Monthly Archives: January 2017

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

America: Time to Take Back Your health Care

“We will no longer accept politicians who are all talk and no action, constantly complaining but never doing anything about it.  The time for empty talk is over.  Now arrives the hour of action.” President Donald J.  Trump Inaugural Address 2017

 The Action 

Ohio State House representative Jim Butler, R-Oakwood in Kettering, is a politician who is taking action.  Rep.  Butler introduced the Healthcare Price Transparency Law in June 2015.  Remember that date-  June 2015, over 18 months ago.  The law passed unanimously, and was signed by Governor Kasich.

 The Reaction  

Yet the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), filed a lawsuit in late 2016 to block the law from starting on January 1, 2017.  The OHA and OSMA claim they need more time.  As if 18 months is not enough. 

The Old Game of Hide and Seek  

Patients have a right to know the cost of their healthcare.  Would you shop at Kroger or Elder-Beerman only to know the price 30 to 60 days later?  Would you by a house only to know the price 30 to 60 days later after closing?  So why is the price of healthcare any different than the cost of food, clothing, and shelter?  The Ohio Hospital Association and the Ohio State Medical Association want to keep the price of their services far from transparent. 

Trying to find the true cost of your medical care-before the procedure-is difficult to say the least.  What makes it even more stressful is that you are doing this when you are sick.  The cost of healthcare seems the least of your worries in a crisis. 

So how does Ohio rate compared to other states as far as healthcare cost transparency?  In 2016, the Healthcare Incentives Improvement Institute gave Ohio a solid “F” along with 42 other states.  That’s right, in the vast majority of states in the US, the cost of healthcare is far from transparent. 

The Hour of Action  

So what can you do as the patient?  Most of your health care visits and procedures are “elective” or non-urgent, in medical terms.  So you have time to find out.  You have the right to know from your hospitals and your doctors the out-of-pocket expenses to you before the procedure.  It is your health and your money in the end. 

But don’t wait for politicians to solve your life and death problems.  Take back your life and take back your health care.  Demand the costs of your health care before the procedure.  You will be shocked at the price differences among hospitals and doctors. 

First Dayton Cancer Care has been providing out-of-pocket cost estimates for patients at the start of their care since 2003.  It can be done, despite what the Ohio Hospital Association and the Ohio State Medical Association will lead  you to believe. 

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

Ohio’s Healthcare Price Transparency Law- What are the Hospitals Afraid of?

Price Transparency advocacy is not new and not just in Ohio. This graphic is from a 2013 Forbes article.You can read here.

In June 2015, the Senate and House of Representatives in the state of Ohio passed unanimously the Healthcare Price Transparency Law. The law was signed by Governor John Kasich shortly thereafter. This law would require hospitals and physicians to provide a reasonable estimate to patients prior to procedures and tests. This would allow the patient to make decisions on whether or not to have the services, to shop for a lower price, or to determine how they are going to pay for this bill.

Our own local State Representative Jim Butler, Republican from Oakwood and Kettering, offered and sponsored the law. Mr. Butler has worked with the Ohio State Medical Association (OSMA) and the Ohio Hospital Association (OHA), as well as a number of lobbying organizations to help implement the Healthcare Transparency law so it is workable for both healthcare providers and patients. Jim Butler’s letter to the President of the OHA can be found on his website.

Now 18 months later, OSMA recently joined a lawsuit with the OHA to block the implementation of the law. They argue that it is not possible to get this reasonable estimate in a timely manner because insurance carriers determine the out of pocket cost and there are simply too many insurance plans. In late December, Williams County Common Pleas Court judge J.T. Stelzer issued a 30 day restraining order blocking the law from taking effect on January 1, 2017.


The Ohio Hospital Association now argues that insurance carriers ‘set the price’ and the hospitals have no control over these prices. But this is false. It is the hospitals who negotiate a contract with the insurance carriers to determine the cost of each and every procedure. While the insurance carrier negotiates a contract with the patient regarding co-pays and deductibles, it is the hospitals who are responsible for the cost. Most people do not realize that the same test procedure will cost different amounts from one facility to another. Sometimes up to 75% more. For those with health insurance such as Medicare where you have a 20% responsibility, a $2500 CT scan and a $400 CT scan is a significant difference; a $500 out of pocket bill in the hospital or a $80 bill at an independent outpatient facility.  People have a right to shop around for quality and cost.

A staff member of mine recently sent her son to a physical therapist at a local hospital while she herself was seeing a physical therapist in an independent practice. Her son’s bill for a 15 minute appointment to have his pinky finger worked on cost her $250. While her 1 hour appointment for her back cost only $65 at the independent practice. She tells me had she known the high cost with the therapist working for the hospital, she would definitely made him go to the other facility.


Those opponents argue that this will delay treatment because the information is not readily available. This is not true. Most insurance carriers have online system that practices can use to plug in the patient’s exact insurance plan along with the ICD-10 procedure codes that will be used. That system , in existence for years, will provide an estimate of cost based on the current contract with that facility.

First Dayton Cancer Care has been providing these estimates to our patients since opening in 2003. Radiation therapy is one of the most complicated set of billing codes in any specialty, yet we manage to provide estimates within 24 hours. Most of our patients appreciate knowing what their out of pocket expense will be so that they can begin planning for it. Many insurance carriers provide a website where their members can do a cost estimator and it will show them what each facility in their surrounding area charges. The information is readily available. In the past 13 years our billing company, MAXX Medical states that providing these estimates has gotten easier. They are able to provide an estimate within an average of +3%.


I do agree that there are specifics to the Healthcare Price Transparency law that need to be worked out. But the state of Ohio, the OHA and OSMA have had 18 months to work this out. The state needs to establish guidelines that relieve some of the burden on the provider and to ensure that the language protects the provider if the insurance carrier provides incorrect information. However, the OSMA and the OHA needs to be advocating for the patient first. Patients do not have lobbyists fighting for them. They need to be told of their right to ask for a cost estimate.

Patients also need to respect that when an estimate is given, it does not mean that we value their payment more than we do providing quality care. We feel by providing this estimate we are helping the patient make informed decisions about both about their health and their family finances. But in all things you purchase, you demand quality and a fair price. Your health should be no different. Price transparency in healthcare is critical in today’s world.

If you are in need of excellent cancer care, call me today at 1-855DAYTON1. Not only will I see you in 1-3 days for an initial visit, but I will provide you with an estimate before treatment begins!

2017 New Year’s Resolution: Get a PSA Test

KNOW YOUR RISKS. Graphic credit

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.