Christopher J. Kane, MD, FACS

University of California, San Diego School of Medicine

La Jolla, California

Christopher J. Kane, MD, FACS, is Dean of Clinical Affairs at the University of California (UC), San Diego School of Medicine. He is also Chief Executive Officer (CEO) of UC San Diego Health Physician Group and Professor of Urology at UC San Diego Health. Dr. Kane is on the Executive Governing Board of UC San Diego Health Sciences and the Executive Committee of UC San Diego’s Clinical Integration Network. In addition, he is the president of the Western Section American Urological Association (AUA) and trustee of the American Board of Urology (ABU). Dr. Kane is an internationally recognized expert in prostate cancer and kidney cancer epidemiology, risk stratification, and outcomes after treatment. He completed his urology residency at Oakland Naval Hospital and UC San Francisco. Dr. Kane earned his medical degree at Uniformed Services University in Bethesda, Maryland, and his BS degree in mechanical engineering at UC Davis. From 2009 to 2016, he was Co-Chair of the Renal Cell Carcinoma Advisory Task Force, National Cancer Institute. Dr. Kane is on the AUA guidelines in prostate cancer committee and was elected to the American Association of Genitourinary Surgeons (AAGUS) in 2014. In 2017 Dr. Kane was elected to the Clinical Society of Genitourinary Surgeons (GSGUS). He was selected as a “Top Doctor” in San Diego in 2008-2022. In 2010, he was selected as one of two Physician Healthcare Champions in San Diego by the San Diego Business Journal and was awarded the Distinguished Engineering Alumni Medal by UC Davis in 2011. Dr. Kane is a retired Navy Captain and a decorated veteran of Desert Storm. He has authored over 370 publications and book chapters, primarily on prostate cancer risk factors and outcomes, prostate cancer surgery, and minimally invasive surgery for prostate and kidney cancer.

Disclosures:

Talks by Christopher J. Kane, MD, FACS

Point-Counterpoint: Active Surveillance for Intermediate-Risk Disease – Con

Posted by Christopher J. Kane, MD, FACS | Nov 2023

Christopher J. Kane, MD, FACS, discusses active surveillance (AS) for intermediate-risk prostate cancer, sharing National Comprehensive Cancer Network (NCCN) Guidelines and defining favorable intermediate-risk disease. Dr. Kane shares the entry criteria for AS and then data from large randomized trials on treated vs. untreated patients that show more patients with intermediate-risk prostate cancer will die on AS as compared with radical prostatectomy, looking at data over a 20-year time horizon.

He then shares similar results from Prostate Intervention Versus Observation Trial (PIVOT) and ProtecT as well as data indicating that 50 percent of intermediate-risk patients on AS will end up with treatment within five years. Dr. Kane emphasizes that while the point of AS is to avoid overtreatment, for many intermediate-risk patients who begin with AS, treatment does occur but it occurs too late and they do not have the optimal outcomes that earlier treatment would allow.

Dr. Kane turns to progression and treatment rates for AS patients and points out that prostate-specific antigen (PSA) density is a key predictor of treatment. He shares his take-home points, including that favorable intermediate-risk prostate cancer patients are candidates for AS with comparable outcomes to low-risk disease on limited studies with short follow up. However, these patients are more likely to undergo treatment, even without reclassification/progression. He advises practitioners to consider other important clinical and pathologic factors such as percent pattern four, presence of cribiform patterns, and PSA density and the number of cores.

In conclusion, he asserts that in younger, favorable intermediate-risk patients, AS is not a sound management strategy in the hopes of avoiding treatment.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Active Surveillance for Intermediate-Risk Disease–Pro.”

Germline Screening and Polygenic Risk Scores

Posted by Christopher J. Kane, MD, FACS | Sep 2023

Christopher J. Kane, MD, FACS, provides a comprehensive overview of genetic testing in prostate cancer. He emphasizes the importance of distinguishing somatic mutations from germline mutations, and explains the concept of high-penetrance genomic syndromes.

Dr. Kane highlights that genetic testing can be done on various tissues, with cheek swabs and blood tests being the most common methods. He identifies common genetic changes, such as BRCA2, and mentions testing companies like Invitae, Color, and Foundation.

The discussion also covers the significance of single nucleotide polymorphisms (SNP) in non-coding regions of DNA and their role in inherited mutations. Dr. Kane discusses the criteria for testing, including personal or family history suggestive of an inherited syndrome, test validity, and its impact on patient care.

He underscores the relevance of genomic testing for advanced prostate cancer patients, as actionable therapeutics are available for those with DNA repair gene abnormalities. Dr. Kane refers to the Pritchard article, which revealed a higher frequency of genomic syndromes in men with metastatic prostate cancer than previously estimated. Dr. Kane concludes by acknowledging the limitations of family history and the superiority of SNP testing as a predictor of prostate cancer risk.

Management of the Primary in Locally Advanced and Oligometastatic Disease

Posted by Christopher J. Kane, MD, FACS | Aug 2023

Christopher J. Kane, MD, FACS, discusses data regarding the management of the primary in locally advanced and oligometastatic prostate cancer. He reviews a study on the diagnostic accuracy of Gallium Ga 68 PSMA-11 injections used with a PET scan (68Ga-PSMA-11 PET) for pelvic nodal metastasis detection prior to radical prostatectomy (RP) and pelvic lymph node dissection. He explains that 68Ga-PSMA-11 PET is critical in the assessment of men with clinically localized high-risk prostate cancer and that many patients with negative PSMA scans and high-risk clinical features will have positive lymph nodes (N1) discoverable by 68Ga-PSMA-11 PET.

Dr. Kane cites updated National Comprehensive Cancer Network (NCCN) Guidelines that include a recommendation not to omit a node dissection based on PSMA PET results. He reviews findings from both the SPCG-7/SFUO-3 trial and the National Cancer Data Base (NCDB) retrospective review, emphasizing the value of treating the prostate in N1 disease. Data from the VA Informatics and Computing Infrastructure (VINCI) database shows that androgen deprivation therapy (ADT) with radiotherapy was associated with improved prostate cancer-specific mortality (PCSM) among patients with prostate-specific antigen (PSA) levels <26 ng/mL and with improved all-cause mortality (ACM) among those same patients. Dr. Kane points to a similar analysis of VINCI data on patients who had undergone RP that found, compared with non-definitive therapy, RP was associated with significantly better PCSM and ACM. Compared to radiotherapy, RP was not associated with a significant difference in PCSM or ACM. Dr. Kane cites data showing a significant metastasis-free survival advantage among patients with a first postoperative PSA <0.2 ng/mL, a finding that has since been replicated. Finally, Dr. Kane emphasizes the value of treating the primary with T3 in high-risk disease, with T3 and N1 in prostate cancer patients, and with radiotherapy in low metastatic burden M1 disease. He explains the threshold of metastatic burden effect is not well known and there is a clinical trial underway exploring RP and radiotherapy in the M1 population with the current standard of care, and he reiterates that pathological N1 patients benefit from salvage IMRT/ADT.

Point-Counterpoint: Surgery vs. Brachytherapy for Intermediate and High-Risk Prostate Cancer – Surgery

Posted by Christopher J. Kane, MD, FACS | Jul 2023

Christopher J. Kane, MD, FACS, delivers an insightful presentation on the topic of surgery versus brachytherapy for intermediate and high-risk prostate cancer. He begins by highlighting the importance of accurately defining high-risk disease and its implications for treatment outcomes.

While various definitions exist, Dr. Kane focuses primarily on high-risk disease characterized by a PSA over 20, Gleason sum of eight, and clinical stage T2C. Dr. Kane presents his viewpoint that surgery is the optimal treatment for well-selected patients with high-risk prostate cancer. He supports this assertion by discussing several key advantages of surgery over radiation therapy.

He emphasizes the benefits of improved pathologic staging and risk assessment that surgery offers. Additionally, he notes the effectiveness of adjuvant and early salvage therapy in curing many adverse pathologic patients. Moreover, surgery provides better local control and reduces the likelihood of ureteral obstructions and urinary procedures at progression.

Dr. Kane then presents comparative risk-adjusted mortality data from various studies. These analyses demonstrate that surgery significantly reduces cause-specific mortality compared to all forms of radiation therapy. The magnitude of the differences increases with disease risk, further underscoring the value of surgery for patients with higher risk disease.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Surgery vs. Brachytherapy for Intermediate and High-Risk Prostate Cancer–Radiation.

Racial Justice and Prostate Cancer

Posted by Christopher J. Kane, MD, FACS | Jul 2022

Christopher J. Kane, MD, FACS, the Dean of Clinical Affairs at the University of California San Diego School of Medicine, and the CEO of the UC San Diego Health Physician Group, discusses the role of race in prostate cancer mortality among Black men. Dr. Kane presents data showing that both the incidence and rate of death from prostate cancer are significantly higher in Black men, and that this ratio has remained consistent over time. Referencing the SEER database, Dr. Kane notes that Black men were twice as likely to die of prostate cancer. While there are claims that biologic differences between Black and White men are to blame for the rate of death, Dr. Kane points out that the genetic differences between Black men are similar to the genetic difference between White men. He further adds that inheritance patterns of Black Americans are highly variable and cannot be considered a homogenous biological construct. Beyond genetic factors, Dr. Kane mentions other possible causes for the disparity including environmental factors, care dynamics, care quality, and availability. He then reviews a study that analyzed three cohorts to determine whether Black race was associated with inferior prostate cancer outcomes if patients had similar access to care and standardized treatment. The results indicate that Black men were not at higher risk of prostate cancer mortality when they had access to better healthcare. He concludes that physicians can save nearly 4,000 Black men who would otherwise die of prostate cancer each year. Regardless of potential factors impacting disease risk and progression in Black men, Dr. Kane maintains that providing superb screening, detection, and treatment can reduce the observed racial difference in prostate cancer outcomes.

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