Because prostate cancer patients often do not have symptoms, annual checkups are vitally important
By: Lorraine Seabrook
According to the American Cancer Society, aside from skin cancer, prostate cancer is the most common cancer among American men and represents the second leading cause of death in men, second only to lung cancer. An estimated 230,110 new cases of prostate cancer will have been diagnosed in the United States in 2004, with 7,930 in New Jersey.
Slow growing, prostate cancer can remain without symptoms for years, but when diagnosed and treated early, it can be cured. Fortunately, there are several new treatments for prostate cancer that are proving quite successful.
The prostate is a small, firm gland that is situated at the base of the bladder outlet in males. It is responsible for secreting an alkaline fluid which is the major component of the ejaculatory fluid. Although the exact cause of prostate cancer is unknown, evidence exists that links the development of prostate cancer to increased levels of androgens (male hormones).
While risk factors such as age, race and family history are beyond a man’s control, diet can play a role. Recognizing that a diet high in animal fat (dairy and meat) seems to increase the risk of prostate cancer, the American Cancer Society recommends a diet low in fat and consisting mostly of vegetables, fruits, and grains.
Because prostate cancer patients often do not have symptoms, annual checkups are vitally important and are recommended for men age 50 and older. Men who have a family history of the disease and/or are African-American should get an annual checkup beginning at the age of 40.
A checkup includes the prostate specific antigen (or PSA) test used in conjunction with the digital rectal exam. Once a baseline PSA reading is established, a patient’s PSA level will be monitored each year.
If there is a significant change in the standard PSA level over time or if there is a suspicious-feeling prostate on digital rectal examination, the patient’s urologist will likely recommend a biopsy. If there is a diagnosis of prostate cancer, the patient’s doctor will stage the cancer and treatment will be decided based on these findings. Brian Chon, M.D., radiation oncologist at Princeton HealthCare System’s J. Seward Johnson, Sr., Radiation Oncology Center, is presenting a free community education program entitled, "What’s New in Radiation Therapy for Prostate Cancer." The program will take place at the Princeton Fitness and Wellness Center on Wednesday, Jan. 26, from noon to 1:30 p.m.
Dr. Chon readily agreed to discuss these treatments, notably IMRT Intensity Modulated Radiation Therapy and prostrate seed implantation (brachytherapy).
According to Dr. Chon, IMRT represents the most sophisticated way of treating the prostate with external beam radiation.
Using over 100 beams, IMRT allows pinpoint radiation delivery, maximizing the dose to the tumor while minimizing the dose to healthy surrounding tissues. Because IMRT allows this accurate dose conformality, higher doses of radiation can be safely delivered. Recently published data from Harvard Medical School and the MD Anderson Cancer Center show that the higher radiation dose translates into higher cure rates. Conversely, the lower dose delivered to the surrounding healthy tissue, such as the rectum and the bladder, minimizes side effects.
Using IMRT, the typical course of treatment averages 20 minutes a day, five days a week, for eight weeks. Most of this time is devoted to quality assurance. Before the beams are turned "on," pictures are taken to insure perfect localization of the prostate. After treatment, one month is given to allow the radiation to have its maximum effect and then PSA levels are checked.
IMRT is suitable for all patients who have prostate cancer, even if the disease has spread. Dr. Chon notes that "for patients with metastatic disease, IMRT allows us to treat cancer to areas that would have been difficult to treat. For example, if the cancer spreads to the base of the skull or around the spinal cord, we can use IMRT to safely and elegantly treat these regions."
Another exciting treatment option involves seed implantation or brachytherapy. This minimally invasive procedure involves the placement of small radioactive seeds into the prostate. Once implanted, the seeds give off localized radiation inside the prostate for several months. This procedure typically takes one to two hours to complete, and most men are able to resume normal activities within several days.
Dr. Chon notes that 10-year follow-up data from the Seattle Brachytherapy Group have shown equivalent outcomes when compared to patients who undergo surgery for localized prostate cancer. Over 87 percent of men remain free of prostate cancer 10 years after brachytherapy treatment.
It is worth noting that for patients with intermediate- to high-risk features, such as PSA 10 or Gleason scores 7, high dose rate (HDR) brachytherapy may confer an advantage over the standard seed implants. This therapy is performed in two phases. Initially, a four-to-five week course of external beam radiation is delivered. Subsequently, catheters are placed in the prostate under ultrasound guidance. These catheters become conduits for the temporary radiation source to travel throughout the prostate. Unlike the permanent seed implantation, the radioactive sources remain in the prostate only for a few minutes. This temporary "seed" implantation is performed two to three times within 24 to 48 hours. Once completed, the catheters are taken out, and the patient is discharged from the hospital.
To learn more about prostate cancer and new treatment methods, attend Dr. Chon’s upcoming program. For more information or to register, call Princeton HealthCare System’s Community Education and Outreach Program at (609) 497-4109 or visit www.princetonhcs.org.