First Multidisciplinary Genitourinary Oncology Clinic opens

Patient Alan Gissler shares his story during Monday’s press conference as Drs. Charles Enke, left, and KC Balaji, right, look on.

A diagnosis of cancer can be life altering under the best of conditions, especially when it comes to the multitude of office visits and appointments needed to see a variety of specialists. But now patients have a unique clinic available to save tremendous time and effort in the diagnosis and treatment of genitourinary cancers. The Multidisciplinary Genitourinary Oncology Clinic (MGOC) is a team of specialists from UNMC and The Nebraska Medical Center who will serve patients with urinary tract cancers including kidney, bladder, prostate, penile, testicular and other rare pelvic and abdominal cancers.

“There is no service available like this clinic in the state of Nebraska,” said KC Balaji, M.D., associate professor, urologic surgery. “Patients sometimes may need to see three different specialists – a surgeon, radiologist and oncologist to discuss management options and decide on the best treatment plan for these types of cancers. This means three different appointments, at three different locations, extra travel and office time. In addition, patients have to wait for all these specialists to confer with each other and agree upon a treatment plan – and these group consultations can take days or even weeks. But all of this inconvenience, loss of time and inefficiency ends at our clinic door. We provide a consensus of opinion following discussion by all specialists involved, in one visit to our patients.”

Clinic offers one-stop shop

“The patient’s diagnosis and pertinent medical information can be reviewed and discussed by all members of the clinic prior to seeing the patient,” said Charles A. Enke, M.D., professor and chair of the department of radiation oncology. “The patient is able to ask questions of all the different specialists at the same time, which results in improved communications between the patient and physicians. In addition, the physicians constantly educate one another on new information pertaining to their specialty – information that may benefit patients.”

From left: Drs. Ralph Hauke, George P. Hemstreet and Charles Enke.

MGOC began serving patients in late November, meeting every other week for three hours and seeing four to five patients per clinic. In March, the clinic will be open every Thursday from 8 to 11 a.m. Clinic staff anticipate serving up to 15 patients per month, which is a significant patient load for genitourinary cancer.

Clinic team offers broad expertise

In addition to Dr. Balaji and Dr. Enke, the clinic team includes George P. Hemstreet, M.D., professor and chair of urologic surgery; Ralph Hauke, M.D., assistant professor of medicine in the department of internal medicine and chief of oncology at the Veterans Administration Medical Center in Omaha; Sonny Johansson, M.D., Ph.D., professor, department of pathology and microbiology, and Neil Abrahams, M.D., assistant professor, department of pathology and microbiology.

Dr. Hemstreet specializes in prostate and bladder cancer and is internationally known for his work in molecular markers for prostate and bladder cancer risk assessment and detection via quantitative fluorescence image analysis.

Patient Alan Gissler with his wife Beverly.

Dr. Balaji is fellowship trained in urological oncology from one of the premier cancer centers in the world – Memorial Sloan Kettering Cancer Center in New York, N.Y. He specializes in performing robotic and laparoscopic surgery in patients with urological cancers. He has performed 70 robotic/laparascopic surgical procedures including the removal of the prostate, kidney and bladder, as well as numerous urinary diversion procedures. He also is primary investigator on a number of projects involving advanced prostate cancer.

Dr. Enke’s expertise is in the treatment of prostate cancer with radiation therapy. He has treated more than 1,400 men for prostate cancer and has been using IMRT (Intensity Modulated Radiation Therapy) to treat prostate cancer for four years. Higher doses of radiation have been associated with an improved success rate, and IMRT is the nation’s leading technology that enables the radiologist to deliver higher doses while decreasing the risk of side effects or complications.

Dr. Hauke specializes in the use of medications for treatment of genitourinary malignancies. These treatments include standard chemotherapy agents as well as new investigational agents including antibody therapy and vaccines. In addition, UNMC and The Nebraska Medical Center offer the only high-dose interleukin-2 program in the area for patients with metastatic kidney cancer.

Monday’s press conference involved, from left, Dr. Ralph Hauke, Dr. George P. Hemstreet, Dr. Charles Enke, patient Alan Gissler, and Dr. KC Balaji.

Pathologists aid team

The accurate diagnosis of all genitourinary cancers depends upon the pathologic handling of the specimen, as well as the final analysis of grade assignment (measure of cancer’s aggressiveness) and staging (measure of tumor spread). Therefore, it is on the information provided by pathologists Drs. Johansson and Abrahams that the other team physicians must plan and implement their treatment strategy. Drs. Johansson and Abrahams bring more than 30 years of combined experience and progressive technology to the diagnosis and management of patients with urologic disorders.

Patient benefits from new clinic

Alan Gissler, 54, a native of Osceola, Neb., is one of the MGOC’s initial patients. Dr. Balaji successfully removed Gissler’s prostate cancer and associated lymph nodes using the robot. After the surgery he felt great and was in no pain, Gissler said. Dr. Balaji made only make five tiny incisions that “can barely be seen,” Gissler said. Remarkably, Gissler lost only a half pint of blood so no transfusions were necessary (in conventional open
surgeries for removal of prostate cancer, blood loss average is around two pints).

He continues to receive a form of hormonal therapy for his prostate cancer. In April he will begin radiation treatments under Dr. Enke. Even though he’ll have to drive 180-miles round trip to Omaha five days a week for eight weeks, Gissler is expected to continue his employment as superintendent of the Ryan Hill Country Club while he undergoes his radiation treatments.

For more information

For more information about the Multidisciplinary Genitourinary Oncology Clinic, contact 402-559-4292 or visit the MGOC Web site at www.unmc.edu/urologicsurgery.