Transcription:
Advanced Urologic Care

Scott Webb: In a special episode of the Health Works Here Podcast today, I'm joined by Dr. John Libertino, urologist and director of Emerson Health Urology, and professor of urology at Tufts University. And he's here today to tell us about the work that he and his all star urology team are doing to help patients today and answer research questions that may have the potential to make things like prostate cancer, a distant memory in the future. This is the Health Works Here Podcast from Emerson Health. I'm Scott Webb. Doctor, thanks so much for your time today. Interested to learn more about urology care and more at Emerson. So as we get rolling here, what makes Emerson a destination for urology care?

Dr. John Libertino: I believe there are two things that make us a destination center, that meaning a center where people come from a distance to seek out professional care., and I think the two reasons are one, the incredible urology staff that we've accumulated. And secondly, the clinical medical staff, the nursing in the department and the Yates Institute of Urology. They're superb. So by way of background. Let me just say that, if I go through the, staff, I can tell you that they're all incredibly high quality, extraordinarily well trained people. We'll start alphabetically with Dr. G who was first in his class at Tulane in bioengineering, and the second of his class at Harvard Medical School.

He did his residency with me when I was at Leheay Clinic which was one of the premier residencies in the country. And then did a three year fellowship at MD Anderson in urologic oncology and was co-director of the University of Wisconsin Cancer Center before coming back east and he's one of the members of the department. Another, is Dr. LaFontaine, who is a Brown Dartmouth, medical school graduate, did his training, at Emory University in urology and did a fellowship in urologic oncology. And then we have Dr. Steven Schloss, who is a Souma Cum Ladi from Yale. And an AOA graduate from Columbia University School of Medicine, who did his urology residency at Leheay Clinic as well.

We have Onika Williams, who was the first in her class at Johns Hopkins as an undergraduate. She was top of her class at Harvard Medical School. Has a masters in public health, from Harvard. And,, she is a superstar. In addition to her. Urologic talents. She is a gifted writer and writes children's books. And finally Dr. Lewis Lou, who I came to know as a medical student, when he was rotating through theology service. At Leheay Clinic and Louis is a six year wonder kind from BU where he got his bachelor's degree and his medical degree in six years. He also has a PhD in molecular biology and I, went to medical school at Georgetown and trained in urology at Yale.

So that gives you the reason that I think the staff is special. They're highly selected. They're not just people who migrate to a hospital and apply for privileges. These people were all carefully selected and recruited. And the same goes for the medical staff, the clinical coordinators and the nurses and the PAs. They're all top flight people. Warm compassionate, welcoming to patients. So I think that's what accounts for us being a destination urology care center.

Scott Webb: Yeah, that's quite a team doctor, a lot of superstars, folks at the top of their class. And as you say, they're all sort of hand picked to work there. And I'm sure there's also some technology involved, like some of the science and medicine and all of that. So when we think about really what sets Emerson apart from other urology centers, let's go through that list.

Dr. John Libertino: Yeah. So I think what sets us apart is that the people that we've recruited have been recruited for specific reasons. So we have a multi-specialty talented urology department with expertise in oncology, in female urology, in stone disease. And in other aspects of urology that allows us to offer the patient expert care by people who are subspecialty trained and practice in a subspecialty environment, their own subspecialty environment. So if you have a person who's needing a bladder cancer procedure, like a cystectomy and neobladder. We can do these complex surgical cases because everybody's incredibly well trained.

And in addition, their special talent is highlighted within the department so they can focus their energy on their areas of interest and areas of expertise. Which I think sets us apart from. Urology, departments. In terms of technology, we certainly have plenty of technology that makes us unique. We are the first program, I think in New England to start a focal therap y treatment center for prostate cancer. Focal therapy is where you can identify a lesion of the prostate with the MRI, and then target that lesion and treat it either with cryotherapy, which is our preference, or with high frequency ultrasound.

I believe we are the first to have the UrinNow system in new England, which is the device that allows the integration of the image on the MRI and the live image during the procedure where you can actually, under direct vision, put the cryoprobe directly into the lesion, identified on the MRI, and freeze it. In addition, we have other technologic equipment, we're I think, expert in using that is designed to manage in an outpatient fashion, benign protic hyperplasia or BPH, which is a benign overgrowth of a prostate that causes men great deals of difficulty in voiding.

And in that regard, we have Resume, which is a relatively new procedure and Euro Lift as well. So, We have the latest technology in eurodynamics as well and stone manipulation and stone disease. So I think that the pan play of equipment that we have is really first rate and high quality and pretty much covers all the bases of a sophisticated urology center.

Scott Webb: Yeah. So you've got this amazing team. You've got all the latest technology, a lot of good reasons. So when you're speaking with patients or just sort of being a person in the world and discussing why a patient may go here or there, why would you want or encourage patients to choose Emerson over going somewhere else for urology care?

Dr. John Libertino: I really don't like to try to encourage patients to come our way. Most of the patients are sent to us by other urologists. On the other hand, I think, the reputation of the department already speaks for itself. So I don't have to encourage them to come this way, but I think in addition to the being a destination urology center and having experts in every aspect of urology and the latest technological equipment, we're also doing some other things that make us rather unique. We are the first bonafide focal therapy department in New England. And we're one of the few in the country that's been up and running.

And so focal, therapy's a piece of prostate cancer that allows patients to have an alternative to surgery or radiation therapy. In addition, focal therapy allows people who have had radiation therapy and have failed by having evidence of recurrent disease. We can use focal therapy to take care of prostate cancer, which has failed radiation therapy, but is still confined to the prostate. So that's one aspect of prostate cancer that we are very intimately involved in. And have a really first center headed up by Dr. Lewis Lou.

And you'll probably hear more about that at another time. We've been instrumental in working over the years, developing prostate scans and we've been one of the first, , institutions in new England to have PSMA scans, both diagnostic and therapeutic. The research has born fruit in the sense that the therapeutic scans have a great opportunity to wipe out metastatic disease of prostate. By using monoclonal antibodies, which attach to PSMA on the cell surface of prostate cells. And it's attached to an isotope, which then Kills the prostate cancer cell.

So, that's some of the research that we've done both in the diagnostic and therapeutic scans that are either available, the diagnostic scans are available. The therapeutic scans are just gaining FDA approval. So in addition to that, we've got a lot of opportunities,, for research, one of which is looking at the genetic profile of patients to predict whether they are gonna be responsive to BCG, which is a treatment that is used for high grade noninvasive bladder cancer. The genetic profile can predict who's gonna respond and not respond to BCG. And that of course is a advance, in a sense that you don't waste patients time giving them therapy, that doesn't work.

Which is an expensive cost to Medicare and health insurance companies. And secondly, it allows you to know that you can identify the non-responder early on by the genetic profile of the patient and move directly toward more curative surgical operations, like a cystectomy and neobladder, which is the creation of a bladder out of intestine that allows males to void through their urethra. And in females you can create, continent reservoir so that they don't have to wear an ileostomy bag, things of that nature.

And finally, I think we'r in the throes of developing several devices. One of which is a probe that when it's placed into prosthetic tissue can by its signal profile, tell us the Gleason score or grade of the tumor. So those aspects of urology are, some of the research efforts that complement our clinical expertise.

Scott Webb: Yeah, doctor is you think about the future, right? You as the director, you think about the future and everything that you're doing today and all the work that's being done, let's say for tomorrow answering those questions for tomorrow, what gives you hope? What's your optimism level that some of the things that folks suffer from today in 2022, that will maybe just be a memory in the years to come?

Dr. John Libertino: Well, I've always been optimistic as a person. I've always been optimistic as a urologist and urologic surgeon. I think the future is very bright. We're gonna have therapies , car T therapy, which is immunotherapy for many of these cancers that we face, are gonna be eliminated by monoclonal antibodies specifically designed to target different cancers. So I'm very optimistic about the future and I'm happy that our department will be right on the cutting edge of the evolution of those new technologies and new techniques.

Scott Webb: Yeah, cutting edge leading the way I've had the pleasure of learning more about car T-cell immunotherapy, and it's just, it's like something outta science fiction. And, but it's not, it's here, it's here now it's working now. And the future is just seems almost limitless as they begin to figure out how to apply it to other types of cancer. So doctor, thanks so much for your time today. You stay well.

Dr. John Libertino: Well, you do the same, nice chatting with you. Take care.

Scott Webb: And call 978-287-8950. For more information or to book an appointment. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here, Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.