Monthly Archives: October 2017

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.