Prostate Cancer Screenings Reduce Death Rate by 90%

Posted on October 29, 2011 by jelandry

Although I’m not a lawyer, I like hyperbole like a bear likes honey. This statement is in a video I transcribed by a world renown oncologist who’s clinical practice is to treat patients with advanced and recurring prostate cancer. Dr. Charles E. Myers publishes an “Ask Dr. Myers” video every week addressing various aspects of prostate cancer treatment and survivorship.  J E Landry October 2011

DR MYERS (ASK DR. MYERS) THINKS US Preventitive Services Task Force recommendations are nonsense.

Dr. Charles E. Myers, a 68 year old medical oncologist who treats prostate cancer patients exclusively. He has a clinic full of men whose cancer is recurrent after surgery or radiation. He is also a prostate cancer survivor who was diagnosed in 1999 with cancer that had spread to his lymph nodes. He happens to be disease free but it was diagnosed at an advanced stage at age 54 because he neglected to go for screening via PSA.

Clearly he has a bias and a horse in this race, and if patients don’t go for screening his business will grow. There will be many more patients with recurrent or advanced disease who will seek his help and what the task force has done is guarantee there will be plenty of business in his clinic, many more patients in his clinic. 

Dr. Myer says with this announcement and recommendations by the USPSTF, he is filled with a terrible sense of foreboding about the needless suffering and deaths that the recommendations may have caused.

After reading the study he says it’s a classic sense of having not not seen the forest for the trees, craziness of this thing, these recommendations, and that it appears they have not studied how urologist and oncologist diagnosis and track their patients.  

He speaks about how there are 25 to 30,000 deaths every year and prostate cancer is one of the top ten causes of death. The task force gives the impression that this is an indolent slow growing disease that does no harm and not a leading cause of men’s death. Note: According to the American Cancer Society reports that there were 33,000 deaths and 240,000 new cases in 2011. 

Why is there such a disconnect with the mortality figures and the vision of the disease portrayed by the task force in the report?

Unfortunately prostate cancer is a complex disease with two different forms of the disease. 

1) On one extreme there’s one form that is very common, very slow growing that doesn’t spread beyond the gland. It’s about as common as gray hair and part of normal male aging. If left alone it will not cause any medical problem and typically will not present any symptoms so it doesn’t need to be diagnosed and treated.

2) On the other extreme is the less common form of the disease. It is aggressive, relentlessly growing and will kill if you don’t get rid of it. Prostate cancer is the “Terminator” as in one of Arnold’s movies. It will kill you.

Task force has decided to focus on the more common slow growing, indolent and to ignore the aggressive form. They did this for the common good, and in the process has ignored a highly lethal form of prostate cancer that causes 25,000 to 35,000 deaths. 

THAT IS THE NATURE that his patients are in battle with and is completely curable today from what the medical profession knows – if you can catch it early.

What we want to do is detect these nasty cancers and get rid of them 

What we should be concentrating on is - 

To take the best practices of the best centers and make it a community practice, and  instead we’re going the other way.

If you catch it early from what we know today it is completely curable and death rates could be reduced by 90%.

One of the major arguments the task force makes is that once we make the diagnosis we can’t tell the indolent cancers from the aggressive cancers.   That’s BULLSHIT! It’s crazy. It’s as if the task force has not taken the time to acquaint themselves with what the urologists and oncologists currently know and how they track patients with prostate cancer.

American Urological Association have done a SUPERB job of setting up guidelines and of assessing relative risk. 

There’s no problem on the other extreme. If you have a Gleason of 7, 8, 9 or 10, your PSA is rising rapidly, then you know you’ll get into trouble if don’t do anything about getting treatment.

There’s no excuse for this and there are men who are being subject to needless surgery and radiation.

Problem in America is to educate or police physicians at the local level, so as to make sure that overtreatment does not occur; and that someone with a Gleason 6 is not treated with surgery or radiation.  

But it seems the Task Force chose to ignore the problem and may let 20 to 30 thousand men die needlessly.

The recommendations are as bad as the recommendations on mammograms for breast cancer patients. They are showing the same callous disregard as in the breast cancer screening recommendation.

 

     THE PSA TEST IS USEFUL

IT IDENTIFIES PEOPLE WITH HIGH RISK OF THE DISEASE

IT LEADS TO THE DETECTION OF CANCER

IT WILL SAVE LIVES IF WE DO THE BEST WE CAN DO FROM WHAT WE KNOW TODAY

WE CAN AVOID UNNECESSARY TREATMENT FOR PEOPLE WITH LOW GRADE DISEASE, THE PROBLEM IS PEOPLE WHO WE THINK HAVE LOW GRADE DISEASE HAVE HIGH GRADE

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The Rationing Begins

Posted on October 28, 2011 by jelandry

I’m repeating a post from the Texas Public Policy Foundation even though I am aware that the headline can be seen as politically charged (red meat) the article is factual.  For four and half years I’ve leaned toward the center on many of our publications but these are life and death times, and we have to be clear on what we stand.  J.E. Landry October 2011

Last week the US Preventative Services Task Force (USPTF) released their study and recommendations on prostate cancer screenings. Their findings argue that “Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality…” The nation’s largest urology group, among others, quickly spoke out against these findings saying, “Because of early detection efforts, the death rate from prostate cancer has decreased 38% (from almost 40 per 100,000 men in 1992 to fewer than 25 per 100,000 in 2007).”

Despite these protests by physicians patients’ access to these screenings may be limited. The New York Times has reported that, based on the USPTF recommendation, insurers were considering removing coverage for screenings. They report, “Both Aetna and Kaiser Permanente said it was unclear whether they would continue paying for the test. ‘We are currently reviewing the U.S. Preventive Services Task Force’s recent announcement on prostate cancer screening,’ Jason Allen, a spokesman for Kaiser Permanente, said in an e-mail.” By removing coverage of these screenings a patient’s ability to receive them may be constrained.

This rationing may not be as overt as one sees in socialized systems like the United Kingdom, but it still holds the potential to restrict a patient’s ability to receive the care they desire. A patient’s health care decisions should not be determined by the recommendations of any federal board, no matter how distant. A patient’s need of prostate cancer screenings, along with all other health care, ought to be a decision made by the patient with the advice of their doctor. Health care reform needs to come by a reduction of costs not care.

- Spencer Harris

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Urotoday Publishes Comments by Alan Wein, MD, Chief of Urology at UPenn

Posted on October 26, 2011 by jelandry

Screening for prostate cancer with PSA testing: current status and future directions

The US Preventive Services Task Force’s recent announcement with respect to the evaluation of routine PSA screening was a very interesting one to me.

From the standpoint of physicians who actually take care of these patients, and recognizing that oncologists certainly share in the treatment of patients in the late stages of the disease, my own personal philosophy can be spelled out quite simply.

Certain facts are irrefutable:

  • The mortality from prostate cancer has decreased coincident with the use of PSA screening.
  • There has been a stage migration in diagnosis, meaning that it is much less common to see patients presenting with metastatic or even extensive local disease.
  • It is illogical to assume that late, advanced disease is as easily cured or successfully managed as early stage disease.
  • There is no question that there are some patients who are over-treated.
  • There is no question that some patients are not fully informed of the risks of various types of active management; further, some patients remain relatively uninformed regarding active surveillance.
  • PSA screening cannot distinguish high-risk or aggressive disease from low-risk or non-aggressive disease.

With these facts in mind, my personal philosophy is that in general, patients with a life expectancy of less than 8-10 years (and I do not cite a specific age because age is very often unrelated to life expectancy) do not benefit from screening for prostate cancer. Patients with a life expectancy of greater than 8-10 years need to be asked, “If you had prostate cancer would you want to know about it, and would you want to participate in decisions regarding the type of management?”

This assumes that the discussion would include the alterative[s] to active surveillance. If the answer to this question is “Yes,” then I think the patient deserves to be screened with PSA testing and digital rectal exam (DRE). If the answer is “No,” then I think, with proper documentation, one can omit PSA screening. I do, however, believe a DRE should still be carried out since it checks not only for prostate abnormalities but for abnormalities of the rectum as well.

One point that bears mentioning is that it is generally not the urologist who initiates PSA screening but rather the primary care provider — whether a family physician, internist, nurse practitioner, physician assistant, or medical subspecialist.

Finally, if a patient chooses not to be screened for prostate cancer, there needs to be a prohibition disallowing him from seeking legal sanctions under the accusation of “failure to diagnose” — and the extensive ramifications that always go along with this sort of lawsuit.

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Pick Up Your Lances – A Press Release from William Catalona, M.D.

Posted on October 26, 2011 by jelandry

NORTHWESTERN UNIVERSITY NEWS

MEDIA CONTACT: Erin White at (847) 491-4888 or ewhite@northwestern.edu

FOR RELEASE: October 12, 2011 MEDIA ADVISORY DR. WILLIAM J. CATALONA, PIONEER OF PROSTATE CANCER SCREENING AND NERVE-SPARING SURGERY, IS AVAILABLE FOR COMMENT

CHICAGO — “PSA is the best screening test we have for prostate cancer, and until there is a replacement for PSA, it would be unconscionable to stop it,” said William Catalona, M.D., Director of the Clinical Prostate Cancer Program at Northwestern Medicine and international expert on screening.

Catalona’s comments are in response to the recent U.S. Preventive Services Task Force (USPSTF) recommendation against PSA (prostate-specific antigen) screening.

“Contrary to the USPSTF report, compelling evidence shows that PSA screening reduces prostate cancer deaths,” Catalona said. “This evidence needs to be shared with the public.”

Catalona said three of the five clinical trials the task force used to make its recommendation were of very poor quality and not representative of how PSA testing is currently used. The other two were of good quality and showed the substantial benefits of the test in decreasing prostate cancer deaths. Putting all five studies in one pool diluted the results of the two studies.

“This would be akin to using two fresh and three spoiled bananas to create a smoothie, then concluding that bananas should no longer be used in smoothies because the resultant mixture tastes bad,” Catalona said.

Catalona led early studies on PSA screening, showing that it results in earlier detection, allowing men a wider array of treatment options.

“Because the cancer begins on the prostate’s outer edges, it produces no symptoms until it is far advanced and too late to cure,” Catalona said. “You can be a ‘healthy’ man and have a steadily climbing PSA, silently trumpeting the danger alarm. Early diagnosis is everything. It is the cornerstone that has dramatically reduced death and suffering.”

Prostate cancer is the most common non-skin cancer in men and the second-leading cause of death from cancer. “Since the simple blood test for PSA became widely adopted, death rates from prostate cancer have dropped 40 percent in the United States and also decreased in other countries where the testing is widespread but not in those where it is not used,” Catalona said. “In addition, the National Cancer Institute database shows a 75 percent decrease in metastatic disease at diagnosis since PSA testing.”

This USPSTF recommendation, if implemented, could result in Medicare and private insurance companies not covering the cost of the test and would be especially detrimental to the health of men with a family history of prostate cancer and to African-American men, who are 50 percent more likely to have prostate cancer and 200 percent more likely to die of it, Catalona said. Yet, African Americans were not included in studies used to make the guidelines that could result in increasing healthcare disparities.

Implied in the USPSTF recommendation, incontinence and impotence are being measured against saving lives. The fact is that both side effects of prostate cancer treatment are greatly diminished with an experienced surgeon and other ongoing improvements in the quality of treatment and should not be used as fear tactics in the face of life-saving screening and treatment.

If accepted by the government, this recommendation would essentially become healthcare rationing, in which only people who can pay out-of-pocket, would receive this life-saving test.

To arrange an interview with Dr. Catalona, contact Erin White, Northwestern University Broadcast Editor, at (847) 491-4888 or ewhite@northwestern.edu. (An article based on a prostate cancer screening presentation Dr. Catalona gave at a recent meeting of the American Urological Association is available upon request.) NORTHWESTERN NEWS: www.northwestern.edu/newscenter/

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Death by Bureaucracy by Newt Gingrich

Posted on October 22, 2011 by jelandry

Earlier this month, a panel appointed by the Department of Health and Human Services made a recommendation so detached from the good of individual patients it could only have come from government bureaucrats. They recommended eliminating screening for the most common cancer among males nationwide.

The United States Preventative Services Task Force (USPSTF) is composed of 16 government-selected experts whose recommendations often influence the reimbursement policies of Medicare and private insurers. The range of members’ backgrounds is narrow considering the group is charged with advising the federal government and other healthcare providers on specific medical procedures: almost all are academics or administrators rather than practicing physicians. The panel includes experts in pediatrics and newborn care, in mental health and geriatrics, but not a single urologist who actually takes care of prostate cancer patients.

Despite lacking any specialist who deals with the issue, the panel issued a recommendation this month to stop using the only available test to screen for prostate cancer. PSA tests, which measure levels in the blood of a marker known to be elevated in men with prostate cancer, are the sole method of screening other than digital examination by a doctor, which cannot detect the most common form and usually identifies those cancers it can much later, when they are less curable.

Without the PSA testing, many men will have no way to know they have the disease until it has developed into much more dangerous problem. In some cases, it will be a too late by the time they discover it.

What is the basis for the panel’s recommendation to discontinue screening that can save lives?

It has nothing to do with the merits of the test. Instead, these government-appointed experts advised against screening because they disagree with what some doctors and patients choose to do with the information once they have it.

Prostate cancer is a complicated issue, and elevated PSA is not always a sign that a man should enter treatment. In some cases, men can live with benevolent cancers and remain healthy for years. In many other cases, it is simply unclear even from biopsies whether the cancers are benevolent or lethal, as both kinds register on test results.

Understandably, many men faced with this information want to do everything possible to make sure they do not have a lethal cancer, and many doctors, as well, recommend curative therapy even when they are not certain the cancer is lethal. There are definitely patients, especially older men, who undergo treatment for prostate cancer they could have lived with if it had gone undetected.

If prostate cancer is over-treated, the sensible response for the USPSTF would have been to call on the National Institute of Health and the National Cancer Institute to help develop a better and more accurate test, and to advise doctors and patients to consider more conservative approaches when the test suggests the presence of prostate cancer.

Instead, the task force’s answer is simply to deny doctors and patients the chance to consider early treatment by recommending they not screen for prostate cancer in the first place.

That is not a reasoned response to the problem. It is a bureaucratic response to the problem. And people will almost certainly die because of it.

This points to the difference between the bureaucratic approach to healthcare, which leads to rationing, and an approach to empower individuals and their doctors to make the best decisions for them.

Bureaucrats cannot comprehend the complicated details of all the individuals for whom they try to make decisions and so they issue one-size-fits-all pronouncements for large classes of people. In this case, when the bureaucratic approach identifies a class that is being over-treated, it calls for the elimination of screening to warn of the disease. That way fewer people will have the information they need in order to be faced with choices involving some options the bureaucrats consider undesirable. Physicians can’t over-treat a prostate cancer they have not detected.

Of course, it is ridiculous to have a handful of government bureaucrats with no expertise in the matter issuing recommendations that influence federal, state, and private health systems in crafting policies. Doctors and patients are in the best position to determine whether individuals should be screened for prostate cancer and to judge the best course of action afterward.

No one should want the government interfering in these very personal medical decisions. Lethal bureaucracy is a disease we can’t afford—and one that is entirely preventable with the right policies.

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Task Force Does Not Follow Hippocratic Oath

Posted on October 20, 2011 by jelandry

Primum Non Nocere – “Do No Harm” not followed by task force when they disparage the PSA screening test and develop very specific recommendations. The U.S. Preventative Services Task Force (USPSTF) results are based on data from large random studies. However there’s been serious criticism leveled on the design and conduct of of every trial used to develop the data and clearly not one of the six larges studies meets the standards for good evidence based medicine. If the data and the method of analysis is flawed and the USPSTF concedes more it probably needs more study, why draw and make very specific recommendations about screening? 

Here’s are leading paragraphs written by Charles Bankhead, Staff Writer, MedPage Today October 12, 2011 about the American Urological Society response to the PSA screening recommendation. 

A recommendation against PSA-based screening for prostate cancer has drawn little official reaction from medical organizations but mixed — and strong — reactions from individual physicians.

The American Urological Association responded almost immediately to the U.S. Preventive Services Task Force (USPSTF) recommendation with a reaffirmation of the AUA’s support for PSA screening.

“We are concerned that the task force’s recommendations will ultimately do more harm than good to the many men at risk for prostate cancer, both here in the U.S. and around the world,” AUA president Sushil S. Lacy, MD, said in a statement.

“The AUA’s current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pretreatment staging or risk assessment, and monitoring of prostate cancer patients.”

“Until there is a better widespread test for this potentially devastating disease, the USPSTF — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test,” added Lacy, who practices in Lincoln, Neb., and has a clinical appointment at the University of Nebraska.

MedPage Article on Prostate Test

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Prostate cancer runs in my husband’s family on both sides:…When should our sons (34 and 28) start getting their PSA checked?

Posted on October 12, 2011 by jelandry

A QUESTION SENT TO DR. CHARLES E. MYERS, PROSTATE FORUM CHARLOTTESVILLE, VA.

Prostate cancer runs in my husband’s family on both sides: a grandfather, two brothers, and a cousin…When should our sons (34 and 28) start getting their PSA checked?

Any answer I give for this question is sure to trigger controversy. My own experience heavily influences my recommendations. In 1999, it was thought that only 2% of cases were diagnosed under 55 and most of those had familial prostate cancer. So I waited until age 55 until I myself went for staging. I was shocked when my PSA was above 20 ng/ml and I had locally advanced disease that had broken through the capsule, invaded the seminal vesicles and spread to the lymph nodes along the iliac arteries. I consider myself very lucky to be alive today. It is very clear that if I had waited another year, I would have been incurable.

This experience has made me very biased toward aggressive and early screening. A PSA test costs less than a meal at a restaurant. Even if you need to pay for it yourself, it is a small price to pay to avoid advanced disease. Just reread the earlier questions about advanced disease to get a sense of what you are trying to avoid. The youngest prostate cancer patient I have seen presented with back pain at age 34. His PSA was just above 80 ng/ml and the back pain signaled the presence of bone metastases.

I recommend that both your sons start to get their PSA checks this year. In both cases, it should be under 0.5 ng/ml. If it is above that, I recommend they travel to Ventura, California to see Duke Bahn for a color Doppler ultrasound. If their PSA is below 0.5 ng/ml, I recommend a repeat every other year. If you see an increase, I would switch to yearly. Remember, if the PSA shows a doubling time, the only known cause for that pattern is prostate cancer. For example, if the initial PSA was 0.1 and the subsequent yearly PSA levels were 0.2, 0.4 and 0.8, they almost certainly have prostate cancer.

Again, you need to know that these recommendations come from a physician who cares for advanced disease and has struggled with this cancer himself. Unlike many involved in the discussion of screening issues, I think issues of cost of screening are of no concern. Similarly, I have no concern about the supposed psychological stress caused by PSA screening. As daily I see men dying of this disease, I think such concerns verge on obscene and make me very angry.

ProstateForum Newsletter   Ask Dr. Myers Blog

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Best in Class Facility – Only Pencil Beam Scanning in North America

Posted on October 3, 2011 by jelandry

Toward the Future of Radiation Therapy: MD Anderson’s Proton Therapy Center Pioneers Pencil Beam Technology for Cancer Patient Care

08/03/2010

Treating cancers of the pelvis, brain and in children with new technique designed to “paint” the tumor

The radiation oncologist’s mantra is to deliver the maximum dose of radiation to the malignant tumor, while limiting damage to healthy surrounding tissue. In proton therapy, this balance is achieved by using proton particles, accelerated to nearly the speed of light, to mimic the shape of a tumor and effectively deposit their energy within the confines of it with sub-millimeter precision.

New tools are enabling physicians at the Proton Therapy Center at The University of Texas MD Anderson Cancer to harness supercharged proton particles and conform them more precisely to the rugged landscape and uneven contours of a tumor. Using a technology known as pencil beam scanning, also known as spot scanning, protons are given the mission: Hone in on cancer cells and destroy. As much an art form as a war tactic, pencil beam proton therapyhas the ability to treat the most complex of tumors, like those of the prostate, brain, base of the skull and eye, while leaving healthy tissue and critical structures virtually untouched. The powerful coupling of strength and accuracy offers unmatched capacity to treat a patient’s tumor without compromising quality of life during and after treatment.

In nearly a decade since pencil beam’s birth in a Swiss physics institute, the world’s leading practitioners in radiation science at MD Anderson’s Proton Therapy Center have integrated the tested technology into the institution’s multidisciplinary approach to patient care and translational cancer research.

A New Frontier for Proton Therapy

Proton therapy derives its advantage over conventional forms of radiation from its ability to deliver radiation doses to a targeted tumor with remarkable precision that avoids the surrounding tissue, which results in fewer side effects and improves tumor control. Most proton patients are treated with a technique known as passive scattering,which uses apertures to shape the proton beam and deliver a uniform dose to the tumor. Since opening in the spring of 2006, MD Anderson’s Proton Therapy Center has treated nearly 1,700 patients with this passive scattering technique [See Sidebar: A Best in Class Facility].

Pencil beam proton therapy delivers a single, narrow proton beam (which may be less than a millimeter in diameter) that is magnetically swept across the tumor, depositing the radiation dose like a painter’s brush strokes, without the need to construct beam shaping devices. The technology continues to build on the patient benefits already offered with proton therapy– more targeted, higher tumor dose, shorter treatment times, reduced side effects and increased treatment options – to treat complicated tumors perilously close to critical structures, such as the eye, brain and esophagus.

“The difference between passive scattering and pencil beam is like painting something with a can of spray paint versus using an airbrush,” said Andrew Lee, M.D., M.P.H., associate professor in the Department of Radiation Oncology at MD Anderson, and the director of the Proton Therapy Center. “Pencil beam is more like a very fine airbrush. Instead of needing a brass template to define the shape, the proton beam is made ultra fine to conform to the contours and landscape of a tumor.  When all these small beams are combined, they can cover the entire tumor volume with a high degree of conformality. If the tumor is shaped like an egg, then the proton dose will look like an egg.”

Rapid Fire with Exquisite Precision

The U.T. M.D. Anderson Proton Therapy Center, which began treating patients with pencil beam in May 2008, continues to be the first in North America and one of only three clinical centers in the world to treat patients with this technology.  Because pencil beam does not require any external shaping devices, the treatment is less time consuming on a daily basis than passively scattered beams, with most treatments only taking a few minutes.

Using rapidly fired pulses, the pencil beam hits each planned spot within the tumor with the prescribed amount of radiation, starting at the deepest layer and working in succession, layer by layer, until the whole tumor is covered. Lee estimates that a typical tumor has between 1,000 to 2,000 separate spots arranged in up to 24 layers in a single pencil beam treatment. “We are able to maximize the protons generated and deposit more cancer-fighting energy directly into the tumor,” Lee said.

MD Anderson has used pencil beam proton therapy to treat patients with cancers of the brain, prostate, liver and esophagus – and has extended its use to begin treating tumors in pediatric cancer patients. Anita Mahajan, M.D., associate professor in the Department of Radiation Oncology at MD Anderson, who treats many of the Proton Therapy Center’spediatric patients notes that it is an especially attractive option for solid tumors in children, who are generally more sensitive to the short- and long-term adverse effects of radiation. “Without the apertures, pencil beam deflects fewer neutrons into healthy tissue, which have been shown to increase the risk of second malignancies in young, still growing patients.”

As the only center in the nation treating patients with pencil beam proton therapy, Lee said that MD Anderson can offer children with cancer an even more targeted option to fight cancer and limit damage during and after treatment.

“This type of technology, along with our extensive experience in treating more types of childhood cancer than most other proton centers worldwide, continues MD Anderson’s mission to provide pediatric patient care with the most advanced, research-based therapies as are available to our adult patients,” he added.

MD Anderson has treated over 300 patients with pencil beam to date – both adult and pediatric patients. 

Eloquent Treatment Planning Masters Complex Tumors

Pencil beam is only as good as the complex and intricate treatment planning systems used to direct the beam’s motion, depth and strength.  As these systems evolve to the extent of pencil beam’s capabilities, the team at MD Anderson’s Proton Therapy Center will tackle cancer’s most difficult tumors based on their shape and location in the patient.

“The beauty of pencil beam is that we have the ability to target the tumor with exquisite accuracy and spare surrounding healthy tissue and structures,” Mahajan said. “It’s best utilized when we need to conform high doses of radiation to irregularly shaped tumors embedded near or wrapped around critical structures in the head and neck, such as the eye or brain.” The advantage lies in the beam’s capacity to approach the tumor from multiple directions, creating a “U” shape around these structures and avoiding them entirely during treatment. Side effects common after standard radiation therapy are reduced and healthy organs are preserved because the radiation is confined to the tumor.

The future introduction of intensity modulated proton therapy at MD Anderson will also be possible as pencil beam delivery is further developed. Intensity modulated proton therapy uses the same pencil beam configuration, but the energy or intensity of the proton beam can be adjusted at any time to penetrate the tumor at varying depths. “This is the holy grail of radiation therapy,” Lee said. “Starting with pencil beam, and then working to develop treatment plans marrying the two together, is necessary to achieve this degree of sophistication for our patients.”

Zeroing in on Advances for the Patient

A pioneer in radiation oncology, MD Anderson has paved the way for more effective radiation therapy around the world. The Proton Therapy Center will continue to make strides in the field by making the combination of precision and potency found in pencil beam technology accessible to increasing numbers of patients in a clinical setting. Each patient who receives pencil beam treatment will be part of a growing body of research protocols at MD Anderson, examining proton therapy’s benefits over conventional radiation therapy and refining the technology to care for future generations of cancer patients with the best therapies available.

SIDEBAR: A BEST IN CLASS FACILITY

The Proton Therapy Center at MD Anderson stands as an international center of excellence for proton therapy, research and education.  Within its 96,000 feet of space the Center houses three treatment rooms equipped with giant gantries – three stories tall, 35 feet in diameter, weighing 196 metric tons– each capable of maneuvering the proton beam to precisely target the patient’s tumor.  A fourth room utilizes a stationary beam for larger tumors in the body, including tumors of the pelvis. Pencil beam technology is currently installed in one of the gantry rooms and is used to treat adult and pediatric patients.

The Center offers patients:

  • Access to the most advanced radiation therapy stateside and MD Anderson’s world-renowned research, faculty and multidisciplinary patient care.
  • Treatment for the most comprehensive range of disease sites including pediatric cancers and cancers of the head and neck, eye, prostate, brainstem, esophagus, lymphoma, liver and lung, among others.
  • Reduced side effects and minimal damage to healthy tissue, which contribute to quality of life during and after treatment and enable patients to live longer, more fulfilling lives.

About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For six of the past eight years, including 2010, MD Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News & World Report.

(c)2010 The University of Texas MD Anderson Cancer Center

MD Anderson maintains it’s No. 1 ranking in cancer care with a 100/100 score in 2011.

 

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Two New Board Members for the ProtonPals

Posted on September 30, 2011 by jelandry

Ban Capron, Peter Taaffe, and I make up the leadership team (formally the ProtonPals Board of Directors). Ban and Peter have been with me from the beginning of my journey and my efforts with the ProtonPals.  This week we met with our newest director Dave Stevens for an annual ProtonPals meeting and decided to increase the number of board members from 3 to 5.

Many of you have met Legionnaire Dave (Dave Stevens) over the past few months as he was being treated and coordinating the Wednesday night dinners. He started volunteering with the ProtonPals as he researched and studied the medical literature, published and responded to letters from men who were treated, newly diagnosed or on hormone therapy, hence the Lupron Legionnaire title. Dave’s given two instructive talks to the Prostate Patients meeting in May and in September. I think we’ve hitched our wagon to Dave’s star but we’re doing everything we can to make sure his research and knowledge get out and shared with as many patients as possible.

Our other new board member who you probably met is Drew Cox. Drew completed his proton treatment earlier this year and has been very active in support of the Proton Center and in working with the ProtonPals. About 2 months ago, Drew signed up to be a “regular” M.D. Anderson volunteer and agreed to be vetted and trained. Like John Barna-Lloyd another volunteer in the center who works in Dr. Lee’s follow-up clinics, Drew volunteers every week at the Center also. He then follows up by organizing and attending the Wednesday night ProtonPals dinners held at different Houston restaurants able to handle a large group.

Earlier this year, while in his treatment cycle, Drew and Kathy Cox got word that the toy fund was running low since pediatric patients are now so numerous. As a child (or Pedi as they are called) completes his treatment at U.T. M. D. Anderson there’s a custom of “ringing the gong” ceremony and choosing a toy out of the full toy wagon.

So they, along with other prostate cancer patients and caregivers took the initiative to form a toy fund, one that ProtonPals can support and give back to the Proton Center. The donations are not an obligation, but if you feel so moved any size donation would be appreciated. Drew asks that the donation be a gift card from Toys “R” Us or Target with the donor’s name, patient number (medical ID), labeled ProtonPals and the amount. These should be given to Kelly Wagner the new child life specialist who’s introduced in our newsletter and on the Anderson Website. Your gift to this wonderful custom will be acknowledged with a personal note from one of the physicians. (for the full story see the September Newsletter stored in the archives. http://archive.constantcontact.com/fs057/1102575607143/archive/1102679232772.html

 

Please welcome both Dave Stevens and Drew Cox as new members of the ProtonPals board of directors, and share you knowledge by letting them know how you’re doing.

JEL

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Why Did My PSA Go Up at my 6 Month Check Up?

Posted on September 30, 2011 by jelandry

That’s not supposed to happen is it?

Let’s start with the easy answers: Having sex, doing bike/motorcycle/horseback riding within a week of your PSA test. Or taking testosterone supplements or “performance enhancing” herbs to speed up your recovery. Or going to a different lab to have your PSA done. Any of these could be the culprits. You should tell your proton therapy doctor if you did any of these prior to your PSA reading, since he might want to reschedule another PSA test.

OK, suppose you stayed away from those activities before your recent PSA reading. In that case, the medical literature tells us a great deal about PSA readings and patterns after radiation therapy. (Proton therapy is too new to have a significant body of medical literature on this, but it is believed that the characteristics of protons and radiation are similar in this area.) We’re also assuming you’re not on hormone therapy, where PSA levels respond differently.

So, why did your PSA go up after proton therapy? Radiation therapy studies show that the radiation can act for a long time after therapy ends, and this is true for protons, too. It can take as long as two years after therapy ends (or even three years in extreme cases) for radiation to kill all the cancer cells in your prostate and to be reflected in a low PSA reading. Part of the reason is that radiation (and protons) kill cancer by attacking their DNA, but cancer cells are vulnerable to these attacks only during part of their cell cycle. Sometimes the effect of protons attacking a cancer cell’s DNA is felt only after that cell has reproduced several times but where all of the “descendants” of that cancer cell die without reproducing. Also, prostate cancer cells reproduce slower than cancers in other parts of the body, so that adds more time to the process.  - Dave Stevens  September 2011

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