Urologist H. Ballentine Carter, M.D., has dedicated his career to filling the “gaps in knowledge” in the use of prostate-specific antigen (PSA) to detect prostate cancer. Some of his major contributions include:
PSA velocity (PSA’s rate of change over time) is associated with the presence of prostate cancer, and directly associated with lethal prostate cancer.
Frequency of testing.
Testing every other year is sufficient to find the cancers that most need to be diagnosed.
Median PSA levels based on age.
PSA levels above the median for age can predict the development of prostate cancer 20 or 30 years from now.
When it’s safe to stop PSA testing.
A man over 75 who has a PSA below 3 ng/ml (this “represents two out of three men in the population,” Carter says) is highly unlikely to develop lethal prostate cancer.
Active surveillance can be done safely in men with favorable-risk prostate cancer.
In 1995, when Carter began the active surveillance program for prostate cancer at the Brady, “there was substantial resistance to monitoring men with a diagnosis of prostate cancer, regardless of grade,” he recalls. “Our goal was to demonstrate the safety of this approach for carefully selected men. We now know that for these men, the risk of death from prostate cancer, or development of metastatic disease, is 26-fold lower than the risk of death from other causes over 15 years.”
To honor Carter’s research legacy and ensure the continuation and furtherance of his work at the Brady Urological Institute, patients, their families, and Carter’s colleagues established the H. Ballentine Carter, M.D., Prostate Research and Innovation Fund. Already, the fund’s donors have committed nearly $1.5 million. Many of those who have contributed are new donors to Johns Hopkins, who were moved to give by Carter’s standards for care. Others are surgical patients whose cancer was successfully treated by Carter as long as 25 years ago, and still others are men who have been in active surveillance for years, or even decades.
One of these generous donors is Bill Clarke, who met Carter nearly 20 years ago, at age 49, when Carter performed his radical prostatectomy. Clarke was not the first in his family to have prostate cancer; his father had also had a radical prostatectomy done in Boston, by a surgeon using the then-new nerve-sparing procedure developed by Patrick Walsh. After his cancer was cured, Clarke says, “I stayed in touch with him, and I also was in a position to help him with his research.”
With this Fund, “we will continue research in refining the data, and continue the path that Bal has been on,” continues Clarke. “We know a lot, but certainly there is more to learn, about the markers, the disease itself, and how to deal with it when something should be done. It is my intention to honor Bal’s career with my contribution. Bal became a friend, and shared his research with me. I could see how much he appreciated, not only being able to do the operations and cure patients, but also to do the research so that he and the people who came after him could treat patients in a better fashion. That’s really what it’s all about to me.”