 "Dr. Slawin is a recognized authority on prostate disease and in addition to numerous scientific articles and book chapters published on this topic, he co-edited the “Atlas of the Prostate, Third Edition” together with renowned prostate expert, Dr. Peter Scardino, Chairman of Surgery at Memorial Sloan Kettering Hospital in New York. In addition, he authored the chapter on Robotic Radical Prostatectomy, one of seventeen chapters contained within the text."
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Urology Program at Memorial Hermann-Texas Medical Center named One of Nation’s Best by U.S. News & World Report
Memorial Hermann-Texas Medical Center earned distinction as one of the nation’s top hospitals in U.S. News & World Report’s “America’s Best Hospitals” issue, published July 21, 2008.
After an absence of several years, Memorial Hermann-TMC returned to the rankings at number 39 in the country for its urology program in only the first year after it entered into a strategic partnership with the Vanguard Urologic Institute, led by Dr. Kevin Slawin, who was appointed Director of Urology at Memorial Hermann-TMC in May 2007. Read more
Center for Screening, Prevention, Detection, Surveillance, and Minimally Invasive and Focal Therapy for Prostate Cancer
 "The Vanguard Center for Screening, Prevention, Detection, Surveillance, and Minimally Invasive and Focal Therapy for Prostate Cancer was developed specifically to bring to bear the entire body of knowledge with respect to these sequential issues during the decision making process between each patient and his physician, and to use the latest online Web-enabled nomograms and other tools, to help men make the best, most well-informed decisions that fits each man’s philosophy and goals with respect to his health and lifestyle"
To make an appointment to see Dr. Slawin, call 713-366-7847. Dr. Slawin now participates as an “in network” provider in most of the major managed care plans.
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“We believe that ultrasensitive PSA can be used after robotic or open radical prostatectomy as an unbiased indicator of complete prostate removal. In our hands, patients who achieve a very low level of PSA by ultrasensitive assay (< 0.01 ng/mL) have a high likelihood of cure and may face future follow up visits with less anxiety about possible cancer recurrence”
“Most patients who have undergone radical prostatectomy surgery for the treatment of prostate cancer, performed either robotically or through an open approach, are followed after surgery with PSA blood testing, typically beginning about six weeks after surgery. Using a standard PSA blood test, an undetectable PSA level reported to the lower limit of most assays (<0.1 ng/mL) has typically been accepted as indication that a patient is cancer-free, however up to 20 – 30% of patients who initially achieve this low level will go on to develop a rising PSA level indicative of prostate cancer recurrence at some future date. read more
 AUA Ultrasensitive PSA (207.6 kB)
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Dr. Kevin Slawin, Among Elite Group of Prostatectomy Experts in the Nation |
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A recent study published in The Journal of Urology suggests that prostate cancer patients treated by more experienced urologic surgeons achieve improved results.
Prostate cancer is the most common non-skin cancer in American men, who have about a 1 in 6 chance of being diagnosed with this disease in their lifetime. Radical prostatectomy, performed either through a standard incision, or more recently through a robotic-assisted minimally invasive approach, is a surgical procedure in which the surgeon attempts to remove the cancer-containing prostate gland, without damaging the surrounding structures that control sexual and urinary function.
According to the study, “Low Annual Caseloads of United States Surgeons Conducting Radical Prostatectomy”, conducted by Caroline Savage and Andrew Vickers from Memorial Sloan-Kettering Cancer Center, a surgeon needs to have completed a minimum of 250 prostatectomies to reach the “learning curve plateau” at which point cancer cure is maximized and surgical complications minimized. After adjusting for tumor severity, a typical patient treated by a surgeon who reached the learning curve plateau had a 10.9% risk of recurrence at 5 years compared to 17.7% for those treated by a less experienced surgeon. Similarly, surgical complications were decreased by 20% in patients treated by the highest versus the lowest volume surgeons studied.
Furthermore, for the 75% of patients diagnosed today with cancers still confined to the prostate gland, the most highly experienced surgeons, those who had performed at least 1,500 prior surgeries, achieved recurrence rates of less than 1%, suggesting that recurrence is largely dependent on surgical technique.
Despite these findings, the study authors found that approximately 25 percent of United States surgeons performing radical prostatectomy surgery perform only a single procedure per year, while about 80 percent of surgeons performed fewer than 10 procedures per year. Nationally, only 1.8 percent of surgeons perform more than 50 prostatectomies per year. The study also concluded that most surgeons will never reach the key threshold of 250 radical prostatectomy cases in their surgical careers.
“Practice patterns in which the majority of prostate cancer patients undergoing surgery are treated by surgeons performing fewer than 10 procedures a year suggest that better results may be achievable for many of these men. The study provided data that supports what common sense suggests; that a more experienced surgeon will likely produce more positive results for patients undergoing a procedure as technically complex and challenging as radical prostatectomy,” said Kevin Slawin, M.D., director of urology at Memorial Hermann-Texas Medical Center and the Vanguard Urologic Institute.
In a February 13 article on the outcomes achievable with either open or robotic prostatectomy reported on the front page of the New York Times, respected NYT medical correspondent Gina Kolata suggested that experienced surgeons achieve the best outcomes regardless of the approach. However as Dr. Michael Barry, a professor of medicine at Massachusetts General Hospital said in the article, “Everyone tends to cite data from centers of excellence as though they were their own,”. The handful of expert surgeons in both open and robotic prostatectomy quoted in the article had performed thousands, not tens or even hundreds, of operations.
During the course of his career, Dr. Slawin, a nationally renowned urologist and prostate specialist, has performed more than 1,700 prostatectomies, consistently averaging between 100 – 150 cases per year for more than a decade. This makes him a member of this small, select group of surgeons in the country that are true experts in the field.
Since joining Memorial Hermann-Texas Medical Center in 2007, Dr. Slawin has continued his high volume practice in early stage prostate cancer, and has broadened his focus to patients with more advanced disease, spearheading the clinical development of a novel cancer vaccination technology for metastatic, castration resistant prostate cancer.
Just this month, Dr. Slawin was recognized as one of America's Top Doctors in Urology & Cancer for 2009 - 2010 by Castle Connolly Medical Ltd. Dr. Slawin has consistently been recognized as one of America's Top Doctors for over a decade as a leader in his field.
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View a Webcast of Dr. Kevin Slawin’s recent lecture at the European Association of Urology in Spain |
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View a Webcast of Dr. Kevin Slawin’s recent lecture at the European Association of Urology in Barcelona Spain chronicling the development of the [-2]proPSA prostate screening test, a product of work he initiated a decade ago (See February 9th and May 11th news items below). Pivotal trial results of the performance of the Beckman Coulter “Prostate Health Index”, based on this test, were presented at the American Urological Association meeting in San Francisco May 30 – June 3, 2010 (view 1st Abstract, view 2nd Abstract). The Vanguard Urologic Research Foundation was a key participant in these important studies currently under review by the FDA. For more coverage of this new test, visit http://prostatecancerinfolink.net/2010/04/20/coming-soon-beckman-coulters-prostate-health-index/ |
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New Prostate Cancer Screening Test Approved in Europe & Awaiting FDA Regulatory Determination in US |
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Prostate cancer remains the leading cancer diagnosed and the second leading cause of cancer mortality in men in the United States. Despite these sobering statistics, and the common sense notion that earlier detection through prostate cancer screening can reduce these numbers, there remains significant controversy about the role prostate cancer screening should play in the management of this disease. At the root of this controversy is the use of the Prostate Specific Antigen (PSA) blood test in prostate cancer screening, which has been the mainstay of early detection programs since its development in the early 1990’s. When elevated, the PSA blood test signifies an abnormality in the prostate gland but it is not specific enough to differentiate prostate cancer from other benign problems in the prostate gland, including benign enlargement or inflammation. In order to determine the cause of the PSA elevation, a urologist must perform a prostate biopsy which, while safe, may sometimes lead to complications like infection.
Recently published randomized clinical trials have demonstrated this lack of specificity associated with PSA-based screening leads to some overdiagnosis and overtreatment for each life saved. Based on these findings, the American Cancer Society recently updated their screening recommendations cautioning against routine PSA-based screening without careful input from each patient’s physician, and the American Urologic Association, while reaffirming their support for PSA-based screening beginning at age 40, also emphasized the importance of an individualized approach directed by physicians. Despite these controversies, it is widely agreed that new screening tests that are more specific for identifying aggressive cancers would be a major advance in the field. Over the past two decades, research into the molecular biology of PSA has led to advancements and new tests that have move the field closer to this goal. In 1998, based on a pivotal clinical trial performed by six leading investigators nationwide, including Kevin Slawin, M.D., director of the Vanguard Urologic Institute at Memorial Hermann-Texas Medical Center, the FDA approved the “free PSA” test as a more specific way to differentiate between men with prostate cancer and those with a benign condition when the PSA blood test was modestly elevated. “The PSA test has evolved in the same way measuring cholesterol has,” says Dr. Slawin. “We used to evaluate cholesterol as a single level but now we look at the ratio of LDL (“bad cholesterol”) to HDL (“good cholesterol”) to predict the risk of heart disease. In a similar way, the “free” or “good” PSA in a ratio with the total PSA improved the specificity of PSA testing and reduced the risk of unnecessary biopsies in men with an elevated PSA.
However, over the next decade, through successful use of these tests in ferreting out many men with prostate cancer, the “free” PSA test has lost much of its ability to enhance the specificity of PSA based screening, leaving doctors back to the drawing board in searching for a better, more specific prostate cancer screening test.
Dr. Slawin, instrumental in performing the pivotal studies that led to FDA approval of the free PSA test, has now once again played a leading role in advancing the field of PSA and prostate cancer screening. In studies initiated in his laboratory and published back in 2000, he and his co-workers discovered two novel, disease specific forms of “free” PSA, BPSA or “benign” PSA associated with benign enlargement of the prostate, and [-2]proPSA, associated with prostate cancer. Now, after a decade of clinical development by Beckman Coulter, Inc., which licensed this technology, and after completing pivotal international clinical trials, has obtained regulatory approval for a new test, the “Prostate Health Index (phi)” in Europe and is awaiting a decision by the FDA for determination of this test in the United States. The results of these trials, to be presented at the Annual Urological Association meeting this spring, demonstrated that the “phi” improved the specificity of PSA by 3-fold for the detection of prostate cancer, fulfilling the call for more specific tests to screen and diagnose prostate cancer. Furthermore, researchers at Johns Hopkins recently reported that the phi could also help determine which cancers were the more aggressive needing treatment and which might be safely monitored.
‘It’s been gratifying to play a role in moving the field of prostate cancer screening and early detection forward over the years with focused research on the problem”, Dr. Slawin said. “I’m excited that work we began a decade ago is now finally achieving regulatory approval so that patients and physicians can benefit” he added. Dr. Slawin is continuing his work in advancing the field of prostate cancer diagnosis and treatment, and is a leader in robotic surgery for prostate cancer, and in developing protocols for active surveillance, focal therapy and other modalities of therapy including advance image guided radiation therapy, vaccine therapy, etc.
Click here to view the Video. |
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A New Vaccine Technology Shows Promise in the Treatment of Prostate Cancer |
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In a development likely to be viewed as a major milestone in the history of cancer therapy, the Food and Drug Administration on April 29, 2010 approved the first cancer vaccine, Provenge, developed by Dendreon Corp. for the treatment of advanced prostate cancer. In clinical trials, it extended the lives of patients about four months compared with placebo, longer than the 2 to 3 month survival advantage gained using the only other approved therapy for these patients, docetaxel chemotherapy, but without the serious side effects including fatigue, hair loss and neuropathy associated with chemotherapy. One unusual aspect of treatment with Provenge that has generated controversy is that the vaccine doesn’t shrink tumors or change the PSA level in most patients, so while the vaccine extends survival, patients have no way of knowing whether the vaccine is working.
Now, researchers at the Vanguard Urologic Institute at Memorial Hermann-Texas Medical Center are conducting a trial to test an innovative vaccine product, BPX-101, that builds on this success but will hopefully lead to more effective, longer responses in patients while maintaining the safety and lack of side effects seen with Provenge.
BPX-101 is a novel cancer vaccine specifically designed to be “activated” precisely at the optimal time and location in the body through the administration of an activating agent called AP1903. AP1903 acts as a molecular “key” that exactly fits a complementary molecular “switch” engineered into the cells comprising the vaccine product. AP1903 is administered to patients once vaccinated cells have traveled to local lymph nodes, where activation leads to a potent immune response against the targeted cancer cells. BPX-101 is designed to be effective against a broad range of cancers, including prostate cancer.
Developed by Kevin Slawin, M.D., a nationally recognized expert in prostate disease and director of the Vanguard Urologic Institute, in collaboration with Baylor College of Medicine researcher David Spencer, Ph.D., the promising new therapy is mid-way through completion of the first-in-human Phase I-II clinical trial for patients with mCRPC, with the results recently reported in a Late-Breaking abstract session at the 101st Annual Meeting of the American Association of Cancer Research held recently in Washington, D.C.
The trial was designed to establish the safety and maximum tolerated dose of BPX-101 in combination with activating agent AP1903, administered every other week for six doses. Exploratory efficacy endpoints include radiological and biochemical assessments of clinical response, and assessments of serum and biopsy samples for systemic and antigen-specific immunological responses.
Interim data from six subjects shows the combination of BPX-101, with no unexpected drug-related adverse events reported. Clinical responses, including shrinking tumors and reduced PSA levels, were evident within the first 12 weeks of treatment, in both low and mid dose cohorts.
The apparent dose-response correlation between clinical and immunological responses will be further investigated in six subjects now enrolling in the final, high dose cohort. “We are very excited and encouraged by this early data, which appears to contradict the prevailing belief that while cancer vaccines can prolong overall survival, they do not elicit measurable clinical or biomarker responses in the near term,” said Dr. Slawin. “We look forward to completing our trial later this year and initiating Phase II trials in 2011.”
All procedures are being conducted on an outpatient basis at the Memorial Hermann-TMC Clinical Research Unit under the auspices of The University of Texas Center for Clinical and Translational Sciences.
KPRC Local 2 News story. Houston Chronicle/NY Times story. KHOU Channel 11 News story |
Robotic Prostatectomy - Prostate Cancer: Dawn of a New Era
 As Director of the Baylor Prostate Center for the 15 years, and now Director of the Vanguard Urologic Institute and the Texas Prostate Center for the past two years, I have dedicated my life to the improvement of care for patients with prostate disease, primarily prostate cancer.
Despite widespread success in reducing the mortality due to prostate cancer over the past two decades, new data from randomized trials performed in this country and in Europe are leading to a sea change in the way we care for men concerned about their risk of prostate cancer and committed to taking the necessary steps to maximize their chances of living a full life with minimal impact from this disease. Achieving this requires the right balance at every step of the process, including how often to perform PSA-based screening, when to employ methods at prostate cancer prevention and which make the most sense, when to perform a prostate biopsy and when necessary how to perform it, and what to do when prostate cancer is detected and when it is not. The answers to all of these questions have become more confusing than ever to the average man.
So for any man contemplating his options with respect to his prostate health, there are many decisions he needs to make which may greatly affect his future length and quality of life as it relates to prostate cancer. And while there remain many unknowns, these decisions can be well-informed and aided by our current extensive knowledge and informatics tools to assist the decision-making process at every step.
The Vanguard Center for Screening, Prevention, Detection, Surveillance, and Minimally Invasive and Focal Therapy for Prostate Cancer was recently inaugurated specifically to bring to bear the entire body of knowledge with respect to these issues during the decision making process between each patient and our physicians, who are leaders in the field, and to use the latest online Web-enabled nomograms and other tools, to help men make the best, most well-informed decisions that fits each man’s philosophy and goals with respect to his health.
Of course, when treatment for prostate cancer is required, our extensive experience with the latest technologies, including Robotic Assisted Laparoscopic Prostatectomy (RALP), performed by Dr. Slawin in over 750 patients since he performed the first case in Houston in 2001, provides patients with the best achievable outcomes. But this may not be the right choice for every man... we don't view ourselves as a robotic prostatectomy "assembly line" but rather a center for the comprehensive evaluation and treatment of prostatic disease. For example we also offer Image Guided Radiation Therapy (IGRT), and minimally invasive therapies like High-Intensity Focused Ultrasound (HIFU), along with active surveillance in appropriate cases. You can read more about these and other services within these pages.
I hope this website helps those of you searching for answers regarding prostate cancer and benign prostatic hyperplasia (BPH), while providing a glimpse of some of our exciting and novel work in these areas. In addition to text, this website contains links to scientific papers and presentations, surgical videos, electronic nomograms and other useful tools for patients and physicians.
Local and National Media
News and Views
Patient Testimonials |
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 Kevin Slawin and Dr. Tung Shu are the first in the U.S. to use AxoGen's Avance nerve grafts to repair the cavernous nerves robotically.
Vanguard Urologic Institute founders Kevin Slawin, M.D., and Tung Shu, M.D., have long been leaders in the development of minimally invasive techniques for radical prostatectomy using the da Vinci® surgical system. The outcomes speak for themselves: minimized damage to tissues surrounding the prostate and excellent cancer control rates that are equivalent to the traditional open approach to radical prostatectomy. Results also include decreased length of stay and decreased morbidity as measured by a more rapid recovery of potency.
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I was very worried about my future. But once I decided to undergo the laparoscopic procedure under your care, everything has gone so well, so smoothly, certainly beyond my expectations. I was up and walking the day of the surgery and went home after a big breakfast the next morning... I recovered sexual function within ten days. I have minimal urinary incontinence that improves every day... Thank you for your work!
Greg Granello
Underwent Robotic Prostatectomy (RALP) to remove Prostate Cancer
August 2010 - Dallas, TX
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Today marks the 17th day since my surgery. I feel good. I'm at about 85% of my energy level. This is my third day back to work... Overall, I am very pleased with the surgery and the results... I am very pleased with the excellent job that Dr. Slawin and Mr. Dodge did on my procedure.
JV Elder
Underwent Robotic Prostatectomy (RALP) to remove Prostate Cancer
August 2010 - Houston, TX
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My recovery from robotic- assisted laparoscopic surgery has been remarkable – even better than I imagined. Dr. Kevin Slawin and his assistants are at the top of their game with prostate surgery. While I expected success, I was surprised to experience almost no incontinence beginning the first day and night after the catheter was removed
Eugene Chiappetta
Underwent Robotic Prostatectomy (RALP) to remove Prostate Cancer
Fort Worth, TX
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While I expected success, I was surprised to experience almost no incontinence beginning the first day and night after the catheter was removed
Morris N. Harper
Underwent Robotic Prostatectomy (RALP)
to remove prostate cancer
Austin, TX |
When I’m having surgery, if my choice is a hall of famer in the prime of his career vs., potentially, an unproven rookie even if he or she may be a first round draft pick, I don’t have much of a decision.
Jim Murray
Underwent Robotic Prostatectomy (RALP
to remove prostate cancer
San Antonio, TX |
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