Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: October 09, 2018
Dr. Bertrand Tombal, Chairman of the Division of Urology at the Cliniques universitaires Saint Luc and Professor of Urology at the Université catholique de Louvain (UCL) in Brussels, Belgium, is the current President of the European Organization for Research and Treatment of Cancer (EORTC), the leading European academic research organization in the field of cancer.
Dr. Tombal is keenly interested in treating advanced prostate cancer and in the development of hormonal treatment and new biological agents
Prostatepedia spoke with him about why he became a doctor.
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Dr. Bertrand Tombal: My mother was a nurse who went to patients’ homes. When I was young, I went with her on weekends and became interested in healthcare. I was very scientific. I have always been driven by science, so it was natural for me to become a doctor.
When I was around 17, I got interested in archaeology. Maybe because of Harrison Ford’s movie, I wanted to be an archaeologist. But I wasn’t sure what major to declare for college, so I decided to become a doctor while still enjoying archeology.
For a long time, I wanted to be a pediatrician, and I was quite good at that, so I was preselected to do pediatrics. In Belgium, we had a certain number of obligatory rotations. You have to do four months in internal medicine and four months in surgery. Because I so wanted to be a pediatrician, I skipped one month of surgery, but they wouldn’t let me graduate without that month.
I ended up working in a peripheral hospital for a month with a private urologist. I became crazy about urology, went back to my professor in pediatrics, and told them I didn’t want to be a pediatrician anymore. I wanted to be a urologist. And that’s how I started as a urologist.
Dr. Tombal: I like that urology is a broad specialty. You treat cancer patients and incontinence patients. You engage in a lot of private emotional things, so I liked it from day one. After two years, I did my PhD thesis on prostate cancer, which took about four years in the end, and that’s when I got interested in prostate cancer.
Dr. Tombal: After completing my PhD thesis in 1998 in Brussels, I got an appointment at Johns Hopkins, where I finished my PhD. My former boss recognized that I liked to treat prostate cancer, but he preferred surgery, so he had me take care of the advanced cancer. I took care of advanced prostate and bladder cancers, which was not really a multidisciplinary approach at that time because there was no Taxotere (docetaxel) yet. Medical oncologists were not involved at all. We had a handful of old, hormonal treatments like estramustine phosphate (estrogen) or dexamethasone. That’s how I got interested in this. The bottom line is that I would follow many of my patients until death.
In 2000, supportive and palliative care were not yet developed. As a urologist, you would take care of guys usually in their 70s, and that’s where I started to speak with them and learn about interesting things, such as the relative importance of overall survival as compared to quality of life. That was meaningful. I learned from a few patients that, at some point, the only advantage you have as a doctor is that your patient has started the last round or two. You know he will die from the disease. You don’t know when, but you know it’s not that good. I learned that it’s important to have discussions and ask lots of questions. Where do you want to go? What is important for you? Do you have a point you want to reach? What are you ready to accept?
It’s always been extremely important that we don’t impose the treatment sequence at the very end. There is always a point beyond which we should discuss with the patient the philosophy of the treatment and what we expect. In the end, we have to make the choice together. To me, it’s always been extremely important having that kind of conversation, so many of these patients gave me this philosophical approach.
I still believe that managing castrate resistant prostate cancer is more about philosophical choices than scientific evidence. That’s why my background, having seen many patients before these drugs existed, is so important to me.