A Rise in PSA Can Be A GOOD Thing after CyberKnife Treatment for Prostate Cancer

Men who undergo CyberKnife treatment become keenly aware of their bodies’ functions-and very aware of any change in their PSA levels.

For most men, the PSA level continues to get lower after CyberKnife treatment, gradually falling even after 5 years.  But in some men, about 1 in 5, the PSA abruptly goes up and then back down.  This rapid rise and fall in PSA is called “the PSA bounce,” and usually happens about 1 ½ to 2 years after radiation treatment.

Prostate cancer specialists speculate that “the PSA bounce” is an inflammatory response after radiotherapy, but we really don’t know for sure.  “The PSA bounce” certainly causes a lot of worry both for the patient as well as their doctor.

But the good news is that those men who go through “the PSA bounce” actually do better and survive longer cancer free.  This good news was recently published by Dr. Michael Zelefsky and his co-workers in the September issue of the Journal of the American Society for Radiation Oncology (ASTRO).  With this extensive study, prostate cancer patients and their doctors can rest easier if they should see the “PSA bounce”

If you have any questions about your prostate cancer diagnosis and its treatment, feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.  I guarantee that I will see you in 1-3 days of your call.

10 Year Results Prove CyberKnife Provides Excellent Results for Prostate Cancer

Recently published data from a prospective study of 230 men with low-risk prostate cancer showed 98.4% had local disease control 10 years after receiving stereotactic body radiation therapy (SBRT) administered with the CyberKnife system, and toxicity was mild.

“This is a groundbreaking study—the first to report on the efficacy and toxicity of SBRT in the treatment of low-risk prostate cancer following 10 years of treatment,” says Alan Katz, MD, of Flushing Radiation Oncology. “All patients participating in the study were treated with the CyberKnife system, which delivers extremely precise radiation treatments using unique, real-time image guidance and automatic motion correction. The study outcomes were excellent both in terms of disease control and tolerability, and were superior to long-term conventional intensity-modulated radiation therapy, based on results from other studies.”

Study participants completed their entire treatment in just five daily sessions, compared to conventional radiation therapy which typically takes 30 to 40 sessions. Additional 10-year outcomes showed:

  • The disease free survival rate was 93.7%, indicating there were no signs or symptoms of the cancer during the evaluation period;
  • The median prostate specific antigen value was 0.1 ng/ml. A low PSA value is associated with a reduced risk of cancer recurrence or metastases; and
  • Patient-reported bowel and urinary function scores showed initial declines that recovered to baseline where they remained throughout the remainder of the study period.

The prostate gland can move unpredictably throughout the course of treatment, making the ability to track, detect, and correct for motion critically important. Throughout the course of treatment, the CyberKnife system continually collects images to determine exactly where the tumor is, ensuring that clinicians deliver radiation exactly where they want it. The system detects the tumor motion and automatically adjusts the radiation beam in real time to match the motion of the tumor, giving clinicians confidence to apply smaller treatment margins and enabling higher doses and fewer treatments.

“Following early stage prostate cancer diagnosis, men have a variety of treatment options from which to choose,” says Fabienne Hirigoyenberry-Lanson, vice president of global medical and scientific affairs at Accuray. “CyberKnife prostate SBRT is increasingly being selected by men with low- or intermediate-risk disease who opt for treatment with radiation therapy. This new CyberKnife research adds to the most extensive compendium of published prostate SBRT studies available in the industry.”

Dr. Edward Hughes of First Dayton CyberKnife’s results are even more promising with disease free survival rate of 98% at the 5 year mark. Dr. Hughes expects his patients’ 10 year results to surpass those in this study. The improved outcomes are a result of radiation treatment planning done by his Medical Physicist, Matt Kolasa. Planning is individualized for each patient to spare the healthy tissue while targeting the cancer.

Reference

1. Katz A. Stereotactic body radiotherapy for low-risk prostate cancer: a 10-year analysis. Cureus. 2017; doi: 10.7759/cureus.1668.

BREAST CANCER: SIZE MAY NOT MATTER

Genetic testing shows aggressiveness of even small breast cancer tumors. It was once thought the smaller the more benign, we know that is not always the case.

The decision to treat breast cancer patients with chemotherapy used to be easy, didn’t it?  Breast cancer patients whose tumors were small didn’t need chemotherapy.  Or maybe just hormonal therapy.

But the biology of an individual woman’s breast cancer may change  all that.  We’re now in the age of “precision medicine.”  To put it another way, your breast cancer specialist may now be able to custom tailor your treatment to your specific breast cancer’s genetic makeup.

ARE SMALL TUMORS LESS DANGEROUS?

In the study of 6,693 women in Europe, a total of 826 breast cancer patients had very small (less than 1 cm) breast cancers and no spread to the lymph nodes.  By use of a special genetic test (called MammaPrint) on the breast cancer itself, the doctors were able to identify 23.7% of women who were “low risk” by the old criteria but “high risk” by the new genetic test.  The key result was that the “high risk” breast cancer patients with small cancers did better on chemotherapy.  In fact, the 5 year survival rate was 98.5% with chemotherapy, but only 95.8% without it in those women who were “low risk” by the old criteria but “high risk” by the MammaPrint genetic test.

The results of this clinical trial (called MINDACT) was recently reported in the September 2017 meeting of the European Society for Medical Oncology held in Madrid, Spain.  Dr. Evandro de Azambuja of The Jules Bordet Cancer Institute in Brussels commented on the study and said “Small, node-negative tumors can be very aggressive, even if they are classified as low clinical risk.  Tumor biology needs to be taken into account when deciding adjuvant treatments in this patient population.”  And Dr. Konstantinos Tryfonidis, the senior author of the MINDACT trial, of the European Organization for Research and Treatment of Cancer in Brussels said “Our results challenge the assumption that all small tumors are less serious and do not need adjuvant chemotherapy.”

If you have any questions about the treatment of your breast cancer -with chemotherapy, hormonal therapy, or radiation therapy- please feel free to call me, Dr. Edward Hughes, at 855-Dayton1.  I guarantee that I will see you in 1-3 days.

COMPLETING RADIATION FOR THROAT CANCER IS CRUCIAL-YOUR LIFE DEPENDS ON IT

Our dedicated experts will help you get through treatments. Your life depends on it.

Each and every week I hear the same questions from my patients with cancer of the head and neck. “Doctor, do I really need to have all 33 treatments? This is really hard. Haven’t we done enough? Can’t I just quit?”

My answer is almost always the same. “It’s not a good idea. You’ve come this far. Quitting now  puts your chances of a cure at risk. You really need to complete every one of the treatments.”

Now there is an important study that supports my answer. In the study of 8.388 Medicare patients with advanced cancer of the throat or larynx (voice box), the important result was that patients who did not complete chemotherapy and radiation therapy did worse than patients who did. Much worse, in fact.

The second important finding was the patients who completed chemotherapy and radiation therapy did just as well as those patients who had surgery. The surgery for advanced larynx cancer is called a laryngectomy that involves removing the voice box permanently. The study was published about one year ago in the prestigious journal titled Cancer.

So finishing those last few treatments of chemotherapy and radiation therapy-admittedly the hardest part of the process-really is important for your survival. It’s also the time where an experienced radiation doctor and support team, including the chemotherapist, radiation therapists, swallowing therapist and oncology nurses- are really crucial. The management of side effects is key. This is why having a dedicated team of experts who focus on you is so important to me as a physician.

If you have any questions about your head and neck cancer, please feel free to call me, Dr. Edward Hughes at 1-855-DAYTON1. I guarantee that I will see you in consultation in 1-3 days of your phone call. And when you call us, you’ll talk to directly to my team who work beside me; not a call center.

VA Medical Centers Beat Lung Cancer with the CyberKnife

The VA knows the importance of the CyberKnife for treating our veterans with lung cancer.

In the study of more than 1,600 veterans with early-stage lung cancer, stereotactic radiosurgery, like that delivered by the CyberKnife, more than doubled the chances of surviving compared to conventional radiation. Importantly, the study was conducted at VA Medical Centers over the past decade. The study was presented at the 2016 meeting of the American Society of Therapeutic Radiology and Oncology or ASTRO.

Dr. Brian Kavanagh, a Past President of ASTRO, told the Medscape news, “Although we are talking about treatments of an advanced technology that has only been allowed in the last 10 years or so, it is also smarter, more efficient and more cost effective way to do things. It involves fewer trips to the treatment center for the patient, fewer side effects, and is generally easier to take.” CyberKnife treatments for lung cancer are painless and can take as little as 20 minutes each. Only 3-5 treatments are needed.

CyberKnife has also been shown to be just as effective as open surgery for patients with early stage lung cancer, but without the hospitalization, the risks of open surgery, and the pain and recovery. CyberKnife is available only at First Dayton Cancer Care in the Dayton Region. And CyberKnife is the only radiation device that breathes with you as it tracks your tumor with every breath.

If you have questions about treatment of your early stage lung cancer, please feel free to call, Dr. Edward Hughes at 855-DAYTON1. I guarantee I will see you within 1-3 days of your call.

First Dayton Cancer Care Celebrates 14 Year Anniversary

Dr. Hughes enjoys being able to spend a lot of time with patients answering all of their questions. He is able to do that in his own practice.

Local cancer doctor, Ed Hughes, MD, PhD, feels that his cancer patients have rights. They have a right to the best medical care possible. They have a right to choose a treatment that is best for them. They have a right to superior health care at a reasonable cost. They have the right to treatment done quickly. They have the right to quality of life. They have a right to stay in Dayton for world class medical care. The reason this doctor left the hospital 14 years ago is even more important today. As more and more physicians sell out to big hospitals, they are losing their rights.

First Dayton Cancer Care was opened in 2003 because Dr. Hughes believes cancer patients have the right to the best. He is an expert in Radiation Oncology. He uses radiation technology to destroy cancer cells throughout the body. It is virtually painless to the patient. “Radiation therapy is all we do. This is not a side service to us. I have a team of experts. This is our passion,” states Dr. Hughes. Over the past 14 years, Dr. Hughes and his team have given more than 126,500 radiation treatments to more than 7,000 people from the southwest Ohio region.

Dayton has some of the most advanced cancer fighting tools in the world thanks to Dr. Hughes. He has been the driving force to bring advances like robotic seed implants for prostate cancer, Intensity Modulated Radiation Therapy (IMRT) and the CyberKnife Stereotactic Radiation Therapy to our city. He has always been on the forefront of these medical breakthroughs.

Dr. Hughes was one of the first oncologists in the country to use Stereotactic Radiation Therapy. He makes financial investments, often foregoing profits, because he wants his patients to have world class cancer treatments right here at home. Dr. Hughes states, “People ask me all the time, ‘If the CyberKnife is such phenomenal technology then why doesn’t every hospital have one?’ I can honestly tell them that is not a profitable service line. It is simply better medicine. And I believe as a physician, my most important mission is to save lives using every possible tool.”

We asked Dr. Hughes why he chose to leave the hospital and open his own center in today’s challenging health care market. “When I worked at the hospital I was always being told what I could and could not do for my patients. Owning my own practice allows me to care for them as individual people. I can do so much more this way.” For example, First Dayton is the only center in the region to actually pick up patients for their treatments. It is a free car service. Mary of Centerville tells us, “It has been a true blessing to have such fine people drive me to my daily appointments. My kids all work. I don’t know how I would have made it otherwise.”

When you have been told you have cancer, you want answers immediately; so Dr. Hughes will see patients within 1-3 days of their first phone call. Dr. Hughes often spends over an hour with his patients and their family at their initial visit. “I want to learn about this person. I want to present all of the treatment options and help the patient decide what will give them the best chance to beat their cancer. I want to answer all of their questions. I couldn’t spend this much time when I worked at the hospital. People with cancer are scared. Patients want hope.”

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.

1 in 4 Lung Cancers are in Never Smokers

When every extra day counts, turn to the CyberKnife.

Did you know that “never smokers” make up 28% of new diagnosis of early stage non-small cell lung cancer patients?

 Dr. Eric Lim and colleagues from London looked at 2,170 British men and women who had  lung cancer surgery from March 2008 to November 2014.   

The remarkable finding was that “never-smokers” with lung cancer increased each and every year from 13% in 2007 to 28% in 2013.  And the trend was due to a dramatic increase in the absolute numbers of “never smokers” with lung cancer.   Fifty five percent of those patients with lung cancer were found “incidentally.”  That is to say, their lung cancers were found by CT scans, PET-CT scans, X-rays, or MRI’s ordered for other reasons-not because their physicians suspected lung cancer.  Only 14% of patients had symptoms of lung cancer-like coughing up blood or profound shortness of breath. 

Like many good medical studies, Dr. Lim’s article raises more questions than answers.  Were these lung cancer patients who were “never smokers” exposed to second-hand smoke at home or in the workplace?  What about other exposures, like chemical toxins, in the workplace?  Are there differences in “never-smokers” who live in the city versus out in the country?  What about family history?  Do the same trends hold for people in the US? 

So whether it’s family history, genetics, race or just bad luck remains to be seen.  But the good news is that lung cancer caught early is highly curable.  Cure rates are now in the 80-90% range for 5 years.  And you may not need surgery at all.  Many studies have now shown that Cyber Knife radiosurgery is equal to or even better than open surgery for patients with early stage lung cancer.  And Cyber Knife is done as an outpatient-no incision, no pain, and no long hospital stays; eliminating the complications that go along with surgery.

So if you have any questions about your lung cancer, please free to call me, Dr. Edward Hughes

What’s the Big Deal about the CyberKnife? Why only 5 Treatments?

The Superior Precision of the CyberKnife allows for Only 3-5 Treatments Most Cancers.

Simply put, CyberKnife Stereotactic Ablative Body Radiotherapy, or SABR for short, controls cancers even better than predicted.  For example, the results for patients with early stage lung cancer have been particularly striking. Studies have shown 85-90% cancer control rates with a 3-5 CyberKnife treatments versus only 30% with 30-40 ordinary radiation treatments.  This means that  85-90% of lung cancer patient treated with the CyberKnife got rid of their cancer. That is a huge increase in successful cancer treatment. More people are beating their disease with the CyberKnife than with ordinary radiation therapy.

Because of this success, a lot of research is being done to find out why it is working so well. And to learn how else SABR can be used to treat cancers and other diseases. Here are some cutting-edge facts:

CyberKnife Damages Cancer’s Blood Supply  

  1. In a recent editorial, oncologist Dr. Paul Sperduto and colleagues stated “the literature supporting this phenomenon (high-dose radiation results in indirect tumor cell death) is not fragmentary, but actually quite robust….  However, we have consistently underestimated the role of indirect cell death by devascularization and its possible role in radiation-induced immune enhancement.”  (Int. J Radiation Oncol Biol Phys. 91, No.1,pp121-13, 2015)
  2. When you cut off the blood supply to the cancer cells, they die. Decades of research shows that a few high doses of radiation will damage the blood vessels supplying the tumor. There is now active research combining Avastin, a drug that blocks blood vessel formation and SABR. Using Avastin and the Cyber Knife may double the efforts to cut off the tumor’s blood supply.

 CyberKnife Can Generate an Immune Response to Attack the Cancer

CyberKnife may help unleash your body’s own immune system to fight your cancer. Recent studies suggest that SABR cause the body to release tumor-specific antigens. These antigens are unique molecules released after radiation destruction of cancer and can generate a cancer-specific immune response.  Once again, there is now active research combining SABR, like that delivered by CyberKnife, with the recent FDA approved drugs called immune checkpoint inhibitors.

CyberKnife Tracks Your Cancer As It Moves

Much like a jet-fighter pilot who always has an enemy target in its cross-hairs, CyberKnife can track your lung cancer as it moves with each and every breath.  CyberKnife’s pencil thin beams of radiation can destroy your tumor, while sparing surrounding normal tissues.  Because of this precision, CyberKnife  uses hundreds of beams of radiation instead of 5 – 7 beams delivered with other radiation machines. With the CyberKnife you do not have to hold your breath during treatment. You just lie still and the machine does all the work for you. Each treatment typically takes a mere 25-50 minutes, with plenty of breaks if needed.

It is not just lung cancers that move. Prostate cancer, liver cancer, pancreas cancer, and many other cancers move inside the body. CyberKnife is the only radiation device that directly watches your cancer as it moves, keeping collateral damage to a minimum.

If you or a loved one has cancer, learn all the options. Discover more here. CyberKnife maybe the answer to beating your cancer. Call me to discover how I can help win your fight.

Computers Helped Save My Life

The CyberKnife 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 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 about half an hour each. 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. (original blog was in July of 2014)

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.”

John was just in to visit with us and he is still cancer free thanks to Dr. Hughes and the CyberKnife. If you want help like John, call Dr. Hughes today.