Profiles in GU Oncology: Focus on Prostate Cancer

One of the members currently serving on the editorial board of GU Oncology Now is Catherine H. Marshall, MD, MPH, Assistant Professor of Oncology, Division of Genitourinary Oncology at the Johns Hopkins University School of Medicine in Baltimore. Her clinical practice at the hospital and her research are focused on prostate cancer. “Prostate cancer is still one of the most common cancers and one of the most common causes of cancer death in the US,” she observes. “There’s still a big need, but there have been tremendous strides made over the past 20 years, so I think the next 20 years are going to be incredibly exciting and potentially revolutionary,” she predicts.

In addition to prostate cancer, Dr Marshall has maintained her connections with the cardiovascular research that she undertook before she was inspired to take up oncology. GU Oncology Now spoke with Dr Marshall to learn more about the path her career has taken and how she views the future of prostate cancer treatment.

Of her career to date, Dr Marshall notes that there are still very few women, particularly women of color, in academic medicine. “I have been very fortunate to have found mentors who have been very helpful for me personally and for my career, and who have really allowed me to succeed,” she acknowledges. “I still have mentors with whom I meet up regularly and probably some of the people who have been interviewed for GU Oncology Now are people that I look up to.”

Nowadays Dr Marshall is based at The Johns Hopkins Hospital in Baltimore. She spends two days a week in clinic, one day at the main campus and one day at the Green Spring Station- Lutherville satellite campus, and three days a week on research and teaching. Having been at Johns Hopkins for over 10 years, “Baltimore feels like home now,” she says.

Dr Marshall’s Career in New York

Growing up near New York City, both Dr Marshall’s parents were teachers. “Initially I thought I was going to be a teacher or a doctor, but now I consider myself to be both a doctor and a teacher,” she says. She attended Harvard University, majoring in evolutionary biology and obtaining certificates in health policy and Spanish. Two of her earliest mentors were at Harvard, David A. Shore, PhD, then associate dean and executive director at the Harvard T. H. Chan School of Public Health, and the well-known paleontologist; Farish A. Jenkins, PhD who, as well as Professor of History at Harvard, also served as Professor of Anatomy at Harvard Medical School. “They were big influences in helping me navigate and be successful at Harvard, and since then,” Dr Marshall acknowledges.

Dr Marshall returned to New York to carry out research on stroke recovery in the Department of Neurology at Columbia University College of Physicians and Surgeons. “Then I entered medical school at Johns Hopkins, graduating with an MD in 2012,” she relates. “Between my third and fourth year of medical school, I took a year off to do a masters in public health (MPH) with a focus on health systems and policy.” She stresses that the course also focused on epidemiology and biostatistics, “which has been very helpful in research I have done subsequently, especially working with the cardiologists on the Multi-Ethnic Study of Atherosclerosis (MESA).”

Dr Marshall remained at Johns Hopkins for her internal medicine residency, during which she carried out research on cardiovascular disease risk factors and noncardiovascular disease-related outcomes in the Ciccarone Center for the Prevention of Heart Disease. She received a Stanley L. Blumenthal, MD, Preventive Cardiology Research Award for her work on the association of coronary artery calcium with noncardiovascular disease in the MESA study, which she presented at the 2014 annual meeting of the American Heart Association.¹ “That’s when I became interested in cancer and heart disease and the overlap between the two diseases,” she recalls. “But the patient experiences that I found the most rewarding were those in the oncology center, so I decided to go into oncology.”

Oncology Fellowship and Interest in Prostate Cancer

To continue her cross-disciplinary research, Dr Marshall remained at Hopkins for her fellowship. “I did one clinical year, and then in 2016 I returned to the Department of Medicine where I served as Assistant Chief of Service (ACS),” she notes. (At Johns Hopkins, the ACS position is similar to chief residents in other programs.) In 2017, Dr Marshall received an ASCO Young Investigator Award to present research on cardiorespiratory fitness testing and cancer incidence at the ASCO annual meeting.² After returning to oncology for the remaining 2 years of her fellowship, she joined the faculty in 2019.

It was during her oncology fellowship that Dr Marshall became increasingly interested in prostate cancer. “A number of family members have had prostate cancer, fortunately localized,” she explains. “It’s a very common disease, but particularly prevalent among the African-American community, which is my background,” she notes. (Black men in the U.S. were about 60% to 80% more likely to be diagnosed with prostate cancer, and twice as likely to die from prostate cancer compared to men of other races in the US.³) “So I felt that it was important to help make positive change and contribute to treating my personal community in Baltimore, as well as the community at large,” she says. “Hopkins has a very strong group and history of people doing prostate cancer research and there were a lot of fantastic mentors and collaborators that I wanted to work with to try and improve the lives of these patients.”

“Prostate cancer is not the only disease some patients have to deal with; cardiovascular disease is another important one,” she stresses. “Men can live very long lives even after a prostate cancer diagnosis, so these other diseases become significant,” she points out. “What I was seeing in Baltimore was that prostate cancer was a disease that was important in people’s lives, but that as an oncologist there was often a need to be cognizant and understand how their treatment might be influenced by some of these other factors like cardiovascular disease risk factors and how the interplay of both of those contributes to patients’ wellbeing.”

New Therapies and Research

Dr Marshall is also looking at the genetics of prostate cancer and prostate cancer outcomes and how gene alterations predict response to treatment.⁴ “More recently, I have started to look at clonal hematopoiesis, to see whether this risk factor for heart disease is relevant to prostate cancer. This is a new area of research and I’m involved in clinical trials, looking at some of the different mutations that we find in prostate cancer that impact clinical outcomes.”

Dr Marshall and her colleagues are evaluating new therapies specifically targeted for men with ATM (ataxia telangiectasia mutated) gene mutations. “We were one of the first groups to report that men with ATM mutations do not have a disease response to poly(ADP-ribose) polymerase (PARP) inhibitors versus men with BRCA mutations,” she notes.⁵ Dr Marshall and her colleagues are also looking at nonhormonal therapy approaches such as PARP (poly[ADP-ribose] polymerase) inhibitors, including a trial (NCT03047135) of olaparib in men with high-risk biochemically-recurrent prostate cancer following radical prostatectomy. “We’re not treating these men with hormone therapy, they’re only getting PARP inhibitors,” she explains. “We’re looking forward to thinking more about some of these genomically-targeted treatments and how they might be helpful even in the absence of androgen deprivation therapy,” she says. “What I’m most excited about is to see more nonhormonal approaches to treating prostate cancer because I believe these alternate strategies will help people live longer lives with fewer toxicities and side effects.”

“I think that the message about prostate cancer is that care is improving dramatically and becoming much more interdisciplinary, and that is a big strength,” Dr Marshall says. “But as people live longer with prostate cancer, there are going to be new questions arising that will need to be addressed by the field,” she predicts.

Linda Brookes, MSc is a freelance medical writer/editor based in New York and London.

References

1. Handy C, Desai CS, Dardari Z, et al. The association of coronary artery calcium with age-related non-cardiovascular disease: the importance of “biologic aging” from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2014;130(suppl 2):A12288.
2. American Cancer Society. Cancer facts and figures for African-Americans/Black people 2022-2024. American Cancer Society, 2022. Available at https://www.cancer.org/content/ dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-c-aa.pdf
3. Handy C, Al-Mallah MH, Dardari Z, et al. Cardiorespiratory fitness and incident lung and colon cancer: FIT-Cancer Cohort. J Clin Oncol. 2018;36(15 suppl): Abstract 1502. DOI: 10.1200/JCO.2018.36.15_suppl.1502
4. Marshall CH, Holler AE, Tsai HL, et al. Clonal hematopoiesis in prostate cancer inferred from somatic tumor profiling. J Clin Oncol. 2021;39(15 suppl): Abstract e17001. DOI: 10.1200/JCO.2021.39.15_suppl.e17001
5. Marshall CT, Sokolova AO, McNatty AL, et al. Differential response to olaparib treatment among men with metastatic castration-resistant prostate cancer harboring BRCA1 or BRCA2 versus ATM mutations. Eur Urol. 2019;76(4):452-458. DOI: 10.1016/j. eururo.2019.02.002