Greg Alexander

New treatment advances help fight prostate cancer

Baltimore Sun, October 2004

The statistics can be frightening. Prostate cancer is the most commonly diagnosed cancer for men and is the second leading cause of male cancer deaths, exceeded only by lung cancer. In fact, the American Cancer Society estimates that there will be about 230,900 new cases of prostate cancer in the United States in 2004 and that one in six men will get prostate cancer during his lifetime. Thankfully, there is good news: only one in 32 men will die from the disease and the death rate is going down, thanks in part by early detection and new advances in treatment options.

Of course, for the disease to be treated, it has to be detected, and, unfortunately, symptoms are few and often overlooked. Frequent urination and a slow stream of urine are two main symptoms, but many men conclude that these are simple annoyances of growing older. “Symptoms of prostate cancer are either non-existent or similar to a benign enlargement of the prostate,” says Dr. Ted DeWeese, chairman of the department of radiation oncology and molecular radiation science at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “That’s why yearly screening starting at age 50 is so important.” Dr. DeWeese adds that for men in high-risk categories – African-American men and those men with family history of the disease, especially – yearly screening should begin at age 40. African-American men have the highest prostate cancer incidence in the world, and those men with a first-degree relative – father, brother or cousin – are two times more likely to develop the disease than a man with no family history of prostate cancer.

The importance of yearly screening is a reason why that St. Agnes HealthCare offers free screenings the first Monday of each month, says Richard S. Hudes, chief of radiation oncology and director of the prostate cancer screening program at St. Agnes HealthCare. “Hopefully, we’ll fill in the gaps for those who do not get tested through their primary care physician or those uninsured men who are less likely to be tested,” says Dr. Hudes, who notes that St. Agnes participates in outreach programs to target high-risk groups. Besides heredity, theories abound on other causes of prostate cancer. “The effect of environmental factors such as nutrition has been considered,” says Dr. Hudes, who notes that a high fat diet increases a man’s risk of developing the disease.

“A basic blood test or a digital rectal examination can be done in two minutes through your primary care physician, and results are usually back in 24 to 48 hours,” says Dr. Nancy Vander Velde, a medical oncologist at the Alvin & Lois Lapidus Cancer Institute at Sinai Hospital.

Blood tests are used to determine the amount of prostate specific antigen (PSA) in the blood. If a PSA number is too high, the physician then tries to determine the likelihood that an elevated amount of PSA is a sign of prostate cancer or not, according to Dr. Hudes. The cells surrounding the prostate make PSA, and small amount is usually found in the bloodstream; however, if prostate cancer is present, a larger amount of PSA will be produced. The digital rectal exam is used to detect any lumps in the prostate. If either test detects abnormalities, a prostate biopsy may be ordered, especially for those in high-risk categories, says Dr. Hudes.

If prostate cancer is detected, there are several treatment options – both surgical non-surgical. Many times, for older men, a strategy of “watchful waiting” is prescribed. “If the patient is elderly, has significant medical problems or has a life expectancy of less than 10 years, observation can be the best treatment,” says Sinai’s Dr. Vander Velde.

For other patients, especially those whose cancer is detected early, surgery may be the best treatment plan. A radical prostatectomy involves the complete removal of the prostate. “Here at Johns Hopkins, we have some of the best surgeons in the world, and hospital stay after the surgery can be as little as three or four days,” says Dr. DeWeese. However, Dr. DeWeese points out that urinary incontinence and impotence are possible side effects. To help decrease the possibility of these side effects, the Kimmel Cancer Center developed a nerve-sparing prostatectomy procedure where the incision is made between the scrotum and anus, which is thought to reduce the effect on the nerves and thus reduce the side effects of impotence and incontinence.

In addition to surgery, two other treatment plans are available to most patients, says St. Agnes’ Dr. Hudes. TomoTherapy is the integration of Image Guided Radiation Therapy (IGRT) and Intensity Modulated Radiation Therapy (IMRT) that allows for a quicker, more precise and safer radiation treatment, explains Dr. Hudes. “There is great excitement in the field; TomoTherapy is revolutionary,” he says, adding that St. Agnes is the first TomoTherapy system to arrive in the mid-Atlantic and northeastern part of the United States and the 10th overall nationally.

Dr. Hudes says that with traditional radiation, which is typically a Monday through Friday treatment for six weeks, the patient’s cancer position is verified weekly. However, weight gain or a slight move of the prostate can cause the radiation treatment to “miss the target.” With TomoTherapy, the patient is imaged and positioned every day.

Another form of radiation treatment of prostate cancer is brachytherapy, which involves implanting small radioactive pellets in the prostate gland in the area surrounding the tumor. “This is a one-time outpatient procedure under a general anesthesia and is restricted to patients with an organ-confined disease – when the cancer is solely in the prostate,” says Dr. Hudes. “Not everyone is a candidate for this type of treatment, but it is especially appealing for out-of-town patients since it’s a one-time procedure, unlike daily radiation treatments,” says Sinai’s Vander Velde.

Like radical prostatectomy surgery, a possible side effect of radiation treatment is impotence, says Dr. DeWeese. “The side effects of radiation or surgery are identical in magnitude,” he says.

Also similar is the outcome, says Dr. Hudes. “Whether you choose surgery, TomoTherapy or brachytherapy, the results are similar. You – along with your physician – can choose a treatment plan based on your preference, the convenience and comfort level. You should match you personality and lifestyle to your treatment plan,” says Dr. Hudes, who notes that the St. Agnes Prostate Cancer Center is a new addition this fall to the hospital.

For more information on prostate cancer, Dr. DeWeese suggests visiting the Web site of the National Cancer Institute,

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