GU Cancers 2019 | Personalized medicine: surgery

John Gore

Surgery may hold a key role in cancer treatment, despite the presence of metastasis. John Gore, MD, MS, of the University of Washington School of Medicine, Seattle, WA, discusses this point and the importance of personalized medicine at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA.

Transcript (edited for clarity):

Surgery is one of those things that hasn’t changed very much in the last several years in terms of in general what we do to do safe surgery. There have been groundbreaking developments in how we do surgery over the last 10 to 15 years. What is changing now is a better understanding of the patients who we here to forethought probably didn’t benefit from surgery, but now we know might.

One of the big emerging things that is a point of discussion, and there’s some talk about at this meeting is role of surgery when someone’s cancer has spread outside of the main organ. For example, in kidney cancer it’s been part of our routine clinical care for many years now that if someone has a kidney cancer that has metastasized we still often take out the primary tumor, but in other cancers, in the general urinary system like prostate cancer we’re learning potentially that they have benefit for their cancers as well.

On the flip side, we’re now learning that for kidney cancer, as we get more and more effective therapies to treat their metastatic disease that extra benefit of taking out the kidney is probably not as high, so now we’re coming to the realization that we can’t use one size fits all decision making for who should get surgery.

Just like we do for systemic therapies we need to take a personalized medicine approach to figure out who should have what surgery, you know, what’s the right surgery for the right patient at the right time in their care. I think one of the things that this meeting is going to help propel forward is a better understanding of what are optimal surgical candidates, what are optimal systemic therapy candidates, what are optimal radiation therapy candidates, and how we can integrate these complimentary disciplines to optimize patient-centered outcomes.

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