# Mark Soloway

Mark S. Soloway (born in 1943) is an American emeritus professor of urology, renowned for his contributions to prostate, bladder and kidney cancer research. He served as a professor and chairman of the Department of Urology at the University of Miami Miller School of Medicine (MSM) and later as the chief of urologic oncology at Memorial Hospital in Hollywood, Florida.
After graduating in medicine from Case Western Reserve University School of Medicine he completed his residency in urology at University Hospitals of Cleveland. Soloway then completed a two-year clinical fellowship at the National Cancer Institute (NCI) of the National Institute of Health (NIH) in Bethesda, Maryland. There, he developed an animal model to investigate the efficacy of several investigational chemotherapeutic drugs for the treatment of bladder cancer. He subsequently returned to Case Western Reserve to complete his residency in urology.

## Early life and education

Mark Soloway was born in the Midwest in 1943. In 1964 he received a bachelor's degree in biology from Northwestern University in Chicago. Subsequently, he studied medicine at the Case Western Reserve University School of Medicine in Cleveland, from where he graduated in 1968. Whilst there, he was inspired towards translational research by neurosurgeon Robert J. White.

## Early career

In 1968 Soloway began a two-year clinical fellowship at the National Cancer Institute (NCI) of the National Institute of Health (NIH) in Bethesda, Maryland, where his contributions to the field of urology began. There, he developed an animal model for bladder cancer to find a better treatment for locally advanced or spreading bladder cancer. This FANFT-induced bladder cancer in mice allowed him to investigate the effectiveness of several investigational chemotherapy drugs for bladder cancer. At the same time he also tested the hypothesis that the high rate of local recurrence of urothelial tumors may be the result of implantation of tumor cells on the urothelial surface following endoscopic resection of bladder tumors. By developing an orthotopic bladder implantation animal tumor model, Soloway was able to establish that an injury to the urothelium created the necessary environment for tumor implantation and the scientific evidence in support of early intravesical chemotherapy following transurethral resection of a bladder tumor. This included his research with cisplatin, then known as cis-diamminedichloro platinum . After completing his fellowship Soloway returned to Case Western Reserve to complete his residency in urology. He then joined the University of Tennessee. His research also included some early studies on combining cisplatin with radiation.

## Later career

From 1991 to 2010 Soloway was professor and chairman of the University of Miami Miller School of Medicine (MSM) Department of Urology. In 2014 he became chief of urologic oncology at Memorial Hospital in Hollywood, Florida.
Soloway was one of the first urologic oncologists to use flexible cystoscopy as an integral part of his office practice; today, the majority of the world uses it.

### Transrectal ultrasonography for prostate cancer

Soloway's contributions to bladder and prostate cancer research are significant, with his work on bladder cancer emerging from foundational studies with his animal model. In prostate cancer research, Soloway has made advancements across six main areas:
* Diagnosis: He pioneered the use of transrectal ultrasonography to improve prostate cancer diagnosis.
* Pain Management: Soloway developed the periprostatic nerve block, reducing biopsy-associated pain.
* Androgen Deprivation: He evaluated the benefits of androgen deprivation therapy before radical prostatectomy for patients with locally advanced prostate cancer.
* Quality of Life: His work emphasized the importance of quality-of-life considerations in treatment decisions.
* Active Surveillance: Soloway recognized and promoted active surveillance as a management strategy for patients with low-risk prostate cancer.
* Surgical Techniques: He contributed to refining surgical techniques for total prostatectomy, enhancing outcomes for prostate cancer patients.
These contributions have collectively shaped prostate cancer diagnosis, treatment, and management, improving patient care and outcomes.
Soloway promoted the TRUS biopsy method to urologists for their outpatient clinics. In an effort to minimize the discomfort from biopsies, he also popularized the use of the periprostatic nerve block. This procedure is used to minimize the pain associated with a prostate biopsy and is used in over 500,000 procedures annually in the US alone.

### Evaluating androgen deprivation

During the 1980s and early 1990s, a high percentage of men with prostate cancer were diagnosed with locally advanced disease. Anecdotally, many of them were given the then 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.

### Positive surgical margins

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.

### Watchful waiting approach

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.

### Work on renal tumors

Soloway has worked closely in tandem with a former resident and co-faculty member, Gaetano Ciancio on kidney cancer. 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.

### Cancer support group

Soloway developed one of the first prostate cancer support groups 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.

## Awards and honors

Soloway's awards include;
* 1967 - Mosby Scholarship for Scholastic Excellence award
* 1972 - North Central Section of American Urological Association Traveling Fellowship award
* 1984 - American Urological Association's Gold Cystoscope Award
* 2008 - Presidential Citation.
* 2015 - British Association of Urological Surgeons awarded him the St Paul's Medal.

## Selected publications

* Soloway, M. S. (April 1980). "Rationale for intensive intravesical chemotherapy for superficial bladder cancer". The Journal of Urology. 123 (4): 461–466. doi:10.1016/s0022-5347(17)55976-5. ISSN 0022-5347. PMID 6767860.
* Soloway MS: Intravesical chemotherapy in superficial bladder cancer. In: Genitourinary Cancer - Contemporary Issues in Clinical Oncology. (ed): Garnick, Mark B. Churchill Livingston, New York, pp. 163–192, 1985.
* Soloway MS: "The use of an animal model to gain insights into bladder cancer therapy". In: Testicular Cancer and Other Tumors of the Genitourinary Tract. (ed): Pavone-Macaluso, M., Smith, P.H. and Bagshaw, M.A. Plenum Publishing Corp., New York, London, Washington, D.C., pp. 315–327, 1985.
* Aso, Y., Anderson, L., Soloway, M., Bouffioux, C., Chisholm, G., Debruyne, F., Kawai, T., Kurth, K.H., Maru, A., and Straffon, W.G.E.: Prognostic factors in superficial bladder cancer. In: Developments in Bladder Cancer. (ed): Denis, L., Niijima, T., Prout, G. Jr., and Schroeder, F.H. Progress in Clinical and Biological Research, Volume 221. Alan R. Liss, Inc., New York, pp. 257–269, 1986.
* Soloway MS: The case for chemotherapy as the initial management of patients with carcinoma in situ of the urinary bladder. In: Controversies in Urology. (ed): Carlton, C.E. Jr. Yearbook Medical Publishers, Chicago, pp. 237–241, 1989.
* Soloway MS: Studien der National Prostatic Cancer Project and Treatment Group des fortgeschrittenen prostatakarzinoms. In: Aktuelle Therapie des prostatakarzinoms. (ed): R. Ackermann, J. Altwein. Springer-Verlag, Berlin, pp. 361–369, 1991.
* Soloway, M. S.; Kurth, K. H.; Herr, H.; Huland, H.; Denis, L.; Suzuki, K.; Blandy, J.; Hisazumi, H.; Koontz, W.; Tsugawa, R. (1986). "Surgical techniques in the management of patients with superficial bladder cancer". Progress in Clinical and Biological Research. 221: 123–132. ISSN 0361-7742. PMID 3809179.
* Soloway, M. S. (1989). "Should all superficial bladder tumors be treated with intravesical therapy?". Progress in Clinical and Biological Research. 303: 491–501. ISSN 0361-7742. PMID 2675006.
* Soloway MS: Studien der National Prostatic Cancer Project and Treatment Group des fortgeschrittenen prostatakarzinoms. In: Aktuelle Therapie des prostatakarzinoms. (ed): R. Ackermann, J. Altwein. Springer-Verlag, Berlin, pp. 361–369, 1991.