Category Archives: Prostate Cancer

4 Facts Senior Men Need to Know about 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.”

Quality of Life Matters when making decisions.

  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.”

  1. 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?”

  1. 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.”

  1. 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.

Politics, Patients, and Prostate Cancer

YOU OWE IT TO YOURSELF TO TALK TO YOUR DOCTOR ABOUT PROSTATE CANCER SCREENING

Whatever your politics, it’s true that ObamaCare came between you and your doctor in more ways than one.  Nothing says that more than the USPSTF decision to reverse its recommendation about PSA screening for prostate cancer.  USPSTF is a mouthful that stands for United States Preventative Services Task Force. 

USPSTF reversed its recommendation for PSA screening for prostate cancer for men 70 years and younger.  The USPSTF now says there is “at least a moderate certainty that the net benefit is small.”  Jamie Bearse, the CEO of ZERO, a patient advocacy group said “While the improved recommendation is a step in the right direction, there is much work to do.  We must undo a decade-long message that discouraged men from getting tested, and encouraged men to talk to the doctor about their risks and the test.”  In 2012, the USPSTF advised against all PSA testing in men of any age. 

But for men 70 years and older, I urge you to discuss PSA testing with your doctor.  Some risks are not so obvious.  For example, a history of breast cancer and ovarian cancer in your family may indicate a greater risk for prostate cancer in men.  Other factors are well-known.  African-American men have a greater risk of prostate cancer than white man.  And recent work from the Johns Hopkins University School of Medicine showed that 2/3’s of all prostate cancers are just due to chance or bad luck.  So it is not so simple as it seems.

 If you have any questions about PSA testing or treatment of your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  I guarantee that I will see you in consultation within 1-3 days of your phone call.

Prostate Cancer: Only You Know What’s Best for You

The Superior Precision of the CyberKnife allows for    Only 5 Treatments for Prostate Cancer.

It seems like a simple idea, doesn’t it?  Only you know what is best for you.  But for patients with prostate cancer, it may be a matter of life and death. 

Since I  treated our first patient with CyberKnife over 5 years ago, I have been more impressed with this breakthrough technology each and every day.  Yet there remains a lot of negative information out there in Dayton, even by healthcare professionals who should know better.  I suppose it can be chalked up to a doctor turf war.  But if you are the man with prostate cancer, you only want to do what is best for you.  And that means not only curing your prostate cancer, but also having a good quality of life afterwards.  By that I mean a life without urinary leakage and other embarrassing side effects.

SEEK YOUR OWN TRUTH 

I encourage men and their families to go out and dig up the information for themselves on their prostate treatment options.  I think it’s crucial for men with prostate cancer to take their time and talk to prostate cancer specialists, both urologists and radiation oncologists.  I would also ask the radiation oncologist how many different ways he or she can actually treat prostate cancer with radiation.  Do they have only one kind of technology?  At First Dayton CyberKnife I have more options than any other center in Dayton, including CyberKnife, IMRT, and temporary radiation implants. 

PROVEN RESULTS

A remarkable result for CyberKnife for men with low and intermediate risk prostate cancer was reported at the 58th Annual Meeting of the American Society for Radiation Oncology.

17 different CyberKnife centers studied the long-term results of 259 prostate cancer patients treated by CyberKnife.  The results were astounding.  At the 5-year mark, the prostate cancer free survival rate was 100% for low risk patients and 88.5% for intermediate risk patients.  At First Dayton CyberKnife, my results are even better.  At the 5-year mark our prostate cancer free survival rates were 98.8%.  And no patient had severe side effects requiring medical therapy or surgical therapy for complications. We have performed over 1,800 CyberKnife treatments.  

WHAT IS SPECIAL ABOUT THE CYBERKNIFE?

Why is prostate cancer treatment by CyberKnife better?  Simply put, CyberKnife is designed to deliver stereotactic ablative body radiotherapy or SBRT.  CyberKnife is given in 5 visits, with no pain and no cutting. There is no surgery. Plus with only 5 treatments instead of the standard 40, men can get back to living their normal life quicker.  

CyberKnife is breakthrough technology that delivers high doses of radiation with an extremely high degree of precision.  CyberKnife is the ONLY radiation device out there that has the unique capability of continually tracking your prostate cancer movement and automatically correcting for that movement in real time.  The prostate can move as much as 10 mm in as little as 30 seconds.  That exquisite precision is exactly how CyberKnife treats with 5 high doses of radiation without damaging surrounding organs, like the bladder and rectum.  

Dr. Donald Fuller in San Diego, the lead investigator of this study said “Outcomes from this long-term, prospective study reinforced that CyberKnife prostate SBRT is highly effective, with typically minimal side effects and impact on quality of life during and after treatment. It is important to note that nearly 90% of patients in the study were treated at community facilities across the United States, which may provide reassurance for men with localized prostate cancer that the results are achievable in their community setting.” 

If you have any questions about your prostate cancer diagnosis or treatment, please feel free to call me, Dr. Edward Hughes at 855-Dayton 1.  I guarantee that I will see you in consultation in 1-3 days.  And when you call us, you will speak to a real person, and not be put on hold or transferred to a call center.

CyberKnife: Beat Prostate Cancer Without Surgery

Only You Know What’s Best For You   

Seems like a simple idea, doesn’t it?  But it may not be so simple when you’re diagnosed with prostate cancer.  A lot of emotions come into play.  And there are so many choices. Your emotions tell you that you’ll be all better once the prostate is cut out of your body.  But it’s just not that easy. 

To the surprise of most men, the chance of recurrence at the site of surgery is an all too common problem.  That’s right.  Up to 20% of men following surgery need radiation because of rising PSA levels.  And it just doesn’t stop there.  After surgery, there may be embarrassing side effects like incontinence – leaking urine when you least expect it. 

The CyberKnife Solution 

With CyberKnife, there is no pain, no cutting.  CyberKnife is done as an outpatient in only 5 visits.  CyberKnife is not surgery at all.  CyberKnife is a highly specialized radiation machine that tracks your cancer continuously.  And it’s the only radiation machine out there that does so. 

What does this mean for you as a prostate cancer patient?  Better prostate cancer control and fewer side effects. 

The Proof Is In the Results 

Dr. Robert Meier of the Swedish Medical Center in Seattle was the lead investigator of the study of 309 men with newly diagnosed prostate cancer treated at 21 community, regional, and academic cancer centers across the United States.  The prostate cancer patients were treated with stereotactic body radiotherapy (SBRT), like that delivered by CyberKnife. 

The results were impressive:

1).  97% of men were free from prostate cancer progression at 5 years 

2).  Only 4 of 309 men had serious side effects.  And the side effects were usually temporary. 

At the 2016 Meeting of the American Society of Therapeutic Radiology and Oncology, Dr. Meier said “After following patients for more than 5 years, we found that serious side effects from a brief course of SBRT were uncommon and that cancer control rates were very favorable compared to historical data.” 

The First Dayton CyberKnife Difference 

I’m proud to report that prostate cancer control rates were a bit better at First Dayton CyberKnife. 

First Dayton CyberKnife’s Results (January 2012- September 2016):

1). 98.8% of men were free from prostate cancer progression at 5 years. 

2). 0 of 187  men had serious side effects.

First Dayton CyberKnife is the only SBRT machine in Dayton that continuously tracks the movement of your cancer.  It’s easy to understand that a lung cancer moves with your breathing.  But your prostate also moves as well during radiation.  With CyberKnife tracking, your continuous prostate tracking means less scatter radiation to your rectum and bladder.  And that means less side effects for you. 

Here the facts for yourself.  Only you know what’s best for you.  If you have any questions about your prostate cancer, I guarantee that I will see you in 1-3 days.  You be the judge.  Call me, Dr. Edward Hughes, at 855-Dayton 1

2017 New Year’s Resolution: Get a PSA Test

KNOW YOUR RISKS. Graphic credit econugenics.com

Turn on the radio or TV this month and prepared to be flooded with commercials for new diet plans and new exercise equipment, costing 100’s of dollars. 

But I’m asking that you spend $48 more wisely and get a PSA test for prostate cancer.  PSA screening for prostate cancer may just save your life, especially if you are a senior American man. 

PSA Screenings Work

When I first came to Dayton in 1994, routine PSA screening by your primary care physician had great results, like a 50% decline in prostate cancer deaths and a 70% decline in detecting stage IV prostate cancer diagnosis.  Diagnosis with prostate cancer metastasis or stage IV disease is treatable, but not curable. 

But in 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening in any American man, regardless of age. 

The Government Took Over

So what happened over the past 4 years?  For American men 75 years or older, 6.6% of men had metastasis or stage IV disease in 2004 compared to 12% in 2013.  There was a near doubling of men with stage IV disease only a few years after screening was halted for prostate cancer.  The rate of diagnosing senior American men with localized disease-intermediate or high-grade prostate cancer-also rose from 58% in 2004 to 72% in 2013.  Similar results were also seen in American men younger than 75 years. 

The study of over 1 million American men was reported in the January 2017 issue of JAMA Oncology. 

Take Back Control

What does this mean for you, your spouse, or significant other?  I’d ask your doctor pointblank about adding PSA testing to your routine yearly blood work panel.  PSA testing may not be covered by your insurance company, but the test cost only $48 at independent laboratories not affiliated with hospitals. 

The PSA blood test may just save your life.  Diagnosing prostate cancer at an early age, rather than an intermediate or advanced age, gives you more options and fewer side effects. 

Take control of your own prostate health.  Call me, Dr. Edward Hughes, at 855-DAYTON1 about the diagnosis and treatment options for prostate cancer.  I guarantee that I will see you 1-3 days after your call.  No other cancer center in Dayton makes that promise.

Radiation After Prostatectomy: More Common Than You Think

Rising PSA after prostatectomy means trouble.

A rising PSA level after prostatectomy, even robotic surgery, is more common the most men think. In fact, each year over 20,000 American men need so-called “salvage” radiation therapy in an attempt to cure men with prostate cancer who have a “biochemical failure” or an increasing PSA level after surgery. 

A number of clinical trials have shown that “salvage” radiation  therapy reduces PSA levels and also spread to lymph nodes and bone. Radiation should be done after surgery for prostate cancers as soon as the PSA levels start to rise.

In the landmark Mayo Clinic study of 1,427 men whose prostate surgery failed, showed that each doubling of the PSA after surgery increased the cancer-specific death by 40% (Stish BJ et al. J Clin Oncol  2016; August 1). These men had surgery alone and it was not successful. As their PSA levels continued to rise, so did their death rate.

So what this is mean for men whose PSA levels start to climb after prostate cancer surgery?  I believe that the Mayo Clinic results speak for themselves and are clear-cut. “Salvage” radiation therapy should be started as soon as possible after the PSA reaches 0.4 ng/mL. If men wait for that PSA to double once more, their chance of dying from prostate cancer increases by 40%. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.

LOW-FAT DIET AND WATCHFUL WAITING FOR PROSTATE CANCER

Many men with early-stage, less aggressive prostate cancer are now opting for active surveillance or watchful waiting.  But in my opinion, the focus should be on the active part of active surveillance and not just watching and waiting around to see your PSA go up.  And in my opinion, active means focusing on diet and exercise. 

So why should men change?  Because study after study now suggest that low-fat eating, along with exercising and reducing stress, can stop or reverse the progression of prostate cancer in its early stages. The research was spearheaded by Dr. Dean Ornish of the University of California at San Francisco, best known for using the same approach in treating coronary heart disease. 

Although the studies were small, the results were huge.  By eating a low-fat diet, PSA levels actually decreased after only a few months.  And in another Dr. Ornish study, the low-fat diet, along with exercise and stress reduction, actually changed the way cancer genes behaved. Remarkably, the low-fat diet switched on tumor killer genes and turned down tumor promoter genes. 

Dr. Ornish told the prestigious journal Scientific American, “We found that simple changes have a powerful impact on our gene expression…Genes may be our predisposition, but they are not our fate.”  Read More Here

So what is good for prostate cancer treatment is usually good for prostate cancer prevention.  If you have prostate cancer, or if your spouse or significant other has a risk of prostate cancer, I would take a careful look at the Dr. Dean Ornish program on the internet.  And you’ll also lose weight and help prevent heart disease. Talk about a win-win program.  There is a lot of good stuff on the Dr. Ornish website. 

If you have any questions about your prostate cancer, please call me, Dr. Edward Hughes, at 855-DAYTON1.

Watch this TED Talk by Dr. Ornish as he discusses the importance of lifestyle and disease.

 

The Cyber Knife Breaths with You

Dr. Hughes explains how the Cyber Knife is used to treat cancers such as lung, prostate, kidney, brain, spine and many others. Not only can we control the radiation beam to mere millimeters, the real time imaging allows the Cyber Knife to track the tumor to ensure that we target only the cancer. It actaully breaths with our lung cancer patients.  It follows the motion of the prostate. It sees into the brain during treatment. There is NO other radiation treatment that can do this. Watch!

Prostate Cancer Watchful Waiting-Success or Failure?

Know the whole truth about watchful waiting.

Know the whole truth about watchful waiting.

Are you contemplating ‘watchful waiting’ for your early stage prostate cancer? Does your family practice or internal medicine doctor have all of the details or just the headlines?  Sometimes this strategy can be a big gamble. The roll of the dice can lead to no progression of your disease or painful spread of the disease.

The September 14, 2016 issue of the prestigious New England Journal of Medicine published an article that showed that survival at 10 years was nearly identical for men who elected watchful waiting compared to those who had surgery or radiation therapy.  Nonetheless, the devil is in the details.  The results clearly showed that those men who elected watchful waiting had a higher likelihood of metastasis or spread to the bone compared to those men who underwent surgery or radiation therapy.

“The clinical significance of this finding is that with the use of active monitoring, more men will have metastasis and the side effects of salvage treatment (meaning at least lifelong intermittent androgen deprivation therapy), which are not inconsequential,” wrote Dr. Anthony D’Amico, chief of genitourinary radiation oncology at the Dana-Farber Cancer Institute in Boston.

From my point of view, there are pluses and minuses to watchful waiting.  But in Dayton, Ohio many physicians simply read the headlines of the article without carefully looking at the details of watchful waiting. In my experience, few men and their doctors follow  the guidelines that have been published concerning watchful waiting.

For example, Dr. Laurence Klotz from Toronto critically analyzed the outcomes of watchful waiting for men with low to intermediate risk prostate cancer.  Dr. Klotz reported his findings at the May 2016 meeting of The American Urologic Association.  Dr. Klotz found that the risk of prostate cancer death at the 15 year mark was only about 5%.  Dr. Klotz protocol is one of the most generous compared to the protocol from Johns Hopkins.  In fact, only 20% of men who present with prostate cancer would qualify for the Hopkins protocol compared to 50% in the Toronto protocol.

The Toronto protocol calls for the following for men with Gleason score 6 or lower prostate cancer with so called non-extensive disease or low percent of positive biopsies. The current protocol that Dr. Klotz adopts is:

  • Eligibility: Most men with Gleason score 6 prostate cancer or lower, and a PSA less than 15 ng/ML.
  • Workup: MR scan and targeted biopsies are done for all men with high-volume Gleason score  6 prostate cancer
  • Follow-up: PSA every 6 months
  • Confirmatory biopsy or MR scan within 1 year.  If the MR is negative and there is a low risk disease, biopsy is optional.
  • Repeat MR/biopsy every 3-5 years until age 80.

In my experience in Dayton, Ohio few men have insurance coverage for MR scans and even fewer will submit to repeat biopsies.

So if you elect watchful waiting, you need to know the real risk of recurrence.  That is to say, just getting a PSA every 6-12 months will not cut it if you truly want to catch prostate cancer early and avoid spread to bone.

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.

The First Dayton Cyber Knife Difference-Prostate Cancer

Treatment with the Cyber Knife is painless.

Cyber Knife treatment is painless and it only takes 5 treatments that can take less than 1 hour. Men do not even have to undress for the treatment; it is that simple.

First Dayton Cancer Care began treating prostate cancer patients in 2012 with the Cyber Knife Stereotactic Radiation Therapy System. Since that time, we have performed over 2,500  treatments.  Our physicians have over 30 years of experience treating prostate cancer with a wide range of treatment systems. They have seen for themselves the dramatic difference treatment with the Cyber Knife makes a man’s quality of life and survival.

Discover the First Dayton Difference:

  • 98.8% PSA control rate on our very own patients since 2012.
  • Cure Rates are as good as surgery, but without painful cutting and surgical side effects.
  • Better Quality of Life by lowering risk of embarrassing side effects.
  • Cyber Knife is the ONLY real-time motion tracking radiation system, killing the cancer while sparing health tissue and organs.
  • Drive yourself to and from treatment in just 5 visits. No hospital stays.
  • Everyone has front row parking.
  • Continue to work.
  • Visit with our physicians within 1-3 days of your phone call.

If you have any questions about your prostate cancer, call me, Dr. Ed Hughes at 1-855DAYTON1.