years ago, and he has done much better than expected.

Aging is a risk factor for bladder, prostate, and kidney cancers because these diseases tend to happen later in life. The most common risk factors for prostate cancer are a family history, consuming a high-fat diet, and being African-American. Doctors aren’t quite sure what predisposes African-American men to get prostate cancer. There’s speculation about androgen receptors and genetic abnormalities, but there’s not an exact answer for it yet.

Molecular markers are genetic changes in cancer that may predispose them to recur or spread. For example, two patients may have bladder cancer, but their cancers don’t behave the same way because they are different on molecular and genetic levels.

Molecular markers help us identify patients who are at a higher risk for recurrent cancer so we can recommend the appropriate treatment for them. Or, if we discover that their cancer is unlikely to recur, we can try to reduce the number of treatments so they don’t have as many side effects.

There will be improvements in personalized medicine such as drugs and chemotherapy that are targeted to a specific tumor. We will be able to determine not only which patients need additional treatment but also what treatment is best for them.