Monthly Archives: April 2015

4 Facts Senior Men Need to Know about Prostate Cancer

1 of 2 mean older than 65 are not getting the correct therapy for prostate cancer.

Most senior men are not getting the correct therapy for prostate cancer.

“I had to worry about prostate cancer only when I was young.”

1. Not true.  Most of the deaths from locally advanced prostate cancer occur in men 75 years or older.

“If I have prostate cancer when I’m old, I only need a hormone shot if anything.”

2.  Again, not true.  In the past several years, two landmark clinical trials have clearly shown there is better survival for men with locally advanced prostate cancer if radiation is added to hormonal therapy versus hormonal therapy alone.  These trials have become the “Gold Standard for cancer care.” The effects of radiation therapy were huge-a 50% decrease in prostate cancer deaths.

“Aren’t radiation and hormones only for men in those fancy clinical trials at big centers?”

3.  Dr. Justin Bekelman of the University of Pennsylvania School of Medicine recently completed a study of over 31,000 Medicare seniors  that led him to conclude that “Men with aggressive prostate cancer regardless of age – where they are in their 50s, 60s, 70s, or 80s – should know that radiation with hormone therapy save lives.” (HemOnctoday: 2015, March, p 24).

“Do I really need to see a radiation specialist too?  Can’t my urologist just do everything.”

4. I wish it were that simple.  In Bekelman’s study, 49% of men older than 65 years and 61% of men older than 75 years had hormone therapy only, and not radiation plus hormone therapy. That means 1 of 2 men older than 65 years and 3 of 5 men older than 75 years, are not getting the correct therapy.

Dr. Dean Shumway and Dr. Daniel Hamstra, both from the University of Michigan Radiation Oncology Department, commented on Dr.Bekelman’s study and wrote “it is also critical to note that the use of primary androgen deprivation therapy has been found to be highly related to which practitioner a patient sees rather than to the patient or tumor characteristics.”  In short, many urologists continue to just prescribe hormone therapy and not radiation, despite the overwhelming evidence for radiation and hormonal therapy.

For more information or to get advice on a specific patient case, feel free to call me, Edward Hughes, M.D., PhD at 855-Dayton1.

2 Things You Need to Know About PSA Screenings

Without Screening, Higher Risk Prostate Cancer Is Increasing

 In an earlier blog from only a few weeks ago, I commented on the fact that I’m seeing more and more patients come into my clinic with higher risk prostate cancer.  And now there is a new study to support my observation.  Dr. Timothy Schultheiss from the City of Hope Medical Center looked at 87,562 men with prostate cancer diagnosed from 2005 to 2013 by the National Oncology Data Alliance. He was the first investigator to show that beginning in October 2011, there was a steady rise in patients being detected with higher-risk prostate cancer. Why the change? Why were these men’s cancer not being detected sooner?

October 2011 is when the US Preventative Services Task Force (USPSTF) first recommended halting PSA testing in all men, at any age.

Two Key Facts

Dr. Schultheiss presented 2 Key Facts at the Genitourinary Cancer Symposium in Orlando in February 2014:

1) Starting in 2011, there has been a 3% increase every year in detecting men with intermediate or higher risk prostate cancer with “no evidence of a plateau.” This rise will continue.

2) The percentage of men age 75 or older who had a PSA greater than 10 ng/mL increased at a rate nearly double that of the overall population.

If You Don’t Screen for Prostate Cancer, the Horse May Be out of the Barn by the Time You Find It

I believe that the take-home message is that, as always, the US government agency (USPSTF) went too far in suggesting that no man should undergo PSA screening.  I think that family history, other medical problems, and results from a routine digital rectal examination on a yearly basis need to be factored into the decision of who gets screened and who does not.  For all patients, an open and informed discussion with your primary  care physician just may save your life.

“Where Hope Is” – Our Logo is still True Today

Where Hope Is

Where Hope Is

“WHERE HOPE IS” – OUR LOGO IS STILL TRUE TODAY

When I opened the doors at First Dayton Cancer Care in 2003 there was an air of excitement about the new center and the new technologies-and rightly so. I opened the center because I felt the people in Dayton deserve the best medical treatments offered anywhere in the world. I still believe that.

But I was quietly proud of our logo “Where Hope Is.” I have proven this yet again by bringing the CyberKnife Radiotherapy System to my clinic. Hope can now be restored for patients who had prostate cancer originally treated with standard radiation and now have a recurrence. Rather than years of hormone injections and lasting side effects, the CyberKnife offers a far superior treatment alternative.

WHEN PROSTATE CANCER RECURS AFTER STANDARD RADIATION                                     CYBERKNIFE MAY BE YOUR ANSWER

For many patients whose prostate cancer recurred after radiation, all is not lost. There are now real options- not just “observation” or “palliative” hormone treatments. Many patients go straight to years of hormone shots because there is the perception by urologists that there are no good local treatment options. And that “salvage radiation” is of use only after surgery. The side effects from years of hormone treatments can be devastating to a man’s quality of life.

But Dr. Donald Fuller, a pioneer in CyberKnife, reported on treating prostate patients whose cancer relapsed after IMRT, permanent seed implants and even proton therapy. The 2-year PSA control rate was 83%. And late side effects were minimal and occurred in fewer than 10% of patients-none involving the rectum (ASTRO meeting, 2014).

WHICH RECURRENT PROSTATE CANCER PATIENTS ARE ELIGIBLE?

The following criteria are factored into the medical decision to treat a recurrent prostate cancer patient with CyberKnife:

  1.   a history of prostate cancer treated with radiation
  2.  no complications higher than grade 1 from the previous radiation
  3.  recurrent prostate cancer confirmed by biopsy
  4.  greater than 2 years from prior radiation
  5.  no evidence of spread to lymph nodes, bone or other organs

 REAL HOPE 

Real hope is treatment in 5 visits or less. Real hope is better outcomes and fewer side effects. Real hope is no surgery, no incision, no pain. Real hope is exquisite precision due to real time tumor tracking. Real hope is little interruption to your daily life. Real hope is a better quality of life. Real hope is beating cancer. Real hope is the CyberKnife.

It is Reds Opening Day. Not all Baseball Traditions are Good.

Baseball’s Long SmokelessTobacco Tradition

Baseball and tobacco traditionally go hand and hand. With the start of baseball season, the debate is renewed. Last year’s passing of  legend Tony Gwynn renewed the debate about smokeless tobacco and its use by baseball players of all ages.

Smokeless tobacco is referred to as dip, snuff or chew and has been banned in dugouts in high school, college, and professional minor league baseball. However, while Major League Baseball (MLB) recognizes the harmful effects, it is not banned. New commissioner Rob Manfred and Tony Thurmond, a state assembly member in California, are both actively advocating for a culture change by asking the MLB Players Union for a ban. In 2011, with the urging from public groups such as the Campaign for Tobacco-Free Kids, the MLB opened a Tobacco Cessation Center that offers educational sessions to their players and staff about the dangers. They are hoping to break this long standing tradition associated with baseball.

Dr. Donald Marger, Oral, Head and Neck Cancer expert at First Dayton CyberKnife, explains that “the cancer causing chemicals in smokeless tobacco is no different than what is in cigarettes and pipes. While they will not contribute to your risk for lung cancer, there is still danger of cancers of the tongue, floor of mouth, throat, gums, cheeks and lips.” Oral, head and neck cancer affects 55,070 newly diagnosed Americans each year with approximately 12,000 deaths. Other health issues include severe dental problems and the terrible staining of the teeth.

Many MLB players and coaches claim to only use dip while in uniform. They say it is simply a habit and a way to relax and pass the time during a game. David Ortiz of the Boston Red Sox only puts snuff in his mouth while he is at bat. Others admit it is a terrible addiction that they simply cannot break and they wish they had never started.

“Cancer of the oral cavity, besides being potentially fatal, almost invariably results in marked physical deformity, swallowing problems, difficulty with speech and breathing. The primary treatment is radical surgery followed by radiation therapy”, explains Dr. Marger.

The debate is not whether dip is harmful ‑‑ clearly it is. The debate is whether or not we want our children looking up to their baseball all-stars and emulating their behavior. At the thousands of baseball fields around our country you see t-ballers chewing bubble gum, high schoolers spitting seeds and professionals spitting tobacco. Would it have made a difference to Tony Gwynn or the many other baseball players with these cancers if someone had told them to never start? Does it need to remain a part of America’s most beloved sport?

April is Oral, Head and Neck Cancer Awareness month. Our local Support for People with Oral and Head and Neck Cancer  will be offering screenings around Dayton the month of April. You will find Dr. Ed Hughes doing FREE screenings on April 18 at the Levin Family Foundation Celebrating Life Health Fair at Sinclair Community College.

Blog contributed by: Kathy Corbett of First Dayton CyberKnife