By Facundo Davaro, MD

Urologic oncology is a rapidly evolving field at the forefront of surgical innovation and cancer care. I chose urologic oncology as a field because of these qualities, the surgical challenges, and the ability to establish long-standing relationships with my patients.

I am motivated by my patients, the trust they put in me, and by their unmatched gratitude. Sitting down with patients in clinic and talking about their fears and concerns really helps me better understand their goals of care and allows me to address them pointedly.

I chose to work at Cleveland Clinic because of its academic rigor and research-heavy environment, which allows me to access multiple tumor boards and collaborate with colleagues across the globe to establish comprehensive treatment plans. I knew that joining Cleveland Clinic would afford me the opportunity to participate in complex cancer care and challenging surgical patients.

In my specialty, urologic oncology, I see patients of all ages and treat various cancers, including prostate, bladder, kidney, testicular, and penile cancer. I believe an essential part of my job is to educate patients about their condition and spend as much time as needed to ensure we are on the same page regarding their treatment plan as every decision comes with benefits but also inherent risks.

Many questions about urologic oncology revolve around preserving functionality. Patients understandably fear loss of continence and sexual function. I try to inform patients about these risks while sharing the many ways in which we try to avoid this, such as through techniques like nerve-sparing. My goal is to balance the treatment of their cancer and also preserve their function and quality of life. I strongly believe in individualized care and aim to incorporate research into my practice. For instance, I use circulating tumor DNA (ctDNA) to personalize treatment based on each patient’s genetics and tumor characteristics.

Circulating tumor DNA or ctDNA is a minimally invasive tool that can be used to detect and monitor urologic cancers. Using a collection of short DNA fragments that come from tumor cells that are released into the bloodstream, we can plan treatment with a greater degree of insight.

Prostate cancer, the most common solid organ malignancy in the U.S., accounted for 300,000 new cases in 2023 and more than 30,000 deaths. We are more aware of racial disparities in incidence and mortality. Today’s standard of care focuses on the individual and an accurate diagnosis, discussing treatment options based on life expectancy, tumor characteristics, and offering support for the patient’s lifestyle. Prostate cancer requires a multidisciplinary approach, emphasizing symptom support, and using community resources to help patients and improve their quality of life.

Advancements in medicine, such as artificial intelligence and genetic testing, are exciting. We are working to incorporate artificial intelligence in the pathologic interpretation of a patient’s disease and leveraging this information to better treat our patients. This could have far-reaching implications in how we manage patients with new diagnosis or recent biopsies. Also, in performing robotic surgeries, we‘re able to use innovative techniques to ensure effective disease elimination while maintaining an excellent quality of life for the patient. In the future, I’m looking forward to using focal therapy for prostate cancer, which minimizes side effects while still treating the disease.

Many people are hesitant to pursue cancer treatment because of fear of losing their independence. However, today’s treatments offer a better chance for cure and fewer side effects than what was available just a few years ago.

I believe in maintaining hope for patients and reassuring them that we can cure or control their disease while minimizing its impact on their lives.

Dr. Facundo Davaro is a urologic oncologist at Cleveland Clinic Martin Health in Stuart, FL.