Genitourinary (GU) cancers include those of the prostate, kidney, bladder, and male reproductive system (e.g., testicular cancer).
In the Division of Oncology, our Genitourinary Malignancies Program consists of medical oncologists who treat patients with cutting-edge systemic therapies and work in a multidisciplinary manner with our colleagues in Urology and Radiation Oncology.
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Referring physicians or patients can call 314-747-1171 to schedule a consultation with one of our Genitourinary Cancer Program physicians.
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GU Malignancies research
The most common non-skin cancer in men, and approximately 1 in 8 men will be diagnosed with prostate cancer. This usually occurs after the age of 65, but can occur at earlier ages. The majority of cases are localized and confined to the prostate, in which case surgery or radiation therapy given with curative intent are usually highly successful. For more advanced prostate cancer, systemic therapies are used to control the cancer. In addition to standard therapies that include “hormone therapy” and chemotherapy, we utilize the newest targeted therapeutics that are successful in controlling more advanced, resistant disease. We have a large number of clinical trials with promising immunotherapies and targeted therapies that in some cases are aimed at replacing traditional chemo and hormonal therapies.
Is the 7th most common cancer in men and women, with approximately 82,000 new cases in 2023. Localized cancer is often treated by a urologist with surgery to remove all or part of the kidney, but sometimes patients may avoid surgery by utilizing non-surgical approaches such as cryoablation, radiofrequency ablation (RFA), or high intensity ultrasound (HIFU). For those patients completing surgery, we can offer FDA approved immunotherapy that can reduce the risk of recurrence. For cancer that has spread we now routinely treat with targeted and immunotherapies, as well as numerous clinical trials. The available medical oncology clinical trials include clear cell renal cell carcinoma (RCC), the most common subtype, as well as clinical trials for rarer non-clear cell types such as papillary, chromophobe, and translocation kidney cancer.
Is the 6th most commonly diagnosed cancer, with approximately 83,000 new cases in 2023. For disease that is diagnosed very early, our urology colleagues treat with surgery. However, for more advanced disease chemotherapy is typically used prior to surgery to remove the bladder. Bladder cancer that has spread can be treated with chemotherapy, immunotherapy, and a combination of immune and targeted therapies. We have multiple clinical trials that span early to more advanced bladder cancer, and utilize novel therapeutics.
Is the most commonly diagnosed cancer in men ~20 to 30 years of age. The vast majority of testicular cancers are cured by either surgery or chemotherapy and radiation therapy. Relapsed and/or refractory testicular cancer may require more advanced systemic therapies or potentially bone marrow transplantation.
Our Treatment Approach
The Treatment Approach of the program — this can include discussion about multidisciplinary teams, tumor boards, types of treatments used, etc.
Our GU Malignancies Program consists of a multidisciplinary approach, with close coordination of care between Medical Oncology, Urology, and Radiation Oncology. We utilize cutting edge advanced imaging modalities such as PET-MRI, and also work closely with our colleagues in Radiology and Nuclear Medicine in order to best visualize any potential sites of cancer spread. We have a multidisciplinary “Tumor Board” every month in order to coordinate care of our GU cancer patients, as well as multidisciplinary discussion of complex cases every two weeks. A newly created “Theranostics Tumor Board” focuses on delivering cutting edge, targeted radiotherapeutics to our prostate cancer patients. We have clinical trials across essentially every GU tumor type, at every stage of disease, in order to offer optimal treatment strategies for every patient with GU cancer.
Eric Knoche, MD
Dr. Knoche sees genitourinary cancer patients at our Siteman West County location one day per week and is also the Hematology/Oncology Section Chief at the John Cochran VA Medical Center. His research focus is primarily in optimizing care and designing clinical trials for veterans with advanced prostate cancer.
Russell K. Pachynski, MD
Dr. Pachynski sees genitourinary cancer patients at the Siteman West County location one day a week. He has expertise in tumor immunology and immunotherapy, and has designed and led several trials focused on immunotherapy. His lab focuses on prostate cancer and developing novel immunotherapies that can be translated into the clinic.
Joel Picus, MD
Dr. Picus sees genitourinary cancer patients at the Center for Advanced Medicine (CAM) as well as at the Siteman South County location. He has extensive experience conducting clinical trials across the various GU cancers, and is currently leading several clinical trials in advanced kidney and prostate cancer.
Melissa A. Reimers, MD
Dr. Reimers sees genitourinary cancer patients at the Center for Advanced Medicine (CAM) and at the Siteman West County location. Her practice is focused on the treatment of bladder, kidney, and prostate cancer. She leads multiple clinical trials for patients with advanced bladder and kidney cancer.
Bruce J. Roth, MD
Dr. Roth sees genitourinary oncology cancer patients at the Siteman North County and Siteman South County locations. He has longstanding expertise in testicular cancer treatment and is currently conducting a clinical trial in this patient population. He has served as principal investigator on many key GU oncology trials.
- Michelle Maurer, ANP-C
- Courtney Porter, AGNP
- Jane Sherman, APN-BC
- Margaret Brockmeyer, BSN
- Cheryl Cima, RN, BSN
- Cara Lewis, RN, BSN, OCN
- Laura Lottes-Bishop, RN, BSN, MSN, EdD
- Rachel Kacena, RN, BSN
- Cheryl Miller, RN, BSN, OCN
- Jamie Sharamitaro, RN, BSN, OCN
- Julie Tucker, RN, BSN, OCN
Research and Clinical Trials
- A novel liquid biopsy to predict responses to prostate cancer therapy
In collaboration with Drs. Chris Maher (Oncology) and Aadel Chaudhuri (Radiation Oncology), Dr. Pachynski has been working to develop a new “liquid biopsy” that can predict responses to treatment. A simple blood draw is used, and DNA that is shed from the prostate cancer is detected and analyzed. Using this approach, patients who are more or less likely to respond to a therapy can be identified. This has the potential to improve patient outcomes and personalize treatment decisions.
- A tumor-targeted immunotherapy
Dr. Pachynski’s lab has developed a novel, tumor-targeted immunotherapy that aims to redirect immune cells into tumors. Increasing the number of “good” immune cells within the tumor has the potential to substantially slow tumor growth, and prostate cancer typically has a paucity of these types of immune cells. Preclinical studies in the Pachynski Lab are ongoing, with plans to move the therapeutic into the clinic to treat prostate cancer.
Ongoing Clinical Trial Highlights
- An Open-label, Multicenter Study of LOXO-435 (LY3866288) in Advanced Solid Tumor Malignancies with FGFR3 Alterations
Up to 20% of patients with locally advanced or metastatic bladder cancer have alterations in a gene called FGFR3. An approved standard of care treatment is available for these patients; however, this phase 1 clinical trial is testing a novel FGFR3 inhibitor for patients who have already received the standard treatment and whose cancer is no longer responding. (PI Reimers, M)
- A Phase 1/2, Open-label, Multicenter, Dose Escalation and Cohort Expansion Study of the Safety and Efficacy of Anti-CD70 Allogeneic CRISPR-Cas9–Engineered T Cells (CTX131) in Adult Subjects with Relapsed or Refractory Solid Tumors
This is a first in human phase 1 clinical trial of a novel CAR-T cell therapy for patients with advanced or metastatic clear cell renal cell carcinoma whose cancer has not responded to at least one immunotherapy and one tyrosine kinase inhibitor (TKI) therapy. (PI Reimers, M)
- A Phase 1 Study Evaluating the Safety, Tolerability, Pharmacokinetics, and Efficacy of AMG 509 in Subjects With Metastatic Castration-Resistant Prostate Cancer
This trial is looking at a new type of immunotherapy that targets a protein on the prostate cancer cell (STEAP1) and actively engages the immune system to kill the tumor cells. The infusion is given weekly by IV, and patients must have had at least 1 prior treatment for their metastatic prostate cancer. (PI: Pachynski, R)