Mark Soloway

With the advent of PSA and early detection of prostate cancer, Soloway, concerned about the risk of overtreatment, has been an advocate of active surveillance for patients with low-risk, low volume Gleason 6 prostate cancer who are compliant with careful monitoring. In 2000 he published his first series of patients including those eligible for watchful waiting, as well as active surveillance and reported that only a few of these patients went on to have treatment. Using a tighter definition for active surveillance, Soloway's group reported that less than 15% of these prostate cancer patients went on to treatment. This series was updated recently in European Urology with the addition of quality of life parameters and a constant of 15% progressing to treatment.

Over the last two decades, Soloway has worked closely in tandem with a former resident and co-faculty member, Gaetano Ciancio on kidney cancer. Together they have revolutionized the surgical approach for large renal tumors, particularly those in which the tumor extends into the vena cava. Ciancio is a urologist, who is fellowship trained in renal and liver transplantation. More than 10 years ago, Soloway and Ciancio worked as a team to reduce the perioperative morbidity and mortality associated with these large tumor masses. Their idea was to incorporate surgical techniques from liver transplantation to increase the exposure of the vena cava with the anticipation that this would reduce blood loss and obviate circulatory arrest. Together they have published over 35 articles beginning with their first description of this technique in 2000. Their most recent publication is an update of their step-by-step approach toward minimizing complications related to renal cell carcinoma with vena cava thrombus. This series emphasizes the improvements in safety and reduction in operative mortality and morbidity related to their technique. Since most tertiary medical centers where these procedures are likely to be performed now have liver transplant surgeons, this technique can easily be duplicated.

Another focus of Soloway's clinical research has been on the relationship between positive surgical margins and the preservation of the bladder neck and approach to the seminal vesicles. His first publication in 1996 on this topic detailed pathological analysis of the location and consequences of positive surgical margins. In a more recent paper published in the Journal of Urology, he reported that the recurrence rate was only 20% in his patient cohort with a positive surgical margin and therefore, the routine adjuvant radiation therapy would over treat 80% of the patients. On the subject of urinary continence, for over 20 years, Soloway has been a proponent of bladder neck preservation for enhancing urinary continence without compromising cancer control for patients undergoing radical prostatectomy. Soloway and M. Manoharan have worked together to minimize the side effects of a radical prostatectomy. They have popularized the lower abdominal transverse incision to minimize pain and enhance recovery as well as providing a smaller, less obvious scar. They have shown that most patients do not require a drain and an inguinal hernia can be easily be repaired at the same operation of a radical prostatectomy using this transverse incision.

Soloway has received numerous honors and awards. These include the Gold Cystoscope Award from the American Urological Association in 1984, and the Presidential Citation of 2008 from the American Urological Association for his contributions to clinical urology and his educational innovations. Soloway was honored with a corresponding membership in the German Urology Association and the Dutch Urologic Society. Soloway has been the Visiting Professor in over 50 academic programs both nationally and internationally and a guest speaker at national meetings in over 30 countries. He was one of the founding members of the International Urologic Research Society. In 2004–2005 Soloway served the Chair of the first International Panel on Cancer, a project that included fourteen individual panels and over one hundred experts in different aspects of bladder cancer. The Societe Internationale de Urologie (the governing body of the International Panel on Bladder Cancer) and the International Consultation of Urologic Diseases have jointly commissioned him again to Chair the second International Panel on Bladder Cancer.

During the 1980s and early 1990s, a high percentage of patients with prostate cancer were diagnosed with locally advanced disease. Anecdotally, many of these patients were given the newly developed LHRH analogs as initial treatment for their disease. Since their initial responses were impressive, it seemed reasonable to give androgen deprivation prior to prostatectomy with the hope of improving progression free and overall survival. Enlisting the cooperation of a multi-institutional group, Soloway initiated a prospective randomized trial to test the efficacy of neoadjuvant androgen deprivation therapy. This randomized trial showed that although the surgical margin rate was lower for men who had received androgen deprivation prior to prostatectomy, there was no improvement in progression free or overall survival. Other groups who later performed similar studies have substantiated these results.

Despite his busy clinical practice and research programs in the mid-1980s, Soloway recognized the need to address quality of life issues associated with the treatments for prostate cancer. He developed one of the first prostate cancer support groups in the country in Memphis, Tennessee. In 1992, he co-authored one of the first QOL studies examining patient preference related to LHRH versus orchiectomy for patients with advanced disease. In 1995 Soloway and his colleagues reported on a study that looked at patients with localized prostate cancer and the QOL implications of surgical management vs. radiation therapy. Recognizing that prostate cancer is a couple's disease, Soloway also studied the psychosocial and sexual implications of this disease on patients and their partners.

Mark S. Soloway is a leading authority in urologic cancer, researcher, former departmental Chair, medical professor and invitational lecturer. He served as Chairman of the University of Miami Miller School of Medicine Department of Urology and is currently a professor at the Miller School of Medicine. Born in Cleveland, Soloway received his B.Sc. from Northwestern University in Chicago (1961–1964). He completed his M.D. and residency at Case Western Reserve University School of Medicine in Cleveland, Ohio (1964–1970). He completed a fellowship at the National Cancer Institute of the National Institute of Health in Bethesda, MD (1970–1972). Soloway has received numerous awards for his work as a researcher and teacher, These awards are American Urological Association's Gold Cystoscope award, Mosby Scholarship for Scholastic Excellence award (1967), North Central Section of American Urological Association Traveling Fellowship award (1972) and many others. These are outstanding achievements for an individual who has contributed most to the field of urology within ten years of completion of his residency program” (1984).