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The Right Treatment for the Right Patient

Dr. Edward Uchio applies precision medicine to urologic cancers.

No doubt about it: Dr. Edward Uchio loves being a surgeon. The UC Irvine Health urologic oncologist and surgical oncologist says that other than spending time with his son, surgery is his favorite thing to do. Yet if he could, he would love to put himself—and other cancer surgeons—out of business.

Evolving cancer treatments are becoming so refined, minimally invasive and precise, that there is less need to perform large-scale operations to remove cancer. Uchio and his UC Irvine Health urologic cancer colleagues are pushing this very frontier.

“We are one of the leaders in innovative technology, using new devices in the treatment and diagnosis of cancers and urological disease,” says Uchio, crediting much of the progress to Dr. Ralph Clayman, a UC Irvine Health professor of minimally invasive surgery and founder of the field of laparoscopic surgery in urology, and Dr. Jaime Landman, the chairman of UC Irvine Health department of urology. Laparoscopic surgery involves making a few small incisions in the abdomen to remove diseased tissue or repair the anatomy.

“We are always looking to be more minimally invasive,” says Uchio, who attended medical school at UC Irvine and then trained at both the University of Washington and the National Cancer Institute. “We’ve gone from very large incisions to much smaller incisions, and now to almost no incisions at all. Hopefully, with prevention and these newer treatments, I will go out of business as a surgeon. And I’m OK with that.”

His patients are the beneficiaries of that attitude. Uchio and his colleagues utilize innovative methods to biopsy organs—like the prostate and kidney—to diagnose cancer with striking precision, which leads to more informed treatment decisions.

“Cancer treatment is evolving,” he says. “In prior days of surgery, we would make a large incision to excise tumors. That is still appropriate in certain advanced cases. But now, with newer imaging modalities, we are diagnosing these tumors earlier, when they’re much smaller and amenable to treatment with robotic surgery and other minimally invasive and focal therapy techniques.”

The benefit for patients is UC Irvine Health has all the advanced modalities for treatment and even newer ones that aren't commercially available yet.

Improving “watchful waiting” of slow-growing prostate cancer

In a growing number of cases, urologic cancer patients are even learning that they can opt for no treatment at all, he says. Some types of prostate cancer are so slow-growing that patients can bypass or delay treatment and undergo close monitoring. Understanding who needs treatment and who can safely avoid it is a significant issue; 1 in 6 men will be diagnosed with prostate cancer in their lifetime. UC Irvine Health urologic oncologists use sophisticated molecular tests of blood and urine to look for markers that can signal the presence of prostate cancer in a manner that is much more precise compared to the standard prostate specific antigen (PSA) blood test.

“Some cancers don’t behave like cancers and won’t affect people’s lives for many years,” he says. “Previous thinking was that all of these tumors had to be treated.”

If a biopsy is required, Uchio and his colleagues specialize in using a newer technology called 3-D MRI fusion, specifically the Artemis system. This is one of the most advanced prostate biopsy systems available. It combines three-dimensional imaging featuring MRI, ultrasound fusion and a robotic needle guidance system to help identify cancerous cells in the prostate. Unlike a standard biopsy in which a needle is inserted in the prostate blindly, the Artemis allows the doctor to directly insert the needle into suspicious lesions. “With this technology, you have a better idea of the aggressiveness and extent of the cancer,” he says.

The tumor tissue is taken to the lab where molecular/genomic testing can be performed to glean information on the behavior of the cancer cells which may help steer treatment decisions. These advances are reassuring to patients who otherwise may be uncomfortable with the idea of “watchful waiting,” Uchio says. Some patients can return for a repeat biopsy in the exact same spot to produce a highly accurate check-up.

“It allows us to follow patients more safely and accurately,” he says. “We are also able to be much more minimally invasive if treatment is required.”

On the hunt for even better treatments

Removing a tumor doesn’t always mean removing the entire prostate. Uchio offers cryotherapy to patients, a minimally invasive treatment that freezes the tumor and kills the cells, as well as high-intensity focused ultrasound (HIFU) that uses sound waves to destroy malignant tissue. Even more minimally invasive ways to kill cancer are being tested in the lab.

“The benefit for patients is UC Irvine Health has all the advanced modalities for treatment and even newer ones that aren’t commercially available yet,” says Uchio, who has been the principal investigator on more than 25 clinical studies specializing in the treatment of advanced prostate cancer over the last two years.

UC Irvine Health is also a leader in innovative, precision treatments for bladder cancer. The standard treatment is to surgically remove a tumor in the bladder using a camera in standard white light. But, Uchio says, “Many times there are more than one tumor and they often recur. There are lesions there, but we unable to see them with our standard technology.”

A new treatment called blue light cystoscopy is proving to be much more precise. A dye is injected in the bladder and absorbed by cancer cells, which give off a red glow under a special blue light. The technique can identify tumors that are not large enough to be seen with the naked eye under white light.

And in the category of “putting surgeons out of business,” Uchio helps direct several clinical trials aimed at finding nonsurgical methods to treat various urological cancers. UC Irvine Health is home to an early-phase clinical trial on a vaccine for prostate cancer in active-surveillance patients.

Another set of studies is aimed at using immunotherapy drugs—medications that prompt the immune system to recognize and fight off bladder cancer. UC Irvine Health is one of the few entities in the country conducting numerous studies on immunotherapy for bladder cancer that is localized but resistant, meaning tumors are still confined to the bladder and haven’t spread and do not respond to standard therapy. Immunotherapy trials are also underway for kidney and prostate cancer.

“The last Food and Drug Administration-approved drug for superficial bladder cancer was over 15 years ago. There have been no new agents for patients with these recurrent cancers,” he says. “We want to better tailor treatments and give patients more options.”