Newest UW Health Urologist an Expert in Bladder Cancer
Dr. Downs completed a urologic oncology fellowship and a molecular biology research fellowship at UCSF after his residency training at Harvard Medical School, Brigham and Women’s Hospital in Boston.
"What attracted me to Madison is the strong program Dr. (Stephen) Nakada and others have established, and the opportunity to continue in this rich tradition as a leader in bladder cancer care and academic research," says Dr. Downs.
Dr. Downs provides state-of-the-art treatments for bladder and other urologic cancers, even in patients with highly invasive disease. His expertise includes advanced procedures such as Robotic Radical Cystectomy, transurethral resection of bladder tumors using the KTP "green light" laser, treatment of penile cancer using glans sparing surgical techniques and renal cell cancer surgery for large renal masses extending into the inferior vena cava.
Noted for the highly technical Orthotopic Ileal Neobladder surgery, Dr. Downs creates a replacement bladder from a portion of the patient's small intestine. Neobladder recipients typically maintain much of their normal bladder function and are able to urinate similar to before surgery. Dr. Downs can perform this procedure on high-risk individuals who have undergone chemotherapy and radiation for bladder cancer.
"Roughly half of these patients are still candidates," he says.
He uses external approaches such as the Ileal Conduit and Indiana Pouch for patients who are not neobladder candidates. Overall, Dr. Downs uses the internal neobladder in approximately 80 percent of bladder replacements, whereas a recent study determined the national rate is approximately 20 percent.
While Dr. Downs recognizes the importance of state-of-the-art surgical treatments, his strongest ambition is to eliminate the need for such operations through prevention, detection and novel therapies.
"To some extent, my goal is to work myself out of a job," he says.
Dr. Downs is establishing a program, in collaboration with the UW Center for Tobacco Research and Intervention, to screen high-risk patients for bladder cancer.
"Given that certain patients have highly aggressive bladder cancers at the time of diagnosis, this early detection approach could lead to earlier treatment and improved clinical outcomes," he says. “My unique title is indicative of our commitment at UW to not only treat invasive bladder cancer with bladder removal, but to provide novel therapies in an intravesical manner (injecting chemotherapy agents into the bladder), and identify and treat non muscleinvasive, or superficial, bladder cancer."
Dr. Downs utilizes a three-pronged approach that consists of prevention, detection and innovative treatment. This includes educating people on bladder cancer risk factors and screening high-risk patients. Dr. Downs wants UW to gain a regional and national reputation for leadership in providing novel therapies to prevent bladder cancer recurrence or progression to muscle invasive disease.
He is currently participating in a clinical trial of an immune modulator geared toward patients who have failed first-line intravesical therapy with the agent BCG. He is part of a chemoprevention group working to identify other novel compounds that can be given to patients in order to reduce recurrence rates of bladder cancer and even prevent bladder cancer development. He is also the Principal Investigator on a chemoprevention study of the compound Polyphenol E.
"I'm excited to provide innovative surgical treatments that improve the quality of life for my patients," says Dr. Downs, "but I would prefer to help patients avoid major oncologic reconstructive procedures."
Dr. Downs is highly motivated by the fact that bladder cancer mortality rates have not changed significantly over the past 20 years.
"This is a cancer that needs to be attacked on multiple fronts," he says.