Attraction of Medical Education and Research

The current study is based on a survey of participants in trial conducted in the late 1990s at MGH and at the Loma Linda University Medical School in California. That study compared the results of two different radiation doses for treatment of early-state prostate cancer. All participants received an equal dose of conventional X-ray therapy and a booster dose of proton therapy that brought the total dose to either the then-standard level of 70 Gy or to 79 Gy, which is now the usual dosage for similar tumors. Proton therapy reduces the amount of radiation delivered to normal tissues in front of and behind a tumor, and the X-ray therapy was also given in a way to minimize the irradiation of normal tissues.

The earlier study showed that, five years after treatment, the higher radiation dose had reduced tumor recurrence by about half, a benefit that persisted up to nine years after treatment. Participants' physicians reported similarly low rates of treatment-related toxicity in both groups, but the patients themselves had not been asked about their post-treatment experiences.

The current investigation was designed to study participants' reports of their experiences, considered to be the most accurate measure of side effects. The researchers sent all surviving participants a questionnaire that included standardized assessments of the urinary, bowel and sexual symptoms usually affected by prostate cancer treatment. Separate from the specific symptom assessment, participants were asked to rank their function in those areas as normal, intermediate or poor. They also were surveyed about their attitudes regarding their current health, their cancer and the treatment decisions they had made.

Survey questionnaires were returned by 280 of the original 398 study participants, evenly divided between the standard- and high-dose groups. Both groups reported similarly low levels of treatment side effects and quality of life problems. Patients in the standard-dose group – who had greater incidence of tumor recurrence, often requiring additional therapies – expressed less confidence that their tumors were under control and more regret about their treatment choice, which in this case was to enroll in the randomized trial. Participants' overall ranking of the urinary, bowel and sexual functions was often better that would be expected based on the symptoms they reported.

Jack Szostak is an Investigator of the Howard Hughes Medical School, Professor of Genetics at Harvard <a href= http://www.medicalschool.org/>Medical School</a>, and the Alex Rich Distinguished Investigator in the Department of Molecular Biology at the Massachusetts General Hospital. He received the 2009 Nobel Prize in Medicine for his discovery of the enzyme telomerase, which protects chromosomes from degrading, a process common to aging and various disease states. He received the 2006 Lasker Award for Basic Medical Research for the same work.

His current research interests are in the laboratory synthesis of self-replicating systems and the origin of life. He and his colleagues have developed in vitro selection as a tool for the isolation of rare functional RNA, DNA, and protein molecules from large pools of random sequences. His laboratory has used in vitro selection and directed evolution to isolate and characterize numerous nucleic acid sequences with specific ligand binding and catalytic properties. He is co-director of Harvard’s Origins of Life Initiative.

Szostak has also been awarded, along with Gerald Joyce of The Scripps Research Institute, the 1994 National Academy of Sciences Award in Molecular Biology and the 1997 Sigrist Prize from the University of Bern, Switzerland. He is a member of the National Academy of Sciences, and a Fellow of the New York Academy of Sciences and the American Academy of Arts and Sciences. In 2000, Szostak was awarded the Medal of the Genetics Society of America.

Brian Paegel is an assistant professor in the Department of Chemistry with a joint appointment to the Translational Research Institute at Scripps Florida, part of The Scripps Research Institute, which is headquartered in La Jolla, California. He is well known for his work in the field of directed evolution, applying Darwinian principles to populations of molecules rather than organisms and using microfluidic technology as a platform for observing evolution in real time in molecules research in <a href= http://www.medicalschool.org/>medical school</a>.

Paegel graduated magna cum laude with a B.S. in chemistry from Duke University (NC) in 1998 and received his Ph.D. in chemistry from the University of California, Berkeley in December 2003. Just prior to joining Scripps Florida in 2008, he was a National Institutes of Health postdoctoral fellow in Gerald Joyce’s laboratory at Scripps Research’s La Jolla campus. He received a National Institutes of Health Pathway to Independence Award in 2007.