by Michael Adkins
Editor’s note: Please refer to “Understanding Prostate Cancer” on page 7 for explanations of many of the clinical terms used in this article.
Prostate cancer treatments have come a long way in a relatively short period of time – in part because of improvements in screening practices, which has led to more patients being diagnosed at early stages of the disease. This means treatment regimens can be started earlier, which means these treatments are more likely to yield positive outcomes for patients.
Deciding which course of action is the right one is a choice each patient should make with his physician. Some of the most promising options offered by the experts at Chesapeake Urology Associates are profiled on the following pages, in order to help patients make the most well-informed decisions possible for their care.
Watchful Waiting
According to the American Urological Association’s Guideline for the Management of Clinically Localized Prostate Cancer, watchful waiting involves monitoring the disease and watching for progression. Dr. Marc H. Siegelbaum, FACS, partner at Chesapeake Urology Associates and chief of urology at St. Joseph Medical Center, says this is an approach often chosen by older men. “If the patient is 75 years old or older, has less than 10 years to live, or has a small amount of prostate cancer, with a PSA less than 10, watchful waiting might be a viable option,” he explains. “We would continue to check PSA levels and schedule a digital rectal exam every six months. Periodic repeat biopsy may be in order.”
Watchful waiting is not always the best option, however, especially in young patients. “Anybody younger than 75 with prostate cancer should have some form of cancer treatment,” Dr. Siegelbaum urges. “These men are usually young enough (life expectancy of at least 10 years) and healthy enough so that they would live long enough to have morbidity and mortality from their prostate cancer. Treatment would prevent these dire consequences. Those who have the best potential for curing their cancer have low-volume disease, have a low Gleason score — 7 or less — and a PSA of 10 or less. We think of these as ‘curable’ cancers, or cancer that can benefit from treatment.”
Robotic Prostatectomy
Prostatectomy, or the surgical removal of the prostate, is most often used for cancer that is in its early stages and has not spread beyond the prostate. The traditional technique for doing this was open surgery through an incision in the lower abdomen. Approximately five years ago, Chesapeake Urology Associates began offering robotic prostatectomy, with the attending surgeon controlling a robotic surgical system for improved precision and magnification (please see the article “Limitless Possibilities” in the previous issue of Chesapeake Urologist for more information).
The da Vinci system, so named because of renowned scientist Leonardo da Vinci’s conception of the first robot and his contributions to understanding human anatomy, uses a laparoscopic approach involving several small punctures, rather than a single large incision. The urologic surgeon sits at a console and controls the robot’s arms during the surgery.
The main benefits of this surgical method are less pain and faster recovery, Dr. Siegelbaum says. “Patients can get out of bed and start walking and performing breathing exercises almost immediately,” he adds. “In fact, most patients are discharged within 24 hours.” Dr. Siegelbaum also notes that the robot’s precision allows for cleaner, more accurate surgeries with considerably less blood loss than the traditional approach. Approximately 70 percent of radical prostatectomies in this country are now done robotically.
IG-IMRT
Another form of intervention for prostate cancer treatment is IG-IMRT, or image-guided-intensity modulated radiation therapy. IG-IMRT is a form of radiation therapy used to target cancer cells. “We insert gold markers in the prostate,” explains Dr. Richard S. Hudes, radiation oncologist with Chesapeake Urology Associates. “These markers are used as guides for targeting the radiation.” The gold shows up on X-rays, allowing for a clearer picture of the target area. This allows a more precise delivery of the radiation to the prostate than the techniques that were used 10 years ago.
Once the markers are in place, the cancer can be targeted with radiation. “It works like a gun, if you will,” Dr. Hudes says. “The IMRT system sculpts the dose to the shape of the target and delivers the intensity needed. One portion of the tumor may need a higher dose than another, and the computer software we use allows us to maintain that level of control.” If given as a standalone treatment, IG-IMRT is given five days each week for 35 to 40 treatments. For more aggressive tumors, IG-IMRT therapy is used for a five-week period and is then followed by brachytherapy.
Brachytherapy
Brachytherapy involves the implantation of radioactive “seeds” in cancerous areas of the prostate. According to Dr. Hudes, the patient is placed under anesthesia, and the physician, using special needles, implants 40 to 100 rice-sized pieces of radioactive material in the prostate. The seeds’ radioactivity is designed to shrink the cancerous growth. The seeds are radioactive for six to 12 months, depending on the isotope used. After the procedure, the seeds remain permanently in the prostate. The procedure is almost painless, and the patient can return to his normal activity within a few days of the implantation.
Chemotherapy
Chemotherapy has been a staple of cancer care for many years — but there were no demonstrably effective chemotherapy options for prostate cancer until recently, according to Dr. Adam R. Metwalli, urologic oncologist with Chesapeake Urology Associates. “About five years ago, a clinical trial demonstrated the effectiveness of docetaxel at prolonging survival and treating bone pain from prostate cancer that has spread,” Dr. Metwalli explains. Docetaxel is well tolerated by the patient and usually does not lead to cases of nausea and hair loss, as are common in chemotherapy for other types of cancer.
Hormonal Therapy
Unlike most other forms of cancer, prostate cancer responds to the presence of the male hormone testosterone. Testosterone is required for prostate cancer cells to grow and spread. Therefore, depriving the body of testosterone can help prevent the growth and spread of prostate cancer, although the cancer often becomes resistant to deprivation techniques after one to three years of use.
Orchiectomy — or the removal of the testicles, where most of the body’s testosterone is made — causes a dramatic decrease in hormone levels. However, many men are reluctant to undergo this procedure, so injections to block the release of the hormone that stimulates the testicle to make testosterone, as well as other drugs called antiandrogens, which block the action of testosterone on the prostate cancer cells, are often used instead.
One of the long-term complications of androgen deprivation is the possibility of developing osteoporosis. Dr. Metwalli and other specialists in hormonal therapy are stepping up efforts to protect patients’ bones while treating their prostate cancer. “All patients on androgen therapy should be taking calcium supplements,” he says. “Also, if a patient’s bone density is confirmed to be low, biphosphonates are used to force calcium back into the bones, making them stronger.”
Erectile Dysfunction Treatment
With many types of active prostate cancer treatment methods, the risk is present for erectile dysfunction, or ED — the inability of a man to obtain or maintain an erection long enough to have sex. Many of the effective treatments can cause nerve damage in the area surrounding the prostate, which can lead to ED.
However, prostate cancer patients can work to prevent ED with the help of Dr. David M. Fenig, urologist at Chesapeake Urology Associates. Dr. Fenig administers a comprehensive treatment program designed to increase nerve stimulation, increase oxygen flow in the area and lower the risk of scarring.
Dr. Fenig’s approach involves the use of multiple treatment options, including mechanical devices, medications and, if necessary, injections to stimulate nerves without the need for surgery. In addition, Dr. Fenig begins working with patients before and during their prostate cancer treatments, which often leads to improved outcomes. “Often, no one treatment is enough,” Dr. Fenig says. “With the clinical expertise and training I have, I can give men the additional information and reassurance they need. By offering this program, Chesapeake Urology Associates is on the cutting edge of urology care.”
Clinical Trials
When today’s treatments aren’t enough, many patients turn to clinical trials for a chance at tomorrow’s options. Clinical trials are usually thought of as being performed at major university research centers, but Chesapeake Urology Associates operates a distinguished research division — Chesapeake Urology Research Associates, or CURA —led by Dr. Ronald F. Tutrone Jr., FACS, Chesapeake Urology Associates’ research director. Dr. Tutrone and his staff have conducted numerous trials for new prostate cancer treatment options at CURA (please see the article “Clinical Trials Offer Most Advanced Care” in the previous issue of Chesapeake Urologist for more information).
The tested materials are at the cutting edge of prostate cancer treatment, Dr. Tutrone points out. “Some of these products may not be available to the public for five years or more after the trials,” he says. “Trial participants get them now. When other treatment options have failed, a clinical trial may be a good option.”
For more information about CURA’s current clinical trials, please see the sidebar on page 17.
Chesapeake Urology Associates – Your Partners in Prostate Cancer Care
No matter which treatment method or methods you and your doctor decide are right for you, Chesapeake Urology Associates and its world-class specialists are there to provide the expert care you need to get through this difficult time. For more information, or to schedule an appointment with a member of the team, call 877-422-8237, or visit www.chesapeakeurology.com.
CUA’s Lifestyle System of Diet and Exercise Helps Prevent Disease and Boosts Healthy Living
CUA is now offering a comprehensive health and wellness program specifically designed to address metabolic issues. While not a “diet,” this lifestyle system integrates low-glycemic eating, exercise and behavior modification into a flexible, step-by-step program that helps participants build healthy habits. The key difference between this system and other weight-management programs is that it offers a more comprehensive, holistic approach to diet and lifestyle changes. It emphasizes losing fat rather than just pounds, thus creating the optimal body composition. Fat loss is achieved by balancing a person’s blood sugar through low-glycemic impact eating. The glycemic index, or GI, ranks carbohydrate-rich foods according to their effect on blood glucose levels. Foods with a high glycemic index, like simple carbohydrates, white sugar, white bread and sugary soft drinks, are converted to glucose very quickly in the body. This fast conversion causes a release of insulin. Subjecting the body to high-GI foods over a period of time leads to a condition called insulin resistance and eventually to type II diabetes. In addition, consumption of high-GI foods tends to increase hunger and triggers a series of hormonal and metabolic changes that can then lead to overeating and eventually weight gain and obesity.
Clinical studies support this program’s effectiveness. The average weight loss per participant was found to be 14 pounds. It is even more impressive that participants lost an average of 4 percent body fat and four inches from their waist circumference.
Our program covers topics such as low-glycemic impact eating to optimize fat loss, detoxification, good fats versus bad fats, inflammation and oxidation as the root causes of disease, the importance of adequate sleep, regular exercise to support lean muscle mass, stress reduction and proper supplementation. We teach participants to focus on a diet that is rich in antioxidants, low in proinflammatory and carcinogenic substances, and low in simple sugars. This diet is combined with a regular exercise plan. These lifestyle changes can make an important difference in improving the overall health of every prostate cancer thriver.
To learn more about CUA’s Your Health and Wellness program, call the Prostate Center at 443-738-9393.
For more information, please visit the Prostate Cancer Foundation at http://www.pcf.org/site/c.leJRIROrepH/b.5814065/k.FB26/Nutrition__Wellness.htm.
This entry was posted on Friday, August 13th, 2010 at 9:53 am and is filed under Press Release. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
