Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole, and we have a panel for you today to discuss the diagnosis and management of superficial bladder cancer. Dr. Joshua Meeks is the Edward M. Schaefer Professor of Urology and an Associate Professor of Urology, Biochemistry, and Molecular Genetics at Northwestern Medicine; and Dr. Song Jiang is a Northwestern Medicine urologic-oncologist specializing in the treatment of prostate, kidney, bladder, and testes cancers. Dr. Meeks, I turn this over to you.

Joshua J. Meeks, MD: Great. Thank you. It's just a real pleasure to be here today to bring one of our new providers into our Northwestern urology and oncology system. And so, Song, I kind of wanted to start with your origins and how you got here. I know you're from the Midwest and it all kind of began here in the Chicagoland area. So, maybe could you start with a little bit about kind of where you came from, how you were involved in Chicago, and then kind of your journey back to here, if you could?

Song Jiang, MD: Yeah, absolutely. First of all, you know, thanks so much, Dr. Meeks, for the warm welcome and really your continued mentorship. I really value that. So yeah, I grew up in the area. I've been in the Chicago suburbs since eighth grade after the completion of my residency training in Minnesota, and then fellowship in urologic-oncology in New York, there was definitely a natural sort of pull or inclination to returning home to the Webb suburbs, you know, from a personal and sort of family standpoint.

And professionally, I was definitely drawn to the institutional and departmental leadership's vision to have an integrated urology program within the NM Health Network across Chicagoland, and specifically, the vision of expanding urologic-oncology at Central DuPage Hospital where I'm located. So, the opportunity to work with you, and the national reputation of the department really made it a no-brainer for me to come home.

Joshua J. Meeks, MD: You know, looking at everything you've done, I think our patients obviously, you know, when they go to the website and they're about to see you and they see your training, you've had a pretty diverse and really extraordinary set of training. So, I know you did an MD PhD. Tell me just a minute about that and how do you think that sort of shaped your focus on cancer care?

Song Jiang, MD: Yeah, absolutely. So, my PhD was in immunology. I studied a germline-encoded receptor family called toll-like receptors. So, these are innate immune receptors that recognize components of microbial pathogens, and then induce an inflammatory response. And so, my PhD focus was on TLR10, toll-like receptor 10, which we found was a sort of immune suppressive molecule.

You know, I think I entered into, or reentered into my clinical training really wanting to leverage the training in science, and really particularly interested and grew fond of some of the newer developments within immunotherapies in GU malignancies. And so, I think that certainly brought greater interest for me to study cancer in particular. And then in terms of choosing urology, you know, it's really the people in urology that I gravitated toward and the mentors there that really helped inspire my pursuits of urologic-oncology. So, I'm really thankful for that. And like I said, it continues my interest in science, and I continue to look forward to working with you to broaden that scope and study and bring clinical trials to folks here in the community.

Joshua J. Meeks, MD: That background is really remarkable. For the training and coming out of the absolute best institutions in the country, and then to come back to work at CDH, first of all, I think that really should be stated, number one, what a pull that really is for you to take care of our folks in the western suburbs where you are from. But I also think that really talks about our system and the investment of just amazing talent.

I mean, the best analogy I can give folks is like LeBron coming back to Cleveland, right? Like, good basketball team, but he clearly had talent that could go anywhere else. So, I think, for us, it's a huge win and we're so happy to have you there. And, like you said, what we see among just the Central as well as the other regions is that we all work together. And so, that's a huge investment that we would put someone with your talent and your quality at a place that's not the Central region says that, again, we can all work together. And I'm really just impressed by that.

Song Jiang, MD: Well, I mean, thank you for your kind words. And I would just want to reiterate how great of a mentor you've been. And that was really a big draw for me.

Joshua J. Meeks, MD: Let's talk about that, Song, because I think again, a lot of people would say, you know, you see CDH, which is a huge hospital, it's a great institution. I've been there for my own healthcare. I've brought family members there. I have a lot of patients that go there. But I also think that the aspiration of bringing in your talent to that institution, so where do you see that as far as what's the goal and then how do you think from an oncologic perspective, what do you see from a cancer journey for our patients? How does CDH fit into that and where do you think it's going?

Song Jiang, MD: Yeah, absolutely. So, I definitely share in that vision of integration and with regard to providing access to comprehensive oncology care in our community. There's evidence of that already within our colleagues in surgical-oncology and gynecologic-oncology where they've developed a quite robust program of complex surgical care in the Western suburbs. But also, they've endeavored to enroll patients in clinical trials in the community setting. And so, my aspiration is definitely to continue to widen that scope for GU oncology as well. And overall, the idea is to bring a tertiary center level of oncology care, again, to our local community. And so, I'm excited to kind of be a part of that and for urologic-oncology to be a resource for our patients here in the West suburbs.

Joshua J. Meeks, MD: You and I, we probably interact more about bladder because that's been my focus, but you take care of other urologic cancers, right? And some people are going to find this podcast, because they see you. So, what other cancers do you care for?

Song Jiang, MD: So, certainly, my academic and intellectual interest is in bladder, but we see all malignancies, for example, prostate cancer, kidney cancer, testes cancer, adrenal cancer, you know, all of which fall into the realm of urologic-oncology. And so, you know, I consider myself a general urologic-oncologist. There's access to treatment for those disease processes definitely here out in the West.

Joshua J. Meeks, MD: And so, tell me a little bit about that. So, who are your partners? In addition to other urologists, who are your other multidisciplinary partners out at CDH that you work with?

Song Jiang, MD: There's a very robust multidisciplinary team. We have Christopher George, medical oncologist; Victor Medina, medical oncologist. We have radiation oncology partners as well as obviously pathologists and radiologists who are all invested, and we work as a team. And, you know, one of the things that I learned from training, you know, in a high power place in New York is the importance of multidisciplinary collaboration. I'm very thankful, frankly, to have that same sort of spirit and culture within our health network.

Joshua J. Meeks, MD: Have you attended one of the tumor boards on Thursday?

Song Jiang, MD: Yeah, absolutely.

Joshua J. Meeks, MD: Maybe you could just tell people real quick what that experience is like.

Song Jiang, MD: Yeah, for sure. I mean, tumor boards are fairly commonplace in many practices, but I think the unique aspect of our tumor board is that there's really sort of an equal participation and excitement from all the different fields. So, we'll have radiation oncologists bring up cases and discuss it in a multidisciplinary fashion, medical oncologists as well, as well as urologists. And I think the participation is excellent and it's something that I was newly exposed to in fellowship training. And like I said, I was really glad to see that it continues to be in a parallel fashion here at NM, that the tumor board continues to be, have that sort of robust discussion from all parties.

Joshua J. Meeks, MD: That's great. So, anything that you want to talk about as far as interests, skills, anything that you're particularly excited about in the Western suburbs that we can finish on?

Song Jiang, MD: With the work that's been done in your lab and with our patients here, I want to highlight the process of non-muscle invasive bladder cancer, specifically high-risk non-muscle invasive bladder cancer. This is a disease process that is prone to recurrence and requires prolonged surveillance and maintenance therapies. And one of the things that plagues our field is, you know, issues like BCG shortage and limited access and really the level of care and the practice patterns for bladder cancer patients can really vary quite a bit between folks in the community and at tertiary centers. I think, within NM, our integrated system really allows patients to be treated and closely surveilled close to their home, even if their treatment course might still be guided by the cutting-edge resources of the academic center. And so, that integrated system, I think, I really want to highlight for our patients.

And the other aspect of the management of high-risk non-muscular invasive bladder cancers is that it often progresses beyond the standard of care therapies and access to clinical trials and participation in research, is something that I want to highlight, working to bring that sort of access to the West suburbs. And the work in your lab has been really pushing the envelope with regard to developing advanced therapies and methods of detecting minimal residual disease and discovering the biomarkers and the predictors of disease recurrence and treatment response. And like I said, it's just great to have that resource to have access to for patients. And I'm sort of excited to be a conduit in terms of providing access to folks in the West.

Joshua J. Meeks, MD: Right. I look at it like a two-way street, right? So, there's definitely times where there's folks that I'll see that are from out there that want to work with us. And I think I use that us term because I feel like they'll see you and they are, again, just delighted by the care they receive. And then, sometimes it's vice versa, where they want a second opinion and we're happy to do that. So, I really think, again, we really work towards the patient's goals and what works best for them.

So, I think with that, that sort of brings our podcast to a close, and I'll turn it back over. But it's so great to have you here, Song, and we look forward to working with you in the future.

Song Jiang, MD: Thanks so much, Dr. Meeks. Likewise.

Melanie Cole, MS: Thank you both for such a fascinating conversation. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.