Monthly Archives: July 2015

The Watch and Wait Approach Early Stage Prostate Cancer

It’s Not As Easy Of A Decision As You May Think 

There’s not a week that goes by in my clinical practice when I don’t talk with prostate cancer patients about their options – surgery, radiation, or “watchful waiting.”  Most patients are surprised that there are no “national standards” for watchful waiting.  But most prostate cancer specialists offer watchful waiting to men with a Gleason score of 6 and a PSA of less than 10 mg/mL, along with a prostate cancer that appears to be contained within the prostate capsule.

Is "Watchful Waiting" the best approach for Your Prostate Cancer?

Is “Watchful Waiting” the best approach for Your Prostate Cancer?

 But a recent study, published in the August 2015 issue of the Journal of Urology, may change all that.  Dr. Paul Nguyen and co-workers from Harvard studied 10,273 man diagnosed with so-called “low risk” prostate cancer in 2010 and 2011.

 The surprising finding was that nearly half of the men (4,467 patients) had worse disease found at time of surgery.  In fact, most of the patients were found to have more aggressive, Gleason 7 prostate cancers.  And 10% of men (992 patients) had their tumor stage increased at the time of surgery, with almost all of these patients having prostate cancer extension through the capsule itself.

What Does This All Mean for the Patient With Early Stage Prostate Cancer?

Dr. Paul Nguyen at Harvard did all of us a real favor by “drilling down” to the nuts and bolts of the possible winners and losers who are thinking about the “watchful waiting” approach. Their study found 3 key factors associated with upgrading and upstaging of so-called “low risk prostate cancers.”

The 3 key factors are:

 1. Age greater than 60 years

 2. PSA greater than 5 ng/mL

3.  Greater than 25% positive biopsies

To put new facts into perspective, a 65 year-old man with a PSA of 8 ng/ML and 2 of 6 positive core biopsies has a 60% chance of having higher grade, more aggressive prostate cancer.

The new study makes the decision for “watchful waiting”  in early stage prostate cancer patients a bit less clear.  Other ways to look at the prostate, such as MRI scans, may be helpful but are in the early stages of development.

If you want more information about your prostate cancer, call me Dr. Edward Hughes at 855-DAYTON1.

 

Weight Loss in Head and Neck Cancer Patients: It’s Not Just the Cancer That Can Kill You

It’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected

At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week.  I tell them that the big battle ground will be nutrition.  I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose.  After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”

Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function.  Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604).  The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths.  Even if they are first cured of their cancer.

My clinical instinct over the years was that nutrition was one key to survival.  But I never thought that weight loss in cancer patients could affect their hearts to such an extent.  If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not.  So much more medical work and research is needed here.

Don’t get me wrong.  The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade.  But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.

 Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think

 Diagnosing muscle loss seems easy, doesn’t it?  Plain and simple.  Just have the doctor or nurse weigh you and examine you.  And taking a good medical history may help.  But it’s not just that easy.

As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women.  That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia.  In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass.  I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.

                                                                 CANCER CACHEXIA =

3 or more symptoms                                    +                    Weight Loss > 5% within 12 months

  • Fatigue
  • Loss of Appetite
  • Decreased Muscle Strength
  • ↑CRP or ↓ Albumin
  • Low Fat-Free Muscle Mass on CT Scan
 So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?

First and foremost, be upfront and honest with your head and neck cancer specialist.  Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite.  Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.

The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common.  But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.

So much more time and money for medical research into cachexia is long overdue.

 

Cyber Knife For Early Stage Lung Cancer: Ready for Prime Time and Beyond

So What’s Up with the Newest Study?

Researchers once a again showed that Cyber Knife is a superior choice for early stage lung cancer patients. In a landmark study recently published in The Lancet Oncology, physician-researchers reported that early stage lung cancer patients treated with stereotactic ablative body radiotherapy (SABR for short), like that delivered by

Treatment with the Cyber Knife is painless.

Treatment with the Cyber Knife is painless.

Cyber Knife, had a 3 year overall survival of 95%.  Surprisingly, early stage lung cancer patients fared much worse with open surgery (lobectomy) with a 3 year overall survival of only 79%.  Cyber Knife treatment stands in stark contrast to lobectomy.  Cyber Knife is a highly specialized form of radiation therapy done on an outpatient basis in 3-5 visits, with no pain and no incisions.  Lobectomy on the other hand is a major operation where surgeons open the chest and remove an entire lobe of the lung, requiring a prolonged hospital stay with all the risks of chest surgery.

Importantly, there were 6 deaths in the surgery group and only one death in the SABR group (The Lancet Oncology June 2015 16(6) 630-637).

Dr. Joe Y Chang, a professor radiation oncology at the world-famous M.D. Anderson Cancer Center said “For the first time, we can say that the 2 therapies are at least equally effective, and that stereotactic ablative radiotherapy appears to be better tolerated and might lead to better survival outcomes for these patients.”

Admittedly, The Lancet Oncology study was small, but the results were stunning as these patients were healthy enough to undergo surgery.  Previously, the majority of early stage lung cancer patients treated by SABR, like that delivered by Cyber Knife, were “medically inoperable” or too sick for surgery. But the patients in the The Lancet Oncology study were part of “randomized trials” whereby patients are selected for surgery or SABR based on a computerized flip of the coin, not by their physicians.

But Can Only 1 Study Change How we Treat Lung Cancer?

This is not the only study that shows that treating early stage lung cancer with the Cyber Knife is far superior to surgery. The Lancet Oncology results complement those reported in a much larger group of early stage lung cancer patients.  Dr. Shirvani and coworkers looked at 9,093 patients with early stage lung cancer who were treated by lobectomy, wedge resection (more limited surgery) or SABR between 2003 to 2009 in the SEER-Medicare database (JAMA Surg Dec 2014 49(12) 1244-1253).

The key fact was that lobectomy was better than wedge resection but SABR appeared to be just as good as lobectomy.

So Why Is This Important for Patients and Physicians to Know?

Modern medicine is keeping people alive longer.  Coupled with advances in lung cancer screening, more and more senior patients will be found with early stage lung cancers.  I believe these studies are telling us that Cyber Knife is a good solution as compared to open surgery. And a solution that does not require a major operation.  No incisions, no pain, and no prolonged hospital stays with a difficult recovery.  By contrast, Cyber Knife is done as an outpatient in 3-5 visits. The patient does not feel anything during treatment. It is painless and quick. All that is required is to lay on a table listening to music.

For more information about early stage lung cancer and Cyber Knife treatments, call me today, Dr. Ed Hughes, at 855-DAYTON1 or email me at info@FirstDaytonCancerCare.com

 

Cyber Knife For Early Stage Lung Cancer: Ready for Prime Time and Beyond

So What’s Up with the Newest Study?

Treatment with the Cyber Knife is painless.

Treatment with the Cyber Knife is painless.

Researchers once a again showed that Cyber Knife if a superior choice for early stage lung cancer patients. In a landmark study recently published in The Lancet Oncology, physician-researchers reported that early stage lung cancer patients treated with stereotactic ablative body radiotherapy (SABR for short), like that delivered by Cyber Knife, had a 3 year overall survival of 95%.  Surprisingly, early stage lung cancer patients fared much worse with open surgery (lobectomy) with a 3 year overall survival of only 79%.  Cyber Knife treatment stands in stark contrast to lobectomy.  Cyber Knife is a highly specialized form of radiation therapy done on an outpatient basis in 3-5 visits, with no pain and no incisions.  Lobectomy on the other hand is a major operation where surgeons open the chest and remove an entire lobe of the lung, requiring a prolonged hospital stay with all the risks of chest surgery.

Importantly, there were 6 deaths in the surgery group and only one death in the SABR group (The Lancet Oncology June 2015 16(6) 630-637).

Dr. Joe Y Chang, a professor radiation oncology at the world-famous M.D. Anderson Cancer Center said “For the first time, we can say that the 2 therapies are at least equally effective, and that stereotactic ablative radiotherapy appears to be better tolerated and might lead to better survival outcomes for these patients.”

Admittedly, The Lancet Oncology study was small, but the results were stunning as these patients were healthy enough to undergo surgery.  Previously, the majority of early stage lung cancer patients treated by SABR, like that delivered by Cyber Knife, were “medically inoperable” or too sick for surgery. But the patients in the The Lancet Oncology study were part of “randomized trials” whereby patients are selected for surgery or SABR based on a computerized flip of the coin, not by their physicians.

But Can Only 1 Study Change How we Treat Lung Cancer?

This is not the only study that shows that treating early stage lung cancer with the Cyber Knife is far superior to surgery. The Lancet Oncology results complement those reported in a much larger group of early stage lung cancer patients.  Dr. Shirvani and coworkers looked at 9,093 patients with early stage lung cancer who were treated by lobectomy, wedge resection (more limited surgery) or SABR between 2003 to 2009 in the SEER-Medicare database (JAMA Surg Dec 2014 49(12) 1244-1253).

The key fact was that lobectomy was better than wedge resection but SABR appeared to be just as good as lobectomy.

So Why Is This Important for Patients and Physicians to Know?

Modern medicine is keeping people alive longer.  Coupled with advances in lung cancer screening, more and more senior patients will be found with early stage lung cancers.  I believe these studies are telling us that Cyber Knife is a good solution as compared to open surgery. And a solution that does not require a major operation.  No incisions, no pain, and no prolonged hospital stays with a difficult recovery.  By contrast, Cyber Knife is done as an outpatient in 3-5 visits. The patient does not feel anything during treatment. It is painless and quick. All that is required is to lay on a table listening to music.

For more information about early stage lung cancer and Cyber Knife treatments, call me today, Dr. Ed Hughes, at 855-DAYTON1 or email me at info@FirstDaytonCancerCare.com