Counseling for Cancer Patients is Crucial

Matthew Cooperberg

Those battling prostate cancer need information, understanding.

Practicing medicine was in the air as Matthew Cooperberg grew up. His grandfather was a hematologist in Montreal, an uncle is a radiologist in Vancouver and another uncle is a pathologist in Irvine, Calif.

But it wasn’t till midway through his undergraduate years at Dartmouth College that Cooperberg’s urge to grapple with big questions, in particular the mysteries of cancer, led him to finalize his decision to pursue medicine.

Cooperberg, 38, is now an assistant professor in urology at UCSF and a urological oncologist at the Helen Diller Family Comprehensive Cancer Center at UCSF. He specializes in diagnosing and treating genitourinary cancer, with a particular focus on prostate cancer.

“There are multiple aspects of cancer care that epitomize the challenges that drew me to medicine: its biological complexity; multifaceted clinical interactions; the myriad ways this diagnosis can affect a patient physically, mentally and emotionally and the many public health considerations,” says Cooperberg. “I’ve always been drawn to those challenges.”

Cooperberg was already deeply interested in oncology when he started medical school. While completing premed classes at Dartmouth College, Cooperberg also studied history and art history, and completed a bachelor’s degree in English. Five years later, he earned an MD and a master’s in public health from Yale University.

He was drawn to surgery early in his first year of medical school. “I like working with my hands and enjoy the technical aspects of surgery, as well as its immediacy,” he says. “If a patient has a kidney tumor, we can do surgery and it’s gone.”

Cooperberg, married and the father of a 3-year-old son, is also acutely aware that caring for people with cancer, particularly men with prostate cancer, requires that he be sensitive to their personal relationships.

“A lot of what I do is counseling,” he says. “Despite the fact that prostate cancer, by a wide margin, is the most common one affecting men in the United States, dealing with it is still an exceptionally individualized decision-making process and treatment experience for each man.”

Cooperberg recalls a case that illustrates his fascination and frustrations with current prostate cancer care. An elderly patient who had been diagnosed with prostate cancer in another state was being prepared for radiation treatment with weeks of his diagnosis. At the request of the patient’s son, Cooperberg talked with the older man and found that he understood very little about his personal disease risk.

“Like so many other men, no one had walked him through where he stood on the spectrum of disease risk and what his diagnosis really meant,” says Cooperberg. “He was at the low end, but no one had taken the time to explain that to him.”

He was able to reduce the man’s fear and sense of urgency, and put the cancer in perspective. But for Cooperberg, the story also shows the dilemma in prostate cancer treatment today.

Widespread screening has led to a dramatic 40 percent drop in the mortality rate of men diagnosed with prostate cancer. But Cooperberg says he’s concerned that increased prostate cancer screening also may have led to over-diagnosis and over-treatment.

“Rather than one person or one patient that drew me to focus on prostate cancer, it was this one problem,” says Cooperberg.

He favors a simple solution: reframe the goal of PSA screening. Call it “screening for high-risk prostate cancer,” and teach men early on that slow-moving cellular changes in their prostate tissue don’t always mean they have potentially deadly prostate cancer requiring high-cost, sometimes high-risk treatments.

That’s also why producing better risk assessment tools is one of Cooperberg’s main research goals. His team recently developed the UCSF-CAPRA score for men undergoing some surgical procedures for prostate cancer.

This 0 to 10 score, validated by several research studies, predicts the likelihood that a man diagnosed with prostate cancer may experience recurrence, cancer spread, cancer-specific mortality or overall mortality. The score is calculated by assigning points to several measurements of severity, as well as to the patient’s age and PSA levels at the time of diagnosis.

“The medical profession as a whole needs to do a better job of targeting treatment to the right patients,” says Cooperberg.

He maintains that only higher-risk prostate cancer needs to be treated immediately with surgery or radiation. For most men with low-risk disease, active surveillance may be the best treatment option.

This measured approach is a big reason why patients come to the Diller cancer center.

“We’re excellent surgeons and offer top-level treatment, but we also understand the disease, from its origin in patient DNA to the way it is managed nationally by the health care system; and we do a far better job putting it in perspective,” says Cooperberg. “That’s what makes the Diller center and our prostate program special.”

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