UROLOGY_NEWS_SPRING_2022

URology University of Rochester Medical Center | Urology News | Spring 2022

Messing Tapped to Lead American Urological Association

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Letter from the Chair

Jean Joseph, M.D., M.B.A., F.A.C.S. Winfield W. Scott Professor and Chair Department of Urology Professor of Oncology Wilmot Cancer Institute University of Rochester Medical Center

I was a resident at Strong Memorial Hospital when Dr. Edward Messing arrived in Rochester in 1995 to become the second W. W. Scott Professor and Chair of the Department of Urology. During his tenure, spanning nearly three decades, he has trained a number of residents and fellows. We all remember him for his vast fund of knowledge, unparalleled work ethic, constant quest to improve the care of his patients, and to advance research.

Whether in the clinical setting or in his research pursuits, he has been a strong mentor and an inspiration to many. Dr. Messing is the embodiment of academic medicine and has been one of the true giants in the field. He is a tireless, dedicated clinician and renowned surgeon whose research has helped lead to new ways to detect, prevent and treat a wide range of urologic cancers.

In May, Dr. Messing will assume the presidency of the American Urological Association. He will be the third member of the University of Rochester Medical Center (URMC) Urology Department to serve in this role. The cover story of this edition of URology looks back at Dr. Messing’s remarkable career and forward for his plans for AUA.

On the cover:

Edward Messing, M.D., F.A.C.S.

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URMC Urology is building on the foundations laid by Dr. Messing and his predecessors to strengthen its position as one of the most active urologic research centers in the nation.

URMC is currently home to several NIH and industry supported research projects in areas such as stone disease, bladder cancer, renal cell carcinoma, prostate cancer, among others. In this URology issue, we cover our efforts to expand clinical

| Department of Urology | urology.urmc.edu

research and provide patients with a better pathway to participate in clinical trials.

This issue also highlights our third annual Bladder Cancer Symposium, which was held this past November.

As was the case in 2020, this meeting was virtual. A large number of urologists attended the symposium to learn about discoveries in diagnostic and therapeutic options for upper tract urothelial carcinoma.

Our department continues to grow to serve our patients in the region and deliver on our training and research missions. Over the next few months, we will be joined by Philip Rappold M.D., Ph.D., who will further our expertise in clinical care and research of renal carcinoma. Nitin Sharma, M.D., will join our Southern Tier operations providing endourology expertise. Thomas Ozinski M.D., will also join our faculty, providing additional depth to the ongoing clinical care and research contributions in our minimally invasive urologic oncology section.

Much of the work we do would not be possible without the generous support of our donors, and grateful patients. In this issue, we share our team’s relationship with Jan Ashley, who has been a patient and friend of Dr. Messing for more than 25 years and a tireless advocate for bladder cancer research and care. As many who have been privileged to work with or to be cared for by Dr. Messing, she describes him as “indefatigable.”

I can’t think of no better tribute and one that truly reflects the University of Rochester’s motto Meliora, to strive and make the world “ever better.”

Incoming AUA President Continuing the Leadership Tradition of URMC Urologists When Edward Messing, M.D., F.A.C.S., assumes the American Urological Association (AUA) presidency in May 2022, he will follow in the footsteps of other leaders in the field from the University of Rochester Medical Center.

Prior URMC department leaders who served as AUA president include Abraham T.K. Cockett, M.D., from 19931994 and Irwin N. Frank, M.D., from 2000-2001. All three leaders are renowned for advancing urology nationally and internationally through landmark discoveries and their commitment to mentoring the next generation of urologists.

“As a leading academic medical center, URMC has a long tradition of providing the best possible urological care to patients, ensuring that our care is based on evidence-based research,” said Jean Joseph, M.D., M.B.A., chair of URMC’s Department of Urology. “Ed Messing, like Irwin Frank and

Abraham Cockett, has made an indelible impact on improving patient care through science and innovation.”

“None of their outstanding achievements were created in a vacuum,” Joseph added. “They were the result of URMC’s strength and support and of our department’s infrastructure – established by our first department chair, Dr. Winfield Wentworth Scott – that fosters collaboration, discovery and intellectual curiosity.”

From the Public Health Service to groundbreaking urology care and research Edward Messing’s path to a legendary urology career and the AUA presidency was sparked by a drive to complete his urology surgery residency and a commitment to the U.S. Public Health Service Commissioned Corps.

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Facing the certainty of being drafted into military service, Messing was determined to finish his urology residency at Stanford University, and he hoped to defer military duty until the residency ended. So, instead of possibly being drafted to serve immediately, he enlisted in the Public Health Service (PHS), a service branch created by President John Adams that today protects, promotes and advances the nation’s health and safety.

While the PHS promised Messing the rank of lieutenant commander following his residency, it appointed him at the lower rank of lieutenant, which also carried a $5,000 lower annual salary. Messing wrote letters to the President of the United States, California’s two U.S. Senators and his local Congress member, Rep. Pete McCloskey, advocating for the PHS to honor its higher-rank pledge.

An aide to Rep. McCloskey, then the ranking minority member on the Merchant Marine and Fisheries Committee overseeing the PHS, called Messing and said, “The Congressman wants to make sure, are you willing to serve or not?” To which Messing replied, “Of course, I made a commitment. The service didn’t honor their commitment.”

With the Representative’s support, Messing entered the PHS as a lieutenant commander assigned to New Orleans, where he served for two years while holding an adjunct faculty position at Tulane University. After the PHS service, Messing completed a two-year fellowship in urologic oncology at UCLA and held a faculty appointment for 14 years at the University of Wisconsin at Madison – the last 10 years serving as director of Wisconsin’s urologic oncology program.

He became chair of the URMC Department of Urology in 1995, a position he held until 2018. Under his leadership, the department became Upstate New York’s leading provider of advanced urological care. Today, Messing remains an active clinician and surgeon. He also serves as a professor of urology, oncology and pathology.

An internationally renowned expert, researcher and surgeon A celebrated expert in all facets of urologic oncology, including the diagnosis and treatment of cancers of the prostate, bladder, kidney, testicle, penis and other genitourinary organs, Messing conducts extensive research in the biology of bladder and prostate cancers. He has been the principal investigator on numerous clinical studies for the detection, prevention and treatment of genitourinary cancers.

Much of his research focuses on helping patients through studies that compare novel treatments to existing ones. One of his primary interests is bladder cancer, a disease in which

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early recognition is critical. He led a bladder cancer study that resulted in the first simple, at-home urine test to screen for the disease and published a landmark study that concluded that bladder cancer screening in healthy men can lead to earlier detection and reduced mortality.

Other important clinical trials for urologic cancers explored difluoromethylornithine’s ability to prevent bladder cancer recurrence; the use of adjuvant hormonal therapy on men with prostate cancer found to have spread to regional lymph nodes at surgery to remove the prostate; the use of adjuvant immunotherapy (Interferon alpha) in patients with locally extensive renal cell cancer after seemingly complete surgical removal; and whether instillation of a chemotherapy drug immediately after removal of a bladder cancer could reduce the likelihood of tumors recurring. Among studied patients with suspected low-grade non-muscle-invasive urothelial cancer – which frequently recurs after excision by transurethral resection of bladder tumor (TURBT) – immediate postresection intravesical instillation of a chemotherapeutic agent, gemcitabine, significantly reduced the recurrence risk.

Messing is currently studying whether bladder cancer has molecular features that can predict response to gemcitabine, including whether certain enzymes that metabolize gemcitabine rapidly could make cancer cells more resistant.

A related project that Messing and URMC are involved with is exploring how an implementation science framework can increase rates of instilling postoperative intravesical chemotherapy in patients with suspected low-grade, nonmuscle-invasive bladder cancer, thereby improving cancer care while reducing patients’ suffering and medical costs.

Through these efforts, the rate of appropriate utilization of intravesical gemcitabine increased from 11 percent to almost 90 percent after a year at the University.

Messing is the author or co-author of 26 book chapters and 346 urology journal articles, and he has been honored with numerous awards. Accolades include the AUA’s Presidential Citation and prestigious Ramon Guiteras Award, as well as the Society of Urological Oncology’s SUO medal and its Distinguished Service Award.

A leader in the field Messing has held previous leadership positions in the AUA and in other national, regional and local organizations, from being president of the AUA’s Northeastern Section and the Society of Urological Oncology, to being interim director of the National Cancer Institute-designated URMC Cancer Center.

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In 2020, Messing decided to run for AUA president. His wife of more than 50 years was diagnosed with lung cancer, so he had to make sure that she was comfortable with him seeking the position. His wife was doing well at the time of the decision, so they agreed the time was right. In addition to her husband meeting the challenges of the position and serving fellow urologists, his wife looked forward to accompanying her husband at the association’s various events around the world.

Messing won the election and will assume the role of president in May 2022. Unfortunately, his wife will not be by his side as she passed away in May 2021.

Goals for the AUA As AUA president, Messing aims to stimulate research, making the association an even bigger research enterprise than it is today through new programs such as a larger grant pool for junior faculty and residents.

Expanding the advocacy role is another major objective.

A key issue he plans to address is student-loan debt and its impact on urologist shortages in rural communities.

“Many urologists come out of medical school with an incredible amount of debt, and that has a lot to do with where they decide to practice – choosing places where they can make a better living,” he said. “As a result, there is a core distribution of urologists in major urban areas, leaving major shortages in rural communities.”

Messing plans to lobby for the expansion of an existing U.S. government program that forgives some debt for primary care physicians practicing in rural communities to include urologists and other specialists. He also wants to address this issue in Canada, where the rural urologist shortage is an even greater concern.

Based on his accomplishments in scientific discovery and on his advances in improving patient care, there is little doubt that he can achieve these goals and more as AUA president.

Urology Department Aims to Significantly Expand Clinical Trials URMC’s Urology Department is working to build on its leadership as one of the most active urologic research centers in Upstate New York, as well as the clinical research legacy of the University.

A forerunner in clinical research resulting in scientific breakthroughs and improved patient care, the Urology Department aims to expand the number of clinical trials across the discipline and give patients a better pathway to participate in these studies.

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Our goal is to be able to offer a clinical trial to every patient that comes to our Urology clinic.”

Currently, the department is conducting six studies, from NIH-funded cooperative studies to industrysponsored and investigator studies. Current research focuses on such areas as kidney stones, bladder cancer, renal cell carcinoma and prostate cancer.

Clinical trials will expand through the department’s collaboration with the University of Rochester Clinical & Translational Science Institute’s Office of Clinical Research, which connects faculty to relevant studies. Department researchers also work closely with URMC’s Wilmot Cancer Institute, given the common intersection of urology and oncology.

The strategy to broaden clinical trials is being driven by department chair Jean Joseph, M.D., and vice chair of academics, Guan Wu, M.D., PhD. In addition to engaging existing faculty in ongoing studies, the department has recruited new faculty with interest and expertise in clinical trials, and has brought on board nursing expertise and additional study coordinators to build the necessary infrastructure to conduct clinical trials. Rachel O’Loughlin, B.S., R.N., was hired recently to server as the department’s clinical trials manager.

“When I came to the Urology Department, I joined with the mindset that we can ramp up our clinical research, which fit well with Dr. Joseph’s strategic direction,” said O’Loughlin. “We plan to accomplish this by attaining additional infrastructure resources that will enable us to perform even more complex clinical trials, as well as by building out our staff.”

Ultimately, the department aims to offer patients clinical trials that provide access to innovative, minimally invasive treatments that improve urological care and save lives. “Our goal is to be able to offer a clinical trial to every patient that comes to our Urology clinic,” O’Loughlin added.

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Bladder Cancer Symposium Marks Third Year The 3rd annual Bladder Cancer Symposium 2021 was held in November. The event is hosted by the UR Medicine Wilmot Cancer Institute and Department of Urology. As in 2020, the symposium was held virtually, with participants from across the globe.

The focus of the 2021 symposium was upper tract urothelial cancer (UTUC), a subset of urothelial cancer that occurs in either the ureter or within the inner lining of the kidney. More than 150 physicians attended the symposium, where they heard from experts in urologic, radiation and medical oncology providing the

PHILANTHROPHY

latest updates and breakthroughs in UTUC research and treatment.

Guest speakers included Seth Lerner, M.D., with Baylor College of Medicine, Kerry Schaeffer, M.D., with Vanderbilt University, Arlene Siefker-Radtke, M.D., with MD Anderson Cancer Center, and Phillippe Spiess, M.D., with Moffit Cancer Center. URMC faculty Edward Messing, M.D., William Tabayoyong, M.D., Ph.D., Peter Van Veldhuizen, M.D., and Elizabeth Ellis, M.D., also made presentations. The next symposium is scheduled for November 2022.

Jan Ashley

For more than 25 years, Jan Ashley has been a passionate advocate for bladder cancer research and supporting those impacted by the disease. This all began when she became a patient of Ed Messing, M.D., in 1996, only a year after he arrived at the University of Rochester Medical Center to assume the chair of the Urology Department.

Jan describes Messing as “indefatigable,” and over the decades of care that continue to this day, the two formed a close relationship. “I have the greatest regard for the way that Dr. Messing practices medicine,” said Jan. She is so grateful that under Dr. Messing’s care she is celebrating 25 years free from bladder tumors.

The Ashley Family Foundation has generously supported the Department’s Edward M. Messing M.D. Endowed Fund in Urology and Bladder Cancer Research Fund.

At Messing’s encouragement, Jan became involved in Bladder Cancer Advocacy Network (BCAN) and served on the organization’s board. BCAN advocates for greater public awareness and increased funding for research to diagnose and treat bladder cancer, and provides thousands of patients, caregivers, and the medical community with educational resources and support services.

Over the years, Jan attended many BCAN conventions and events across the country where Messing and other leading clinicians, researchers, patient advocates, and industry representatives held panel presentations and interactive discussions focused on bladder cancer screening, improving the quality of life for bladder cancer survivors, and challenges in discovering new targets and therapies.

“When I would be at convention meetings for BCAN and Dr. Messing would speak, I would sit there proudly and think that’s my doctor, and he is the brightest one in the room,” said Jan. “It is wonderful that his decades of leadership will be recognized by his peers when he becomes president of the American Urological Association later this year.”

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RESEARCH

Flax Lab

The COVID-19 pandemic has made clear the value of rapid, accurate, widely available and inexpensive means of detecting markers of disease. Funded by a $1.6 million grant from the National Institute of Biomedical Imaging and Bioengineering, URMC researcher Jonathan Flax, M.D., James McGrath, Ph.D. in Biomedical Engineering at the University of Rochester, and collaborators at the University of Ottawa in Canada are developing such a device.

The technology captures and concentrates a disease-related protein biomarker, triggering the generation of multiple DNA tags for each captured protein. Each of the DNA molecules is then counted individually by an electronic sensor. In this manner, a single disease-specific protein present in blood or urine is converted into a large electronic signal, permitting detection and quantification of rare proteins. This process will permit the quantitation of biomarkers in minutes, far faster than many existing laboratory devices, but with an ability to detect rare but diagnostically valuable disease markers in a timely manner.

The device’s low cost, small size and sensitivity are driven by the ultrathin porous membranes developed by the McGrath lab, which permit the enrichment of rare biomarkers present in blood or urine, and serve as a key component of the electronic sensor. The device size will permit the sensor to be utilized in multiple settings, including doctor’s offices and non-health care settings.

EDUCATION PROFILE

To demonstrate the device’s clinical utility, Flax is coordinating testing on clinically validated biomarker proteins in bladder cancer treatment and traumatic brain injury (TBI). The bladder cancer study will focus on quantitating the level of inflammatory proteins that are released following treatment of the bladder cancer with Bacillus Calmette-Guerin. The levels of these proteins have been demonstrated to predict the patient’s response to therapy. If successful, these studies will facilitate the movement of the device from the bench to the clinic. The TBI study will be led by Jeff Bazarian, M.D., M.P.H., a professor of Emergency Medicine and Neurology at URMC and a leading TBI expert. The goal will be to detect proteins in serum released by the brain and spinal cord following injury and confirm that they can discriminate patients with TBI from those with non-neurologic injuries.

Elizabeth Ellis

Elizabeth Ellis M.D., M.S., is a fourth year Urology resident at the University of Rochester. Ellis is dedicating a year of research to understanding the molecular underpinnings of renal cell carcinoma. Specifically, she is utilizing a series of molecular tests, both multi-omic testing and pathological immuno-staining, to differentiate between aggressive and more indolent masses.

The result will help determine if a patient needs additional adjuvant treatment after surgery, or to tell from a biopsy if a patient needs surgery to remove a renal mass. She has designed a study with the assistance of several URMC Urology faculty and in collaboration with Hiroshi Miyamoto, M.D., Ph.D., from URMC’s Department of Pathology.

Ellis has been active in research throughout her residency.

Her prior studies include outcomes after robot-assisted radical prostatectomies, the role of mpMRI in active surveillance of prostate cancer, active surveillance versus primary intervention for small renal masses, patient and physician perspectives on telemedicine, and novel techniques for intrapelvic chemotherapy

instillation. She has given several presentations at the AUA national conference, NSAUA regional conference, URMC Bladder Cancer Symposium and Society of Women in Urology Conference.

She is also dedicated to improving the inequalities of women in surgery and is active on an SWIU committee to promote diversity in the field of urology.

Ellis is a St. Louis, MO native and received a B.S. in Chemistry from Butler University, an M.S. in Anatomy from Saint Louis University, and her M.D. from University of Missouri School of Medicine. She plans to pursue a fellowship in Urologic Oncology.

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University of Rochester Medical Center Department of Urology 601 Elmwood Avenue, Box 656 Rochester, NY 14642

NONPROFIT ORG U.S. POSTAGE

PAID

UNIVERSITY OF ROCHESTER PERMIT 780

DEPARTMENT OF UROLOGY FACULTY

Divya Ajay, MD, MPH Assistant Professor of Urology Zaheer Alam, MD Assistant Professor of Clinical Urology

Jonathan Flax, MD Research Assistant Professor of Urology

Diane Lu, MD Assistant Professor of Clinical Urology

Thomas Frye, DO Assistant Professor of Urology and Oncology Associate Director, Clinical Trials Vice Chair of Clinical Affairs

Edward M. Messing, MD, FACS Professor of Urology and Oncology

Joseph Gabrielsen, MD, PhD Assistant Professor of Urology

Jathin Bandari, MD Assistant Professor of Urology

David Gentile, MD, FACS Professor of Clinical Urology Chief of Urology, Highland Hospital

Jonathan Bloom, MD Assistant Professor of Clinical Urology Jimena Cubillos, MD Associate Professor of Clinical Urology and Pediatrics Director of Quality Improvement Vice Chair of Quality, Safety, and Patient Outcomes David Diamond, MD Professor of Urology & Pediatrics

Ahmed Ghazi, MD, MSc Associate Professor of Urology Co-Director, Endourology, Robotic/ MIS Fellowship Director, Simulation Innovation Lab Rajat Jain, MD Assistant Professor of Urology Yi-Fen Lee, PhD Professor of Urology, Oncology, Pathology and Laboratory Medicine

Jason Donovan, PA Karrah Gantz, NP Diane Giordano, PA Cassandra Gregoli, PA Kim Hoadley, PA Samantha Howell, PA Shawna Hyland, NP Maureen Kiernan, NP

Jeanne H. O’Brien, MD Professor of Urology Associate Chair of Faculty Development and Resident Education Scott Quarrier, MD, MPH Assistant Professor of Urology Assistant Director Residency Program Ronald Rabinowitz, MD Professor of Urology and Pediatrics Hani Rashid, MD Professor of Urology and Oncology Director of Residency Program Otto Sandoval, MD Associate Professor of Clinical Urology Annette E. Sessions, MD

Paul Shapiro, MD Associate Professor of Clinical Urology Chief of Urology, FF Thompson and Clifton Springs Hospitals William Tabayoyong, MD, PhD Assistant Professor of Urology Shlomi Tapiero, MD Assistant Professor of Clinical Urology Jared Wachterman, MD Assistant Professor of Urology Gareth Warren, MD Assistant Professor of Urology Guan Wu, MD, PhD Professor of Urology and Oncology Director of Urologic Oncology Co-Director, Fellowship in Robotic Surgery Vice Chair of Academics Shu-Yuan Yeh, PhD Professor of Urology, Oncology, Pathology and Laboratory Medicine

DEPARTMENT OF UROLOGY RESIDENTS/FELLOWS

ADVANCED PRACTICE PROFESSIONALS Meredith Abbasi, NP Jamie Allen, NP Katie Bates, PA Dan Barney, PA Amy Beyrle, PA Steve Blount, PA Amanda Buckner, PA Jamie Connor, NP

Joy Michaelides, MD Assistant Professor of Urology

Assistant Professor of Clinical Urology

Victoria Mesko, NP Jillian Parshall, NP Emily Potter, NP Erin Ruggieri, NP Claire Smith, PA Kristin Smith, PA Melinda Westbrook, NP

Nitin Sharma, MD, Fellow Thomas Osinski, MD, PGY6 Alexander Cranwell, MD, PGY6 Alexis Steinmetz, MD, PGY5 Kit Yuen, MD, PGY5 Karen Doersch, MD, PGY4 Elizabeth Ellis, MD, PGY4 Austin Lee, MD, PGY3

Aaron Saxton, MD, PGY3 Christopher Wanderling, MD, PGY3 Timothy Campbell, PGY2 Stephen Hassig, PGY2 Laena Hines, PGY2 Carl Ceraolo, PGY1 Trevor Hunt, PGY1 Ashley Li, PGY1

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Jean V. Joseph, MD, MBA, FACS Professor of Urology and Oncology Winfield W. Scott Professor and Chair of the Urology Department