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Medicine and Me: What’s Brought Me to Urology

By: John A. Pablo-Kaiser, BA, University of Arkansas for Medical Sciences, Little Rock | Posted on: 19 Jan 2024

Urology is the strong and reliable unsung hero of the medical world. While many outside the sphere of medicine may not attach the glamor and glitz of neurosurgery or cardiothoracic surgery to urology, I believe that the specialty offers just as much as any other. It is thanks to the developments in urology that a diagnosis like prostate cancer has become much less terrifying with the development of more sensitive diagnostic tools and improvement of care plans, allowing for earlier detection and better recovery. Through the Urology Care Foundation™ Summer Medical Student Fellowship, medical students across the country with a strong interest in urology can partake in furthering the field through summer research.

As one of the 13 recipients of this extraordinary award, I could not be more honored and elated! I come from a line of medicine—my mother is a nurse, my grandmother is an anesthesiologist, and my great grandfather was a surgeon, so I have always known that medicine is where I wished to be. My grandmother, my childhood hero, has been my inspiration for pursuing this path in life, and I felt that I would follow in her footsteps into anesthesia when I first came to medical school (Figure 1). Unfortunately, the hand I had been dealt was for a different game. Like a shoe half a size too small, I could not see myself slipping comfortably into the role of an anesthesiologist. For as incredible as anesthesiology is as a practice, I could tell that I wanted something else.

Figure 1. Grandma and me, 2004.

As someone with the philosophy of trying something earnestly before giving up, I never took urology off my list of potential interests. However, I would be lying if I claimed that I came to medical school with a burning passion for the specialty. It is thanks to my mentor, Dr Alan Diekman, that I immersed myself in learning more and eventually wanting to pursue urology. Before I knew that I wanted to go into urology, I knew that I wanted to spend a summer in research under Dr Diekman. Of course, the prerequisite to working with a reproductive biologist with a special interest in galectin-3, an important protein for prostate cancer, and a secondary appointment in urology at the University of Arkansas for Medical Sciences is to have an interest in urology myself. Wanting to preserve a good image with him, I began to earnestly look into the practice through online resources, shadowing, and asking questions of those I know in the medical field. What I discovered was that urology is a far broader practice than I initially thought, and that there is a good mix between surgical and clinical work, something that I thought was missing in anesthesia. Furthermore, I found that urology would allow me to follow my patients from pre- to postoperation, giving me the opportunity to be there every step of the way.

My research under Dr Diekman centered around the protein galectin-3, which is a carbohydrate-binding protein implicated in local and metastatic prostate cancer. Single changes in the coding for the galectin-3 gene causes different forms of the protein to arise (Figure 2). These different types of galectin-3 have varying odds of leading to prostate cancer because of altered functions. The ability of galectin-3 to attach to its target carbohydrate-bound ligand relies on its ability to group with itself. The long-term goal is to determine the molecular mechanisms underpinning the role of galectin-3 genetic variation in prostate cancer with the hope of developing improved prostate cancer screening, diagnosis, prognosis, and treatment strategies; even with the improvements to prostate cancer diagnosis and care, it remains the second leading cause of cancer-related mortality in men.

Figure 2. Structure of galectin-3. Galectin-3 possesses a C-terminal carbohydrate recognition domain (CRD) and a disordered N-terminal domain containing a collagen-like region and 12 amino acids regions. Polymorphisms are caused by single nucleotide polymorphisms in the galectin-3 gene, causing changes at amino acid positions 64 and 98 in the collagen-like region. This image of galectin-3 was created by Alan B. Diekman, PhD; reprinted with permission.

Because of the nature of my research, I worked well into the field of urology to both further my understanding of the subject of my research and further the research itself. A noteworthy portion of my downtime between experiments has been reading the literature on the functions of various tissue types in the male reproductive tract as well as staying current with practices and research pertaining to prostate cancer. Though my research has been progressing well, I believe it is too soon to begin considering publication.

I know I have yet to experience even close to all that urology can offer as a practice, so I am excited to discover what the specialty has in store for me and my future; with the Urology Care Foundation™ Summer Medical Student Fellowship, I am all but guaranteed the opportunity to explore all these avenues of medicine I feel truly passionate toward. To me, this award is worth its weight in gold as a key that has not only opened the doors in the field of urology, but also to further invest myself in the world of urological care. To me, this award embodies my resolve to forge a path for myself in urology so that I can in turn give opportunities to the next generation to do the same. To me, this award symbolizes what I have accomplished and what I can still accomplish with determination and hard work. This fellowship has ignited an ever-burning fire in the spirit of this medical student.