Leonard Gomella, MD, FACS – A Decades-Long Commitment to Advancing Urology

Leonard Gomella, MD, FACS, is the Bernard W. Godwin, Jr. Professor of Prostate Cancer and Chairman of the Department of Urology at Sidney Kimmel Medical College, as well as the Senior Director for Clinical Affairs in the Sidney Kimmel Cancer Center in Philadelphia, PA. With a distinguished career spanning over decades, Dr. Gomella has made significant contributions to the field of urology, particularly in the areas of prostate cancer research and treatment. He has been instrumental in pioneering multidisciplinary approaches to cancer care, leading initiatives at Thomas Jefferson University to establish a National Cancer Institute (NCI)-designated  cancer center and advocating for precision medicine in patient management.

GU Oncology Now spoke with Dr. Gomella on his journey to becoming a urologist, highlighting his training and experiences at the NCI and Thomas Jefferson University; the importance of multidisciplinary care models, particularly in the context of cancer treatment; and challenges in the field, such as the shortage of urologists and the evolving landscape of precision medicine.

Could you share a bit about your path to becoming a urologist? What led you to specialize in this field?

Dr. Gomella: To keep it concise, I hail from New York originally. I attended medical school at the University of Kentucky, followed by my general surgery and urology training there. Subsequently, I was selected for a fellowship at the NCI, focusing on surgical oncology. It was an incredibly pivotal time, during the mid-1980s, when breakthroughs like IL-2 and discovering the genetic origins of kidney cancer, developed by luminaries like Dr. Steve Rosenberg and Dr. Marston Linehan, were revolutionizing the treatment landscape for previously intractable cancers such as renal cell carcinoma.

Following my fellowship, I was recruited to Thomas Jefferson University to help spearhead the establishment of a formal cancer center. At that juncture, the university lacked a dedicated cancer center, and I was part of the team tasked with that endeavor. Since 1988, I have remained at Jefferson, witnessing our evolution to become an NCI-Designated Cancer Center in 1996. Throughout this journey, my focus has remained on advancing oncology through research, translational efforts, teaching, and patient care at the Sidney Kimmel Cancer Center at Thomas Jefferson University.

What is your current role within the Sidney Kimmel Cancer Center and how it has evolved over time?

Dr. Gomella: My responsibilities have shifted over the years, but presently I serve as the Chairman of the Department of Urology and the Senior Director for Clinical Affairs. I oversee the coordination of our 12 multidisciplinary clinics within the cancer center. While my primary focus remains in urology, we initiated the multidisciplinary approach to prostate cancer as far back as 1997. Since then, this model has proven successful, leading to the establishment of additional multidisciplinary clinics covering various cancer specialties such as lung cancer, head and neck cancer, and continuing our commitment to urologic oncology.

What sets our multidisciplinary clinics apart is the concept of simultaneous consultations with specialists in 1 location. We have explored different models for multidisciplinary care, particularly in urological oncology and prostate cancer. My preference lies with the real-time, simultaneous consultations with multiple specialists, which I believe offer the best outcomes for patients, their families, and providers, as well as an outstanding learning environment for our residents and students. This approach facilitates comprehensive understanding of different oncology disciplines and treatment modalities. We have documented our success in numerous papers and book chapters, and it is heartening to see this approach becoming standard practice not only in the United States but also in Europe, where multidisciplinary care for patients with GU malignancies is increasingly recognized as the gold standard.

Could you walk us through a typical day or week in your current role? How do you balance patient care with administrative and directorial responsibilities?

Dr. Gomella: I generally divide my time into thirds. The first 2 days of the week are dedicated to patient care, both in outpatient settings and in the operating room. The remainder of my week is typically consumed by the myriad responsibilities of a department chairman. In addition, I serve as the enterprise Vice President for Urology at Jefferson Health, overseeing matters such as care coordination, recruitment, and equipment procurement across our network of 17 hospitals and 36 urologists. This administrative aspect occupies a significant portion of my time.

Finally, I devote about 1 day a week to research and teaching. Collaboration with basic scientists is a particular passion of mine, rooted in my experiences as a fellow at the NCI. Their fellowship program immerses clinically trained individuals like me in laboratory environments, fostering collaborations and translational research initiatives with basic scientists. Since joining Jefferson Health, I have continued to explore these interdisciplinary collaborations, resulting in the development of clinical protocols and translational research endeavors in conjunction with our Sidney Kimmel Cancer Center scientists.

Can you highlight a few key breakthroughs or milestones in your translational research that have significantly impacted the field of urology?

Dr. Gomella: Before delving into those, I would like to mention my involvement on external scientific advisory boards for institutions like the Greenbaum Center at the University of Maryland and the Center for Prostate Disease Research and Treatment at Walter Reed Army Medical Center. Additionally, I previously served as the RTOG-NRG Chair for Urology for approximately 20 years, helping design large scale clinical trials. These experiences were instrumental in my understanding of the global landscape of cancer care and opportunities for further translational research projects.

Now, in terms of specific breakthroughs, one area of interest that emerged during my tenure at Jefferson Health was the exploration of prostate cancer micrometastasis. In fact, as early as 1992, we published what I consider a seminal paper on liquid biopsy for prostate cancer, predating the term “liquid biopsy” itself. In this study, we pioneered the collection of blood samples and detection of prostate cancer micrometastasis using RT-PCR signals for PSA. This was truly considered groundbreaking work conducted in the era before the completion of the Human Genome Project and long before the advent of advanced DNA technologies in common use today.

Building on this foundation, we expanded our research to investigate the general concept of shed cancer cells in body fluids. Collaborating with basic scientists, we utilized a cell surface marker known as VPAC. Our research revealed that VPAC markers exhibit significant upregulation before cells manifest histological hallmarks of malignancy, providing a potential early detection mechanism. This phenomenon extends beyond urology, with upregulated VPAC markers present in various epithelial cancers such as ovarian, lung, head and neck, bladder, and prostate cancers. Jefferson has since been awarded numerous patents for our work on shed tumor cells in body fluids, spanning saliva, peritoneal fluid, urine, lung aspirates, breast exudates, and beyond.

My continued interest lies in exploring micrometastasis and advancing our understanding of early cell detection mechanisms. This ongoing research represents another significant area of contribution.

What advice would you offer to aspiring urologists or researchers entering the field today? What are the unique challenges they may face, and how can your experience guide them?

Dr. Gomella: Education and mentorship have been integral to my career since my days as a medical student. In fact, I have authored a medical student book now in its 12^th edition, titled “Gomella and Haist’s Clinician’s Pocket Reference.” The book is aimed at providing essential clinical knowledge for medical students as they begin clinical patient care. Mentorship is key. It is about nurturing individuals’ interests and guiding them in research projects or fellowship opportunities aligned with their passions.

Within medical education, as faculty members, we are accustomed to this cycle of training, empowering students and residents, and then watching them progress in their careers. At Sidney Kimmel Medical College, we have been fortunate to see many trainees ascend to leadership roles in academic medicine.

However, the landscape is shifting. More urology trainees are opting for directly entering practice rather than pursuing fellowships. For those choosing fellowships, their motivations vary, from honing expertise in specific urological domains to pursuing academic careers that blend research, teaching, and patient care.

Addressing the current shortage of urologists in the United States is imperative. Factors like COVID-related retirements and the aging baby-boom population contribute to this shortfall. Encouraging interest in urology among medical students is crucial. At Sidney Kimmel Medical College, we have historically attracted a significant number of students to the field. We continue this effort through initiatives like the Jefferson Urology Scholar program, providing dedicated mentorship and research opportunities to students who elect to take a gap year with our department.

My advice to aspiring urologists and researchers is to seek mentorship, pursue areas of genuine interest, and consider the broader impact of their work. By fostering a new generation of urologists and researchers, we can address current challenges and propel the field forward.

Which area in urology, whether it be subspecialties, research, academia, or elsewhere, requires the most attention in terms of bolstering manpower?

Dr. Gomella: In my view, the critical area of need in urology is in primary care. Particularly in rural and underserved areas across the United States, there is a significant shortage of primary care urologists. This shortage has led to an increasing role for advanced practice providers, such as physician assistants, nurse practitioners, and doctors of nursing practice, in delivering urological care in these regions. While this helps address the immediate need, there is still a requirement for more general urologists to provide essential care to communities of all sizes.

Urban centers may have a relatively stable pool of specialists, but the shortage becomes more acute in rural and less densely populated areas. The majority of patients require general urological care rather than specialized treatment. However, it is worth noting that major cancer organizations recommend seeking a second opinion at larger cancer centers for certain diagnoses—such as prostate, bladder, and kidney cancer—before embarking on treatment pathways. This underscores the importance of access to specialized care, even if it necessitates traveling to larger centers initially for a second opinion.

Looking ahead over the next 5 to 10 years, where do you anticipate the most significant advancements in patient care occurring? Will it be in early diagnosis, treatment breakthroughs, or perhaps in the realm of end-of-life care?

Dr. Gomella: The future of cancer care lies in precision medicine. This requires tailoring screening, diagnosis, and treatment strategies to the unique characteristics of each patient. Whether it is identifying biomarkers, conducting genetic or genomic testing, or utilizing advanced imaging techniques, the goal is to match patients with the most effective interventions. We are witnessing a surge in molecular and genetic testing, and while many new tests will emerge, only some will prove valuable in clinical practice.

Moving away from the traditional one-size-fits-all approach, precision medicine will redefine how we manage cancer across its spectrum, from screening to treatment of localized or advanced disease. We are already seeing the impact of precision medicine in fields like urologic oncology, with tailored treatments based on specific genetic alterations in prostate or bladder cancer, for example. This shift towards personalized medicine will revolutionize cancer care, offering patients more effective and targeted therapies tailored to their individual needs.