Monthly Archives: February 2016

Computers Helped Save My Life

The Cyber Knife can give 300+ beams of controlled radiation to a lung tumor, all while the patient breathes normally.

The Cyber Knife can give 300+ beams of controlled radiation to a lung tumor, all while the patient breathes normally.

 

“I have cancer growing inside of my lungs. I can’t see it. I can’t touch it. But I know that it is there,” shares John, a computer technologist from West Chester.

John states that the doctors have shown him the medical images of his lungs so that he could see his cancer. “Even though I have seen it in CT scans and MRI’s, it is still hard to believe. I thought that my increased congestion was due to allergies. I work with computers all day long, but now computers are helping to save my life.”

In addition to the advanced medical images that diagnosed John’s cancer, the treatment that he chose is also possible because of the advances in computer technology. Surgery was not an option for John because it would have damaged the healthy tissue and was close to his heart. He chose to have radiation therapy with Dr. Ed Hughes instead.

“The fact that we can now use advanced computer imaging during John’s treatment to actually see inside his lungs; has been the biggest medical breakthrough in my 35 year career”, explains Hughes. The CyberKnife’s computers actually track the motion of John’s breathing so that it can deliver the radiation with sub-millimeter precision to only the cancerous tissue.

“Knowing that the doctors could see inside my lungs and that the CyberKnife was so precise and so accurate, helped me to relax. I work. I support my wife and 3 kids. I was not only afraid for my life, but afraid to take off work to recover”, says John. He was able to have 3 CyberKnife treatments that lasted less than an hour. He was able to keep working and was able to keep up with his active family.

It has been 14 months since his CyberKnife treatments and he is now cancer free.

John shares his enthusiasm, “I have always loved computers. They have fascinated me since I was a teenager and now they have saved my life.”

This was originally posted in July of 2014. John is still cancer free thanks to Dr. Hughes and the Cyber Knife. If you want help like John, call Dr. Hughes today.

Prostate Cancer- The Government Did Make it a Federal Case

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

Is  “Watchful Waiting” the best approach for Your Prostate Cancer? There is now a genetics test that can help answer your question.

1. PSA Screening Declines Following Government Mandate 

In late 2011, the US Preventative Service Task Force (USPSTF) recommended against routine PSA screening to detect prostate cancer in men without symptoms.  A new study from the Brigham and Women’s Hospital at Harvard, authored by Dr. Michael Zavaaski and colleagues, analyzed 27 million primary care visits by men ages 50-74 years old.  The major finding was a 57% drop in PSA screening by primary care physicians compared to only 4% in PSA testing by urologists.  Their study was published in the February 8, 2016 issue of JAMA Internal Medicine.  Dr. Zavaaski’s study compared PSA testing from 2010-2012, before and after the USPSTF guidelines were issued.  So it appears that primary care physicians really took the Federal government’s recommendation to heart.

Although I believe these results are dramatic, Medicare or CMS is now considering actually imposing a penalty on doctors who order PSA tests that do not meet the Federal government’s standards.  Certainly this is an unprecedented action and represents a very slippery slope for doctors as well as patients.  My fear is that the bed rock of medical practice-the concern and loyalty of a doctor to his or her own patients-will be trampled upon by the Federal government.  Doctors will now be judged and paid not by attention and concern for the individual patient sitting in front of them, but rather by how doctors treat “populations of patients.”  This is a profound shift in the doctor-patient relationship.  And it is already in Dayton, Ohio.  I just smiled when I received a request from one of the region’s hospitals to attend a new seminar entitled “Treating Populations of Patients in the Future.” To me patients are people, not ‘populations’.

2. Breakthrough Genetic Testing May Help You Choose the Best Prostate Cancer Treatment for You 

For those men who already have been diagnosed with prostate cancer, hope is on the way.  A number of genetic tests on the prostate cancer itself can help you and your cancer specialists judge whether you need treatment or not.  Once such test is the Oncotype DX prostate test.  The Oncotype score can be added to cancer stage, PSA level and Gleason score to help estimate how likely your prostate cancer is to spread to bone-a fatal complication.  I think the Oncotype adds key information that can help you decide whether a watch and wait approach is good for you.

Dr. Evans and colleagues looked at the genetic profiles over 1000 prostate cancers in men with high risk features.  Their study showed a number of genes responsible for DNA damage and repair may be used to help select those patients who need more than standard surgery or radiation-options like adding chemotherapy or hormonal therapy or both.  Their study was published in the Journal of the AMA Oncology January 7, 2016 issue.

And don’t forget-not all men have early-stage prostate cancer.  Now that routine PSA screening has declined, many patients are referred to urologists and radiation oncologists with high risk prostate cancer.  Men at high risk are those with a Gleason score 7 prostate cancer and a PSA of greater than 10 ng/ML or a Gleason 8-10 prostate cancer regardless of PSA level.

So What’s a Man to Do? 

From my experience as a cancer specialist as well as the patient, no man looks forward to the annual digital rectal exam.  Or even a needle stick in the arm for routine blood work.  But I would not be so quick to throw out either test so fast, despite what the Federal government says.  I still may be a “true believer” but I still hold that my job, my obligation if you will, is to the patient sitting in front of me, and not to the Federal government.  If my brother or father had prostate cancer, I would certainly be tested with PSA and undergo a yearly digital rectal examination. As a cancer specialist, it is remarkable to me that Medicare wants to halt PSA testing while, in the next breath, President Obama is launching a new “Moon Shot” in the war against cancer.  With all the talk about precision medicine, I hope that personalized medicine-putting the patient first and foremost-is not forgotten altogether.

If you have been denied a PSA and think you need one; or you have an elevated PSA and are not sure if watchful waiting is best for you, give me a call to set up a visit at 855-DAYTON1

 

THE 2 KEY FACTS YOU NEED TO KNOW ABOUT RECTAL CANCER TREATMENT

 

While colo-rectal cancer rates are on the rise in the US, the death rates are decreasing.

While colon-rectal cancer rates are on the rise in the US, the death rates are decreasing.

Rectal cancer patients now have a BETTER choice – 5 days of radiation before surgery is just as good as 6 weeks of radiation treatment.  Dr. Smitha Krishnamurthi, a medical oncology expert at Case Western Reserve University in Cleveland said the approach “is shorter, more convenient and less expensive… and appears equally active.”  She commented at the recent GI Cancer Symposium 2016 held in San Francisco. 

In the first key study, 515 patients with locally advanced rectal cancer – cancers too extensive to operate on right away – were given radiation and chemotherapy before their operations. Randomly assigned by computer, half of the patients were to have short course 5 day radiation and the other half were given standard radiation therapy of 28 treatments over 6  weeks.  All the patients also received chemotherapy.  Surgery was scheduled 3 months after starting radiation therapy. 

And the results with short course radiation over 5 days were outstanding.  The survival was the same in the  5 day radiation group as compared to the 6 week group.  But the short course group with 5 days of radiation had significantly fewer side effects. The short course has been  the standard of care in European and Scandinavian countries over the past decade. 

Does Radiation Increase the Risk of a Second Cancer?

At the 2016 GI Cancer Symposium, the second key study was that radiation for rectal cancer did not increase a patient’s risk for a second cancer.  In fact, radiation possibly offered some protection.  “These results were very striking,” said Dr. Claus Roedel, Chairman of the Department of Radiation Therapy and Oncology at the University of Frankfurt in Germany. Dr. Roedel went on to mention another study of almost 21,000 patients with rectal cancers in the US.  There was no increase in the risk for second cancer in patients who received radiation therapy compared to those who received no radiation therapy. 

First Dayton Cancer Care – Dayton’s Leader and Pioneer in Short Course Radiation

Since opening in 2003, the stated mission of First Dayton Cancer Care is to deliver the best in radiation medicine over the shortest  amount of time – but only when the radiation treatment is equally as effective as longer course radiation.  And we have over a decade of experience in short course radiation for a number of different cancers. 

Cyber Knife

           Lung cancer treatment in 3 to 5 visits

           Prostate cancer treatment in 5 visits

           Brain cancer treatment in 1 to 3 visits

Leipzig superficial Radiation

           Skin cancer treatment in 6 to 10 visits over 2-3 weeks

High-dose Rate Brachytherapy

            Breast cancer treatment in 1 week

             Locally advanced prostate cancer in 5 weeks

If you have any questions, please feel free to call me, Dr. Edward Hughes, at 855 Dayton1.  I guarantee that I will see any patients within 1-3 days of their phone call.   

 

Cyber Knife: Real Hope for Men with Recurrent Prostate Cancer

Men with recurrent prostate cancer after radiation still present a challenge even in 2016.  It’s a

Dr. Hughes has a very powerful tool to treat recurrent prostate cancer- The Cyber Knife

surprising fact that the vast majority of men are offered only one option-androgen deprivation therapy (ADT). ADT is a polite term for medical castration.  ADT is given by injection and carries a few side effects that may have a major impact on a man’s quality-of-life.  Some of the side effects include loss of sex drive, impotence, loss of muscle mass, loss of bone mass, mild increase in size and tenderness of a man’s breasts, and increased cholesterol.

In a major study, Dr. Tran found 98% of men with recurrent prostate cancer after previous radiation therapy – recurring in the prostate only and not in the bones – were offered ADT or medical castration as their only option.  Dr. Tran’s study was published in 2014 in Urol Oncol. 32, 701-716.

It’s not surprising to me that all of the alternate treatments were invasive, hospital-based procedures needing anesthesia. Treatments like salvage radical prostatectomy, cryosurgery or freezing the prostate, and even re-seeding the prostate with permanent radiation implants.

Cyber Knife: Now A Proven Option

So what is Cyber Knife?  Simply put, Cyber Knife is not surgery at all but a highly specialized form of radiation treatment.  It’s just as effective as surgery but with no cutting or pain.  In fact, it’s noninvasive and done on an outpatient basis.  Cyber Knife treatment takes just 5 visits over one week.  And men can drive themselves to and from the visit. Men don’t realize that the prostate is constantly moving. The Cyber Knife is the only radiation machine that has motion tracking that adjusts to this movement, allowing for highly targeted radiation beam delivery. This accuracy spares the normal surrounding tissues like bladder and rectum, virtually eliminating most side effects.

Cyber Knife treatment not only greatly improves a man’s quality of life by reducing life altering side effects, but the long term success rate is very high. Very few men had their prostate cancer return or spread to the bone.

Dr. Donald Fuller and his coworkers in San Diego treated men with locally recurrent prostate cancer with Cyber Knife.  And the results were outstanding.  The prostate cancer was gone in 82% of men within 2 years. The PSA levels decreased to an average of 0.16 ng/ML.  And none of the men needed hormone therapy (ADT). Dr. Fuller’s  study was published in late 2015 in Practical Radiation Oncology 5, e615-623.

In Dr. Fuller’s study, the vast majority of men with locally recurrent prostate cancer were previously treated with 3D conformal, IMRT, or proton therapy.  And most of the men had Gleason 7 prostate cancers.  Importantly, serious side effects were few, mostly confined to the bladder. There were no serious side effects on the rectum. In contrast, many patients who undergo salvage radical prostatectomy may need a permanent colostomy bag.

So What Is a Man with Recurrent Prostate Cancer after Radiation to Do?

Instead of undergoing medical castration for the rest of your life or even surgical castration, I believe that recurrent prostate cancer patients need to take a good look at Cyber Knife.  At First Dayton Cancer Care, we have performed hundreds of Cyber Knife procedures for our prostate cancer patients.  First Dayton Cancer Care is the only center in Southwest Ohio that has long-term experience with Dr. Fuller’s special planning technique for recurrent prostate cancer.

If you have any questions, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.  I guarantee that I will see you within 1-3 days of your call.