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Archive for February, 2010

Athletic Brothers Shocked by Common Diagnosis of Prostate Cancer

— Studies show brothers are more likely to be diagnosed

with early onset prostate cancer —

 

Westmont, IL, August 25, 2009 – When former golf pro Joe Leskis of Bartlett discovered he had prostate cancer two years ago at age 55, he was shocked that someone his age with such an active lifestyle could be diagnosed with the “big C”.  “Everyone has a fear of cancer and I definitely thought the worst,” he explains.

What came as even more of a shock to Joe was just two years later when his younger brother, Guy, of Winthrop Harbor, and Joe’s former caddy, was diagnosed with prostate cancer at age 53.  Like Joe, Guy is an active golfer, traveler and fisherman and neither brother was aware of prostate cancer in their family history.  Since their diagnoses, both men have chosen and successfully undergone brachytherapy (radiation seed implantation) treatment at the Chicago Prostate Center and have learned that they may share a hereditary susceptibility predisposing them to early onset prostate cancer.

The Leskis brothers’ story is consistent with new research on prostate cancer.  According to an article published in the Journal of Urology, more than 40% of the cases in men diagnosed with prostate cancer before the age of 55 may be due to heredity. Men whose fathers or brothers had prostate cancer are, on average, diagnosed six to seven years earlier than men with no family history of this disease.*

While both men enjoy an active, healthy and normal lifestyle today, what  differentiates the Leskis brothers is how their prostate cancer was diagnosed.  Both brothers had blood tests to determine their PSA levels, an indicator of potential cancer cells.  Elder brother Joe, after watching his PSA level climb steadily to a score of 11 (desired range is 0-4), discovered his cancer after his urologist performed a traditional, in-office transrectal biopsy (TRPB) which took eight samples of his prostate gland.  Guy, on the other hand, watched his PSA slowly climb (any increase in the level can be a warning sign) to a 3.3 and his transrectal biopsy tested negative.  Concerned about a rising PSA with no answers, his brother recommended a visit to Dr. Moran who performed a new state-of-the art biopsy called the stereotactic transperineal prostate biopsy (STPB), which he helped develop.  Guy’s STPB showed cancer in five of a total 31 samples taken and he, too, underwent brachytherapy at the Chicago Prostate Center.

A study by the Prostate Cancer Foundation of Chicago published in the February, 2009 issue of Urology, shows that among men testing negative for prostate cancer who have had at least one TRPB biopsy, nearly 40% of them will test positive for cancer after undergoing the STPB biopsy.

The Chicago Prostate Center was established in 1997 with the goal of providing patients with comprehensive care focused on the treatment of prostate cancer with brachytherapy. The Chicago Prostate Center is the country’s only free-standing facility dedicated to the treatment of prostate cancer.  For more information, visit www.prostateimplant.com or call 630.654.2515.  To view theUrology article, visit http://www.chicagoprostatefoundation.org or call 630-654-2515.

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Brian Moran, M.D. – Comprehensive Biopsy Predictive of Final Pathology

Some patients have been told that one of the advantages of having surgery to remove the prostate (radical prostatectomy) is that it is the only true way to thoroughly review the pathology of the disease.  At Chicago Prostate Cancer Center, we now know that Stereotactic Transperineal Biopsy (STPB), sometimes referred to saturation biopsy, is very predictive of final pathology at time of radical prostatectomy.  Below is an article we have written comparing results of the two procedures.

FINAL PATHOLOGY IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY: A CORRELATION STUDY BETWEEN stereotactic transperineal prostate biopsy AND RADICAL PROSTECTOMY

Dean J. Conterato, MD, Michelle H. Braccioforte, BS and Brian J. Moran, MD

Prostate Cancer Foundation of Chicago, Westmont, Illinois USA

 

Purpose:  Biopsy of the prostate is the most influential factor regarding prostate cancer treatment decisions. Stereotactic transperineal prostate biopsy (STPB) provides a more comprehensive assessment of cancer extent and location due to the large number of systematic biopsies.  The purpose of this study was to analyze patients who underwent STPB prior to radical prostatectomy (RP), and to correlate the pathologic findings between the two procedures.

 

Materials and Methods:  1452 consecutive patients with continued rising total prostate specific antigen (PSA) having had a minimum of 1 prior benign transrectal extended systematic sextant prostate biopsy (range 1-10), underwent STPB at a single out-patient institution between 04/2004 and 11/2009.  Median patient age, total PSA, prostate volume and number of specimens obtained were 63.11 years, 7.9 ng/ml, 45.1 cm3 and 38 specimens, respectively (Table 1).  Specimens were obtained according to x, y, and z coordinates from equal octants with pathology reported accordingly.  STPB yielded adenocarcinoma in 582/1452 (40%) patients.  103/582 (18%) patients with positive biopsy chose to undergo radical prostatectomy.  Radical prostatectomy and pathologic review was performed by multiple physicians at both community and university hospitals. Consent forms and pathologic reports were obtained in 85/103 (82.5%), of patients and reviewed.

 

Results:  There was a 62/85 (73%) concordance rate between Gleason score reported on STPB and final prostatectomy specimen.  Gleason score increased in 13/85 (15%) while downgrading was noted in 10/85 (12%) of patients.  18/85 (21%) patients had positive margins.  There was a strong correlation of Gleason score and prostatectomy positive pathologic margins.  In 81/85 (95%) patients, STPB accurately predicted location of malignancy with prostatectomy specimen.

Conclusions:  STPB is efficacious for diagnosis of non-palpable, isoechoic occult prostate malignancy as demonstrated by the high concordance rate between biopsy and prostatectomy.  It may also enhance research efforts regarding targeted therapy within the prostate gland.  Furthermore, STPB may result in more reliable diagnosis with less undergrading compared to other biopsy techniques.  Finally, histologic grade can suggest probability of positive pathologic margin.  Considering this group of patients was previously undiagnosed and after radical prostatectomy, 21% were found to have positive margins, TRPB may be inadequate for a subset of patients.  This information may influence the decision making process regarding appropriate treatment options.

Table 1: Patient Characteristics

MEAN MEDIAN RANGE
Age (years) 62.84 63.11 40.7 – 85.1
PSA (ng/ml) 9.95 7.9 0.6 – 92.8
Volume (cm3) 49.56 45.1 5 – 163
# Prior TRPB Sets 1.54 1 1 – 10
# Cores on prior TRPB 12.68 12 4 – 56
# Cores on STPB 36 38 10 – 117
# Malignant Tissue Cores 4.21 3 1 – 26
Highest % Involvement 26.8 15 1 – 100

 

Ongoing work and research is moving us closer to offering focal therapy for prostate cancer.  Soon we intend to demonstrate that focal therapy in select patients is a reasonable alternative to whole gland treatment such as prostate brachytherapy or external beam radiation. Provided cancer control is equal to standard treatment options, there are additional benefits, mainly that of dramatically reduced toxicity for the patient and reduced cost.  In conclusion, this approach is not new, as it has been proven in breast cancer treatment with lumpectomy and kidney cancer treatment with partial nephrectomy.  At Chicago Prostate Cancer Center, we have favorable experience using focal therapy in the form of hemi-implant (half prostate implant).  These are patients who have been previously biopsied with STPB, which maps the malignancy.  We have then been able to design an implant for the same side of the prostate as the positive biopsy.  Based on our biopsy information, patients have done well with no local failures and essentially no toxicity.

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Brian Moran,M.D. – Brachytherapy – Best Radiation Treatment for Prostate Cancer

There has been much controversy over the past several years regarding the best treatment option for prostate cancer.  To date, there is no clear-cut data to prove the advantage of surgery over other treatment options.  Recently, there has been a new enthusiasm for IMRT (Intensity Modulated Radiation Therapy) and proton beam radiation therapy for the treatment of prostate cancer.  Again, there is no data to support that either therapy is superior to brachytherapy for the treatment of prostate cancer. However, there is data suggesting that brachytherapy is superior to IMRT.  Data from the latest Meeting of the American Brachytherapy Society, presented by Michael Zelefsky, M.D. from Sloan-Kettering Cancer Center, NY (June 2009), compared 2292 patients that were treated with IMRT or brachytherapy.  Results found that the 7-year PSA relapse-free survival (PRFS) for low-risk patients was 92.4% for patients treated with brachytherapy and 91.6% for patients treated with IMRT.  However, the 7-year PRFS for intermediate-risk patients treated with brachytherapy and IMRT were 91% and 79% respectively.  There appears to be a trend to late failures with IMRT for intermediate-risk patients, thus proving the superiority of brachytherapy over IMRT.[1]  In addition, there is no data suggesting proton beam radiation therapy is better than IMRT [2].  Therefore, using the classic logic argument, if A (brachytherapy) > B (IMRT), and B = C (Proton Beam), then A > C. There will never be a randomized study of brachytherapy vs. IMRT vs. proton beam because of physician bias and patient preference.  Unfortunately, in today’s healthcare market, some physicians are making patient recommendations based on their own financial gain and not regarding the patient’s best interest. (See our blog below regarding Dr. Simone’s article “The Gullible Decade”). [3]

Aside from scientific data, there are other reasons why brachytherapy is superior to other forms of external beam radiation therapy.  A big reason is cost.  Brachytherapy is a much more cost effective form of treatment.  On average, brachytherapy runs $8,000 plus the cost of the seeds.  While the cost of IMRT ranges from $35,000 – $55,000 and proton beam therapy can exceed $100,000.  One must also look at patient consideration when evaluating treatments.  Brachytherapy is a 1-time (1 day, out-patient) procedure with a patient able to resume daily activities within 1-2 days.  However, both IMRT and proton beam therapy involve 30-60 min. treatments 5 times per week over 8 weeks.  Not to mention the travel time to and from the radiation facility which are usually not located right in a patient’s community.

In conclusion, there is much data out there to support brachytherapy as a superior therapy in the treatment of prostate cancer.

1.  Zelefsky MJ, Yamada Y, Kollmeier MA, et al: Comparison of tumor control outcomes and toxicity between LDR brachytherapy and high dose IMRT for clinically localized prostate cancer. Brachytherapy 8:105-180,2009.

2.  Nguyen PL, Trofimov A, Zietman A:  Proton-beam vs intensity-modulated radiation therapy; Which is best for treating prostate cancer? Oncology 22:748-754, 2008.

3.  Simone JV: The gullible decade. Oncology Times  6, Jan 25, 2010.

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Suicide Risk Higher in Patients Diagnosed with Prostate Cancer

According to a recent article published in Reuters (Feb. 2, 2010), being diagnosed with prostate cancer roughly doubles the risk of suicide or death from a heart attack.  A team of researchers from Harvard and Brigham & Women’s Hospital in Boston looked at data from 340,000 prostate cancer patients between 1979 and 2004.  While this particular study found that the elevated suicide risk of patients in this database has decreased since PSA screening became standard practice in 1993, there is still an increased risk of death from heart attacks and strokes.  However, a study in Sweden last month by the same team, did find an elevated suicide risk associated with PSA testing.

The stress of prostate cancer diagnosis alone has its own risks.  If you or a loved one is diagnosed with prostate cancer, please be aware that many options are available to you.  Most importantly, you need to discuss your situation with family, loved ones and physicians to help get through this difficult time. Do not try to go through it alone.

The Prostate Cancer Foundation of Chicago offers a support group the first Wednesday of every month to those who have prostate cancer. The support group meetings are from 7:00-9:00 pm at the Chicago Prostate Cancer Center, 815 Pasquinelli Drive, Westmont, Illinois  60559.

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2 Independent Studies Released on the Effectiveness of Brachytherapy for the Treatment of Prostate Cancer

Westmont, IL, August 27, 2009 – For years, the debate has been ongoing regarding the best treatment method for prostate cancer patients.  Now, two independent studies have reached similar conclusions. Already considered a good option for prostate cancer patients, brachytherapy (radiation seed implants) now has the backing of research from The Prostate Cancer Foundation of Chicago and The Taussig Cancer Center at Cleveland Clinic, proving a superior disease-free survival rate for patients with early stage prostate cancer.

            In an eleven-year study, the Prostate Cancer Foundation of Chicago, a non-profit organization that funds patient support programs, clinical research and public education, analyzed 9,137 patients treated for prostate cancer at the Chicago Prostate Center in Westmont, Il.  From October 1997 to October 2008, patients underwent prostate brachytherapy to treat their cancer.   67.5% of the patients were regarded as low risk, 29.36% as intermediate risk, and 1.01% as high risk.

Of those patients, overall cure rates were 96%, 84%, and 75% for low, intermediate, and high risk patients, respectively. When combined with external beam radiation therapy in intermediate and high risk patients, the brachytherapy results far exceed those of surgery.

The Taussig Cancer Center at The Cleveland Clinic has released their similar 2008 outcomes, demonstrating brachytherapy to be superior to surgery in all cases.  For low risk prostate cancer patients, the study found a 95% survival rate after five years; intermediate risk an 89% rate; high risk 71%.  This research concluded that, for low risk patients, brachytherapy was equally successful as external beam radiation, but more successful than a radical prostatectomy.

Michelle Braccioforte, Research Director at the Prostate Cancer Foundation of Chicago, explains, “There is a misconception that removing the prostate completely results in 100% cure, which is not true.  Not any one treatment is ever 100% successful, but brachytherapy has excellent cure rates, is a one-time, outpatient procedure, and is the most cost-effective.”

In addition to its effectiveness, brachytherapy is a minimally invasive treatment. It involves the implantation of radioactive seeds directly at the source of the cancer. Delivered by a needle and guided by ultrasound, the seeds destroy the DNA within the cancerous cell – effectively killing the tumor. Patients with prostate cancer in the T1 or T2 stages (meaning the cancer hasn’t spread beyond the prostate) choose brachytherapy for a number of reasons:

  • No incisions, minimal pain and blood loss
  • Urinary incontinence rates less than 1% – compared to 10% with surgery
  • 6-25% chance of sexual dysfunction following procedure – compared to 50% with surgery
  • Much lower rates of bowel irritation compared to external beam radiation
  • Convenience – one-time procedure done on an outpatient basis which requires no hospital stay, patients are fully recovered and can return to normal activity within a day
  • Lower cost compared to external beam radiation and surgery

 

With prostate cancer success rates on the rise, it is important to note that early detection can make all the difference when fighting prostate cancer. Doctors recommend that men have a yearly PSA test and digital rectal exam starting at age 50 – and age 40 for African-Americans.

Risk factors have been found to include:

  • Heredity – Greater risk if a father or brother has had prostate cancer
  • Age – Men over 50 are more at risk
  • Race – African-American males are more at risk

For more information on the Chicago Prostate Cancer Foundation research, visitwww.chicagoprostatefoundation.org.  For more information on the Taussig Cancer Center at Cleveland Clinic, visithttp://my.clevelandclinic.org/services/radiation_oncology/outcomes.aspx.

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