Peter R. Carroll, MD

Research Interests

Prostate Cancer Induction, Progression and Treatment

Members of several departments and divisions have organized a comprehensive program focused on prostate cancer induction, progression and treatment. The program is focused on several projects, including genetics of prostate cancer induction and progression, antigen identification, gene therapy, the androgen receptor and recognition of susceptibility genes. Carroll is playing a key role in the project led by Colin Collins, PhD, identifying genetic markers of prostate cancer progression.

Collin and Carroll are examining the hypothesis that combining standard pathological and laboratory criteria with appropriate pre-treatment imaging will enhance the clinician's ability to detect prostatic cancer and assess the risk of occult distant disease. Carroll and colleagues have used formal decision analysis to determine the indication for cross-sectional imaging of the prostate and laparoscopic or open lymphadenectomy before radical prostatectomy and the need and timing for radiation therapy after radical prostatectomy. They have recently examined the ability of preoperative serum PSA, transrectal ultrasound, systematic prostate biopsies, margin status, ethnicity and MRI to accurately predict either focal disease or extracapsular disease extension in the prostatectomy specimen and to predict outcome for patients undergoing radical prostatectomy. Carroll and colleagues have reported UCSF's experience with the use of radiotherapy for biopsy-proven local disease recurrence following radical prostatectomy, and have identified several important predictors for treatment success in these patients.

Novel treatment trials are a priority of the Department of Urology, specifically the Program in Urologic Oncology. Carroll is Principal or Co-investigator of many of these trials.

Bladder Cancer Induction, Progression and Treatment

For the last several years, members of the Departments of Urology, Pathology and Laboratory Medicine have tested the hypothesis that various cytometric and genetic markers may correlate with the clinical outcome of patients with bladder cancer. Carroll and colleagues have shown that measurement of cellular proliferation correlates with standard pathological criteria, such as cancer stage and grade. They are currently analyzing whether or not such markers predict the likelihood of (and time to) either distant or local cancer progression.

Outcome Analysis of Various Treatments for Prostatic Cancer

A prostate cancer disease registry (CaPSURE) has been established which monitors serial changes in health-related quality of life (HRQOL), health-resource utilization, and cancer control rates associated with various prostate cancer treatments (active surveillance (watchful waiting), cryosurgery, radiation, and radical prostatectomy). Information on approximately 14,000 men has been collected to date. Several projects have been completed using data from CaPSURE, including examination of serial changes in HRQOL in men with prostate cancer; analysis of resource utilization in the staging of prostate cancer; comparison of treatment outcomes after radiation, surgery or cryotherapy for prostate cancer as assessed by serum PSA and likelihood of additional treatment; analysis of socioeconomic predictors of HRQOL following diagnosis and treatment for prostate cancer; the impact of biopsy volume and margin status on disease recurrence following radical prostatectomy; and the impact of ethnicity on recurrence and HRQOL.

Continence after Continent Urinary Diversion or Radical Prostatectomy

Carroll and colleagues have characterized the functional aspects of both the ileal neobladder and continent ileocecal urinary reservoir. Earlier return of continence and more complete urinary continence may be associated with recent changes in surgical technique. They have defined the mechanisms of urinary continence in men and women who have undergone bladder replacement and have refined surgical techniques in women undergoing the procedure. They have recently analyzed the impact of a fascial sling in men at high risk of urinary incontinence after radical prostatectomy and have shown that such intervention leads to similar rates of continence compared to men without such risk factors.

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