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Looking for Mutations in Cancer Cells to Screen for Aggressive Prostate Cancers

Rob Nam with wife Yuna and children Amy and Matthew in Jamaica

Robert Nam is an active surgical oncologist who treats cancers of the kidney, bladder, prostate and testes in a busy clinical practice. He is also a committed surgical researcher ("75% clinical and 75% research" - his definition of a surgeon scientist). At Sunnybrook's Odette Cancer Centre, he partners with Arun Seth, a highly productive molecular biologist, studying prostate cancer genes. Together they have discovered a gene fusion that occurs specifically in aggressive prostate cancers and is expressed in circulating tumour cells. Rob was awarded the 2008 RCPSC Medal in Surgery for this research; he delivered a Royal College guest lecture at the University of Western Ontario entitled, "Clinical Application of Prostate Cancer Genetics".

The circulation of shed tumour cells is a phenomenon that has been recognized for over 50 years. Curiously, there has been little progress on understanding this common phenomenon, or using it for diagnosis or prognosis. The Prostate Specific Antigen (PSA) test has been a disappointment as a screening test. It is insufficiently accurate, particularly at identifying the lethal forms of prostate cancer. In addition to over-diagnosing indolent cancers that have no clinical significance, the test is falsely negative in 25% - one in four patients with a normal PSA has prostate cancer. A better test is needed, since one third are aggressive cancers.

To identify new biomarkers for prostate cancer, Rob is exploring the effectiveness and tolerability of screening by biopsy. In a pilot study, 300 volunteers responded to an ad in The Toronto Star; fifty have been biopsied. The majority found this minimally invasive test well-tolerated, and would recommend it to a friend. The biopsy takes five minutes to perform and has a low complication rate. The tissue can be subjected to vigorous and detailed genetic analysis.

Rob is also looking at genetic polymorphisms in prostate cancers in their 4000 specimen tissue bank using gene chips. He continues to find novel genes for prostate cancer and aggressive prostate cancer in addition to the fusion genes that he and Arun have described. Arun has been studying the significance of genetic markers in breast cancer and Rob has extended these studies to prostate cancer.

Rob is a Toronto-born and trained surgeon from start to finish. His sister Diane Nam, an orthopaedic surgeon scientist, is described in a nearby article. His wife Yuna Lee is a general internist and physician educator at St. Michael's Hospital. They were married when Rob was in the Surgeon Scientist program developing his data base, tumour banks, and genetic studies. Yuna and Rob have two children; Matthew is 7 and Amy is 4. Rob is meticulously devoted to being home with his children by 6pm, and carries out his research between 9pm and midnight. They ski, golf and travel as their recreational activities. Grandparents on both sides have facilitated the careers of both parents.

Rob is grateful to Michael Jewett and Steven Narod, the Chair of the Breast Cancer program at Women's College Hospital, for launching his research career, and to Surgeon-in-Chief Robin Richards for his continuing support. Though there are many fellows and postdocs involved in the project, Rob has no urologic surgeon scientist in his program. The urology specialty committee of the Royal College discontinued allowing one year of residency credit for laboratory work, unlike many other surgery committees. Rob has participated in the leadership course of the Department of Surgery and was recently nominated by Robin Richards for the new Schulich one-year executive leadership course to be given to faculty members at Sunnybrook.

M.M.





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