Building on basics

NCI Designation Achieved

Michael Reese Hospital and Medical Center on the South Side of Chicago some 12 years ago, a spreadsheet of prostate cancer data on the table before him. The spreadsheet laid out vital statistics, including ethnicity and PSA test results, for the 100 or so men treated for prostate cancer at the hospital over the previous two years. It seemed to Vijayakumar, as he scanned the spreadsheet, that PSA levels were consistently higher in the African-American patients.

Vijayakumar, then a professor of radiation and cellular oncology at the University of Chicago, was intrigued. The PSA, a blood test used to detect prostate cancer, was relatively new at the time; no ethnic variations in the test had ever been reported.

“I ran to the physics room and pulled out a calculator,” he recalls. The calculator quickly confirmed his suspicion. The average PSA for the African-American men on the spreadsheet was two times that of the Caucasian men.

That conference-room observation became the basis of a 1992 article by Vijayakumar in the journal Cancer Epidemiology Biomarkers & Prevention; it was the first scientific paper to report on racial differences in PSA levels among men with prostate cancer. The observation also sparked Vijayakumar’s career-long interest in understanding and eliminating ethnic disparities in cancer, a research focus he carried with him to UC Davis.

One of the nation’s lead- ing radiation oncologists, Vijayakumar joined UC Davis Cancer Center as professor and chair of the Department of Radiation Oncology late last year. He also serves as medical director of the cancer center’s two regional affiliates, Mercy Cancer Center in Merced and Fremont-Rideout Cancer Center in Marysville.

Passion for prevention

Radiation oncologists, extensively trained in the safe use of radiation to treat cancer, typically are not involved in population and prevention studies.

But Vijayakumar is not a typical radiation oncologist. He was the only radiation oncologist among the more than 90 principal investigators in the Prostate Cancer Prevention Trial. A national trial with nearly 19,000 men participating, the PCPT seeks to determine whether the drug finasteride can prevent prostate cancer.

Vijayakumar was also the lone radiation oncologist tapped as a principal investigator for the African-American Hereditary Prostate Cancer Study, a national effort to gather blood samples from black men with family histories of the disease in hopes of identifying responsible genes.

Vijayakumar’s newest research project also focuses on prevention. Funded by the U.S. Department of Defense Prostate Cancer Research Program, the new study will assess whether vitamin D can prevent cancer recurrences in men who have completed radiation therapy for prostate cancer.

A way to prevent prostate cancer may be a long way off. But Vijayakumar thinks methods of postponing prostate cancer — keeping it at bay for five or 10 years — may be within reach.
“Postponing prostate cancer could have a real impact,” he says. “If we could delay the average age that a man gets prostate cancer, from age 67 to age 77, that would be a good thing.”

A primary care background

Trained on three continents, Vijayakumar earned his medical degree at SV University in Tirupati, India, and completed his surgical and radiation oncology training at the University of Madras in Madras, India. He completed a second residency in radiation oncology at Michael Reese Hospital and Medical Center, where he was chief resident for two years. He received additional training in brachytherapy, also known as radioactive seed implant therapy, in France.

Vijayakumar traces his prevention focus to his years as an oncology resident in India. Medical residents were paid 300 rupees a month, or about $30, roughly half the income a single person needed to live. To make ends meet, Vijayakumar ran a 24-hour primary care clinic, charging impoverished patients three rupees a visit, or about 30 cents, and wealthy patients about 100 rupees. He hired another physician to staff the clinic during the day, staffing it himself nights and weekends — stitching up knife wounds, tending to patients with tuberculosis, and making house calls to care for typhoid patients. “That background,” he says, “made me see the value of prevention.”

Upon arriving in the United States, the young doctor who once overcharged his rich patients to subsidize the poor ones was dismayed to find that social disparities in health care also existed here.

African-American men are diagnosed with prostate cancer at more advanced stages of the disease than white men, and are twice as likely to die of the disease.

For Vijayakumar, a focus on prostate cancer — preventing it, and finding out why black men suffer disproportionately from it -— came naturally.

Soon after settling in Chicago, he began visiting African-American churches on the city’s South Side on Sundays, preaching prostate cancer awareness and early detection. During the week, when he wasn’t treating patients or teaching medicine, he pursued his prostate cancer population and prevention research, along with more traditional radiation oncology studies. Over the past decade, Vijayakumar has published more than a dozen scientific articles on prostate cancer and race.

“Why is the incidence of prostate cancer higher among African-American men? Why is the overall outcome poorer in African-American prostate cancer patients? These are open questions,” Vijayakumar says. “We have to answer them.”

African- American men are diagnosed with prostate cancer at more advanced stages of the disease than white men, and are twice more likely to die of the disease.