Premier program at Walter Reed leads DoW’s efforts in prostate cancer research, treatment

By Bernard S. Little Walter Reed National Military Medical Center, Hospital Communications

September is Prostate Cancer Awareness Month. At Walter Reed National Military Medical Center (WRNMMC), the Center for Prostate Disease Research (CPDR) advances the Department of War’s (DoW) efforts to prevent, diagnose, and treat this disease.

Established by the U.S. Congress in 1992, the CPDR is DoW’s premier translational cancer program dedicated to the clinical care, education, and study of diseases of the prostate, a walnut-sized gland that sits below the bladder and is part of the male reproductive system.

Integrated within the John P. Murtha Cancer Center (MCC) at Walter Reed, the CPDR is a Uniformed Services University of the Health Sciences (USU) center anchored by the Joint Pathology Center (JPC), the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), and other military and civilian research partners. This forms a broad network to advance research and care into prostate diseases.

U.S. Navy Capt. (Dr.) Gregory Chesnut is CPDR’s director and the director of Urologic Oncology at Walter Reed. He is also an associate professor in the Department of Surgery, School of Medicine at USU. He leads “an experienced multidisciplinary team of clinicians, scientists, researchers, and staff committed to better understanding, diagnosing, and treating prostate cancer and providing personalized cancer care for all patients diagnosed with, or at risk for, prostate cancer,” he explained.

In discussing prostate cancer, Chesnut stressed the importance of men learning about the benefits and risks of early screening for the disease. He noted that, on average, a man is diagnosed with prostate cancer about every two minutes. Statistics suggest prostate cancer claims the life of a man every 15 minutes in the United States, according to the American Cancer Society (ACS).

One in 8 men in the United States (1 in 6 for African American men) will be diagnosed with prostate cancer during their lifetime, and more than 36,000 men are projected to die from the disease this year alone, making it the second leading cause of cancer deaths in men after lung cancer, the ACS indicates.

The National Cancer Institute (NCI), a partner with the MCC in cancer research and care, reports that there are more than 3.5 million prostate cancer survivors in the United States, and the relative five-year survival rate for prostate cancer diagnosed in its earliest stages is over 99 percent.

Retired Air Force Lt. Col. Eric Morrow is one of those survivors who was treated at Walter Reed. Diagnosed with high-risk prostate cancer in 2021 at 49, Morrow credits the CPDR, Walter Reed and other military medical treatment facilities across the National Capital Region (NCR), for his successful treatment.

During a physical in 2021, Morrow’s physician at Alexander T. Augusta Military Medical Center at Fort Belvoir, Virginia, referred him for a colonoscopy at Kimbrough Ambulatory Care Center at Fort Meade, Maryland. “When I woke up from that [procedure] the doctor said, ‘Your colon looks great, but your prostate is a little enlarged so you might want to see a urologist about that,’” he recalled.

Morrow was screened by a urologist at Malcolm Grow Medical Clinics and Surgery Center at Joint Base Andrews, Maryland, where he was diagnosed with advanced Stage 3 prostate cancer and referred to the CPDR.

“My success story is an NCR success story,” said Morrow, whose treatment included 39 sessions of external beam radiotherapy and two years of androgen deprivation therapy after the cancer had spread from his prostate to his pelvic lymph nodes. “Although it’s life altering, prostate cancer doesn’t have to be life limiting,” he said. “You can still do big things after a cancer diagnosis.”

“Prostate cancer is life changing but not life ending,” Morrow added. He explained that there are many ways survivors can “continue to live, be active, and take on great challenges” following diagnosis and treatment. He embodied those sentiments last September when he and a group of other cancer survivors scaled Mount Kilimanjaro, the highest mountain in Africa and the tallest free-standing mountain in the world, as part of the Peaks Challenge to raise awareness about prostate cancer.

"As a veteran, as an African American man, and as a man with a family history of the disease [his father died of it], I fit all of those high-risk categories, and I still didn't get screened,” he said. “I was lucky that some other routine exam caught my prostate cancer. If I'd waited until I was 55, or if I'd waited until symptoms had developed, I'm certain I would have had Stage 4 disease because I was so close to having it already."

Prostate cancer impacts veterans at nearly double the rate of the general population, with about 1 in 5 veterans diagnosed with the disease during their lifetime compared to 1 in 8 men overall. Although the exact cause of prostate cancer is not known, it begins when changes occur in the DNA of normal prostate cells causing them to grow and multiply out of control, according to doctors. A recent study by the U.S. Department of Veterans Affairs (VA), who also partners with the MCC in cancer research and care, showed that prostate cancer’s higher risk in veterans has been linked to aging demographics and some military occupations with increased exposures to carcinogens.

Retired U.S. Army Col. (Dr.) Craig Shriver, director of the MCC, DoW’s only designated Cancer Center of Excellence, and USU’s MCC Research Program (MCCRP) director, discussed cancer impacts on military readiness. A cancer diagnosis can take a service member away from their unit for care and render the member non-deployable, he explained.

Chesnut said that men should have an informed discussion with their provider to about whether to be screened for prostate cancer. The ACS recommends that this discussion take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years; age 45 for men at high risk of developing prostate cancer, including African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65); and age 40 for men at even higher risk, including those with more than one first-degree relative who had prostate cancer at an early age.

Treatment for prostate cancer care has become increasingly precise and individualized, added Chesnut. The care can include MRI and image-guided biopsy techniques, active-surveillance strategies, robotic surgery, radiation, prostate-specific molecular imaging, and the growing ability to use tumor genetics and molecular characteristics to guide therapy.

For advanced disease, treatment can include newer hormonal agents, targeted therapies, radiopharmaceutical approaches, and combinations of systemic treatments.

There is no lifestyle habit that can guarantee prevention of prostate cancer, but men are urged to avoid smoking and saturated fats to decrease the risk for the disease, according to the CDPR. Men are also encouraged to maintain a healthy weight, exercise regularly, limit excessive alcohol intake, and eat a balanced diet rich in vegetables, fruits, whole grains, legumes, and other nutrient-dense foods to support cardiovascular and metabolic health.

The CDPR stated that just as important is that men are aware of their family’s health history, keep routine medical appointments, and promptly report persistent urinary, bone, or other concerning issues.

“I simply could not imagine a more meaningful and rewarding job than to be a urologic oncologist,” Chesnut added. “I commonly meet patients and their families on one of the worst days of their lives – the day they learn about a cancer diagnosis. It is a privilege for me to devote my energies and talents towards diagnosing and treating patients with urologic cancers, and to be part of a research enterprise that strives night and day to grow our understanding of cancer and how to better treat it.”

“I hope to honor those patients who choose to have their care with us by giving my very best to them and their treatment,” Chesnut continued. “I really do have a deep respect for my patients, for the complicated disease that is cancer, and for the physical and emotional turmoil that a cancer diagnosis can have on an entire family. I hope that our patients can feel that commitment and connection with every encounter we have with them.” For more information about the CPDR at Walter Reed, call 301-319-2900 or 301-319-2901.

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