Dr. Robert Nam's team is leading the fight against the disease, from early detection and surgery to genetic research and prevention.
STAN ROSENBERGER IS A GUY'S GUY.
The Bradford, Ont. resident has stereotypically masculine hobbies: motorcycle trips with his buddies, rebuilding a 1949 Ford Thames – complete with V8 engine – and camping in the northern wilderness. He was born and raised in northern Alberta on a beef cattle farm, operated heavy equipment and was a truck driver for a family owned construction company. He now inspects heating, ventilation and air conditioning systems.
Stan also has what he calls "man problems." He was born with a genetic propensity toward prostate cancer and didn't know it.
If it hadn't been for astute doctors at Sunnybrook, he might still have a ticking time bomb in his body. Two years ago, Stan's wife was very ill, and while she was having blood tests, he agreed to have a checkup at his general practitioner's office in Newmarket. "That's when I found out my PSA was through the roof," he says of the prostate-specific antigen test.
Stan saw a local specialist, who put him on medicine to treat prostatitis, a swelling of the prostate gland. But Stan felt there was more that needed to be done. "I didn't get a great feeling about it. It was like a fishing expedition – throwing a hook into the water in hopes to find something that would lead me to seek a second opinion."
Stan Rosenberger on Dr. Robert Nam, shown here in surgery:
"I just really like his style. He is so sensitive and so genuine."
Research by his sister-in-law, a nurse practioner, led Stan to Dr. Robert Nam, head of genito-urinary cancer care at Sunnybrook's Odette Cancer Centre. After he was referred to Dr. Nam by his family doctor, things began to move quickly: Dr. Nam saw him within five days and was concerned enough to order a biopsy immediately. Just days later, Stan was diagnosed with an aggressive form of prostate cancer, which needed treatment right away. He and his wife and their two adult children were shocked. "I had no symptoms, absolutely nothing. I felt healthy," he says.
While the diagnosis was devastating, Stan felt at ease with Dr. Nam. "I just really like his style. He is so sensitive and so genuine. He is more like a friend than a doctor," says Stan.
Stan agreed to a radical prostatectomy – complete removal of the prostate gland and surrounding tissue – in May 2011. He was 49. Possible risks of the procedure include erectile difficulty and urinary incontinence. "It's a delicate operation," says Stan. "Someone told me the tissue is very thin. It's like sewing together wet toilet tissue." Before being anesthetized, he joked with Dr. Nam, "I have full faith you'll take care of me. Just don't make me into a she."
Dr. Nam's deft craftsmanship worked wonders. "All I can say is, his nerve-sparing procedures work. My equipment still works, not like it used to, but it still works," says Stan. "I feel very fortunate."
Why did this young, healthy man get prostate cancer? Stan had two uncles on his mother's side with the disease, but didn't realize the risk could be passed down the female side of the family.
Identifying families at risk and determining which men will have aggressive forms of this disease are two of the ways Sunnybrook is leading prostate cancer care.
Prostate cancer is relatively common. About 26,500 men are diagnosed each year in Canada, and 4,000 die of the disease. According to Dr. Nam, about 10 per cent of men inherit the disease and another 20 per cent have an identifiable risk factor, such as being of Western African or Caribbean descent, having a strong family history or having the BRCA1 or BRCA2 genes. The remaining 70 per cent are sporadic cases that he calls "unlucky" – the cancer seems to come out of nowhere.
Sunnybrook's team leads the way along the whole continuum of care for all groups, from genetic research to early detection, surgical and radiation services, education and prevention.
Besides being a dexterous surgeon, Dr. Nam is a world-class researcher. He and his team at Sunnybrook Research Institute recently led research that will help clinicians determine which of the 70 per cent of men whose prostate cancer is sporadic need to be monitored more carefully.
His team scanned the whole genome and found a panel of micro-RNAs (genetic signatures in the blood) associated with a more tenacious type of cancer. "With that tool," says Dr. Nam, "we have a test that is very predictive of aggressive disease. We can say, 'This guy is going to do poorly versus another who won't.' That's huge."
He also recently led a discovery that will change how genetic risk for prostate cancer is calculated. He discovered a rare genetic mutation on the HOXB13 gene strongly associated with prostate cancer risk. A new genetic test will help identify men who have the mutation, called G84E. "Patients with this mutation have 14-fold higher risk for prostate cancer," says Dr. Nam. The team's results were published in the prestigious Journal of the National Cancer Institute.
Another leading expert in prostate cancer at the Odette Cancer Centre is radiation oncologist and researcher Dr. Danny Vesprini. His work focuses on the 20 per cent of men at high risk of developing prostate cancer because they have a mutation in one of the BRCA genes, a strong family history of prostate cancer or are of Western African or Caribbean descent. "These men tend to develop aggressive disease at a younger age and therefore have a shortened life expectancy." The group is working to identify biomarkers – signs of disease in the blood and urine – that help explain why these men have a poorer prognosis, and ultimately provide a screening tool to detect the disease earlier, before it becomes aggressive and threatens their life.
Dr. Vesprini and genetic counsellor Justin Lorentz are leading a collaborative research team with researchers from Princess Margaret Hospital and Women's College Hospital in Toronto to build a registry of men known to have BRCA1 or BRCA2 mutations, and this will eventually expand across Canada.
Dr. Vesprini is also leading a clinical study to determine whether the use of state-of-the-art magnetic resonance imaging screening of the prostate gland can help to identify cases in high-risk men before their disease becomes aggressive.
The pan-Canadian collaborative group will also develop clinical trials using new medications that target DNA repair in prostate cancers with a BRCA1 or BRCA2 mutation.
"We're going to detect prostate cancer that has the potential to become aggressive earlier so that it can be dealt with promptly, while also indentify those men with low risk disease that can be safely watched with active surveillance. This approach will ultimately improve survivorship outcomes in prostate cancer," says Dr. Vesprini.
Cutting-edge research translates into practical solutions in real time. Sunnybrook's Prostate Risk Calculator is online at prostaterisk.ca to help clinicians rate a patient's risk. "The beauty of Sunnybrook is that innovation really pays off," says Dr. Nam.
Stan Rosenberger works on his beloved 1949 Ford Thames.
For Stan Rosenberger's 23-year-old son, Michael, these advances are good news. The musician and business student at the Laurentian University campus in Barrie knows he is at increased risk for developing prostate cancer. "I will get screened earlier than a typical person would," he says. "Sunnybrook would be my first choice, because of the success my dad's had."
Although it was a difficult time, Stan speaks fondly of his four 46-kilometre trips to Sunnybrook from Bradford for prostate cancer diagnosis and treatment. "I can't say enough great things about the way I was treated at Sunnybrook, from the parking lot attendant, coffee bar staff, an amazing office administrator [Jen], and interns. Dr. Nam's office runs like a fine tuned machine. It is quite a place down there – so large and yet so welcoming."
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.