Duke Urology is among the top 10 urology programs in the nation and serves as a high-volume regional and national tertiary-quaternary referral center. As one of the original NCI-designated comprehensive cancer centers since 1973, Duke University has always been privileged to treat patients with some of the most complex and varied genitourinary malignancies. The Duke Cancer Institute (DCI) is a state-of-the-art, thoughtfully crafted 265,000-square-foot space that houses the Genitourinary Oncology space. The DCI houses all oncology services including infusion/chemotherapy, surgical and radiation oncology along with cancer imaging — all under the same roof, acting as a one-stop facility for all of our cancer patients’ needs.
To provide the SUO fellow with a first-rate surgical experience, the fellow operates up to four days per week. After demonstrating proficiency and thoughtful surgical decision-making, the fellow begins to assume progressive responsibility for patient care and teaching of the residents. We feel that this is an invaluable part of developing surgical expertise, and it is wholeheartedly embraced.
The fellowship is structured in a hybrid mentorship model with the fellow accompanying oncology faculty in the operating room and clinic. Surgical experience is a priority and thus the fellow is expected to attend all index cancer surgical cases involving all aspects of GU surgical oncology that the fellow might encounter in his/her career. The fellow is exposed to a wide range of surgical techniques including the most minimally invasive needle-based cancer treatments, mult-port and single-port robotics and laparoscopy, and maximally invasive open extirpative surgery. As a quaternary referral center, Duke urologic oncology will treat patients with large tumors including upper abdominal lymphadenectomy requiring hepatic mobilization techniques and adjacent organ resection, level 3-4 vena caval resections/reconstructions and post-chemotherapy and post-radiation extirpation. We perform a number of minimally invasive laparoscopic, retroperitoneoscopic, LESS, and robotic cases for prostate, kidney and bladder cancers. We have the latest robotic equipment including dual-head consoles with simulator modules and newly renovated robotic operative suites.
The Duke Medical Pavilion, completed in 2013, provides additional operative suites, including two intraoperative therapeutic MRI scanners and an intraoperative CT scanner for image-guided prostate and kidney procedures. Fellows will gain experience in new and evolving cancer diagnostics and therapies such as TRUS-MRI fusion biopsy techniques, sentinel lymph node mapping of pelvic tumors, and focal therapy for prostate and kidney cancer.
During the research year, the Fellow will take some call however the year is protected at least 80% based on the SUO curriculum guidelines. During the clinical year, the Fellow has admitting and operative privileges and therefore functions as junior faculty. The Fellow is assigned to call commensurate with the other clinical fellows in our division, which typically works out to one week of call per quarter, depending on the number of faculty and fellows rotating in the call schedule. For ICGME fellows, faculty call is not permitted.
The SUO fellows have the opportunity to participate in several multidisciplinary interactions to improve their basic and clinical knowledge and to manage patients with complex cancer needs.
- Urologic Oncology Clinic: The patient-centered clinical experience is housed in the Duke Cancer Center, and urologic oncology very often interacts with medical and radiation oncology regarding patient care plans. Our physical environment is unified to facilitate this interaction as we practice in the same space as our GU oncology colleagues. Included in this clinical context is the need to develop a comprehensive care program for each patient, that includes nutrition, onco-primary care, psychosocial support, survivorship, and other downstream services. There is direct interaction amongst these various disciplines
- The Operating Theatre: Select cancers require complex multi-disciplinary extirpative and reconstructive surgeries that may involve general surgery, orthopedics, plastic surgery, and/or GU reconstruction, sometimes involving intraoperative radiation. These procedures are planned in advance, and not uncommonly may initially be presented at a different tumor board (e.g., Sarcoma Board).
- Multidisciplinary Prostate Cancer Clinic: Meets nearly every Friday morning in the Cancer Center, as is staffed by urologic oncology, radiation oncology, and medical oncology. We discuss multidisciplinary and commonly integrative care with patients who present to Duke for a second opinion on treatment options.
- GU radiology: The Fellow is expected to attend and contribute to the bimonthly genitourinary imaging conference (one-hour each session). Radiological images are discussed at each tumor board [meets approx weekly). Additionally, we have an active mpMRI and targeting working group both for clinical care and research. Many of the Fellows have done research within this group and attend biweekly MRI reading, segmentation and post-biopsy analysis. Interaction between the Fellows and GU imaging is very frequent.
- Uropathology: There are six weekly lectures at the beginning of the academic year on urologic pathology. Also, GU pathology attends all tumor board conferences. The Fellow interacts with the pathologist prior to tumor board. The Fellow also has the opportunity to engage in multidisciplinary research that commonly involves pathology. Fellows are advised to personally review interesting surgical pathology specimens with the pathologist as part of routine clinical care.
- Grand Rounds: Every Wednesday morning Urology Grand Rounds are held. These rounds are multidisciplinary and cover a broad range of topics of interest to the academic and practicing urologist
- GU Oncology Tumor Board: A weekly multidisciplinary meeting with Urology faculty, Pathology, Radiology, Medical Oncology, and Radiation Oncology to discuss challenging clinical cases in urological oncology using latest evidence-based medicine. When Urology hosts tumor board (once per month), the Fellow is expected to identify and prepare clinical cases, mentor the oncology-assigned resident to deliver sound presentations and become familiar with the literature supporting each case.
- Biomedical engineering: We have several collaborative projects including development of multi-parametric ultrasound, Acoustic Radiation Force Impulse (ARFI) imaging of prostate cancer, instrument design, immunotherapy, and high intensity focused ultrasound (HIFU).
- Duke MEDX: A platform that encourages collaborations between the School of Medicine and the Pratt School of Engineering that provides opportunity to propose a collaborative project between the two disciplines. Fellows have worked on collaborative projects or instrument design. Patents: Interdisciplinary joint projects with biomedical engineering faculty and students for designing and manufacturing new surgical systems or devices
- Duke Cancer Institute Multidisciplinary Prostate Imaging and Targeting working group: This biweekly conference was recently approved and funded as an educational program and consists of Urology, radiology, biomedical engineering and pathology faculties to develop an interdisciplinary approach to challenging cases of image-visible prostate cancer. Fellows have the opportunity to learn interpretation of prostate mp-MRI, application and principles of PI-RADS v2 scoring system, identification of normal prostate vs. benign hyperplasia vs. “significant” vs. “insignificant” prostate cancer foci, transrectal ARFI sonography, computerized fusion and co-registration, clinical indications and techniques for MR-targeted fusion, and mpTRUS direct (non-fused) image-guided biopsy.
- Prostate Cancer Research group: A multidisciplinary group that includes over 80 researchers across multiple specialties including but not limited to cancer and RNA biology, exercise physiology, immunology, nanotechnology, pathology, biostatistics, radiation biology, nutritional biology, metabolomics, genetics and genomics, epidemiology, and biomedical engineering. Meets regularly once per month and holds quarterly planning sessions.
- Duke Institute for Health Innovation, and the Duke Men’s Health Initiative Prostate Cancer Screening event: The Planning Committee, comprising members of Urology, GU Oncology, Radiation Oncology, the Duke Cancer Institute, Primary Care, Biostatistics, Health Equity and Disparities, among others, begins planning the annual September event a year prior to launch. The Fellow has the opportunity to interact with these leaders, particularly on the primary care side, to develop working relationships that benefit men’s health initiatives.
- Duke Friday symposium: This half-day multidisciplinary conference is run three times per year. There are usually two oncology presentations and is a great opportunity for Fellows to become familiar with nationally recognized guest speakers discussing latest developments in the field. Didactic lectures, interactive panel discussions, and case presentations are the formats of this activity.
The educational component of the program includes lectures and seminars on a variety of oncologic topics covering the spectrum of urologic cancers.
As a Junior Faculty position, the fellow will participate in didactic education of residents and medical students on urologic oncology topics. In addition, the fellow will lead the multidisciplinary tumor board conference in collaboration with pathology, medical oncology, and radiation oncology.
Other educational opportunities
- Duke Cancer Institute Advanced Prostate Imaging and Targeting working group: Meets biweekly to discuss mpMRI targets, ARFI US targets, clinical and pathological results. QI initiative, collaboration between urology, radiology, pathology and biomedical engineering.
- Robotics committee: Multidisciplinary meeting to discuss QI and performance. Meets monthly.
- Pelvic Medicine Research Consortium: Meets monthly to discuss research, networking/collaboration development.
- Duke Institute for Health Innovation Multidisciplinary Prostate Cancer Screening and Active Surveillance working group: Periodic meetings and presentations to primary care regarding screening and surveillance. In 2016, our fellow presented at approximately a dozen primary care practices.
- Duke CACHE-AI (Collaborative to Advance Cancer Health Equity): A data science initiative to address disparities and access and quality of cancer care in our surrounding communities.
- Prostate Cancer Academy and Bladder Cancer Academy meetings conducted by LUGPA and AUA - for SUO fellows
- AUA-SUO meeting for CRPC updates
- We have been able to get fellows into some courses, such as ASCO/AACR Methods in Clinical Cancer Research Workshop
All of these facets of the Duke SUO Fellowship together serve to provide our fellows with the substance requisite to becoming future leaders in Urologic Oncology. We are proud of our mission to provide patients with state-of-the-art care for all their oncologic needs, and we are proud to train some of the most talented men and women in the world who will be equally proud to be Duke doctors.