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Precision Prostate Cancer Treatment

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LOS ANGELES, CA ( Ivanhoe Newswire) - New treatments are helping men with prostate cancer live longer, but can still cause embarrassing side effects. Now, a new type of guided radiation is making life easier.

Rick Dancer's life is a balancing act; he bounces his way through his intense two-hour daily workouts.

"I think I'm in the best shape that I've ever been in in my life," Rick Dancer told Ivanhoe.

When Rick was diagnosed with prostate cancer last year, he was determined not to let it affect his lifestyle.

"I don't want to live not being able to do the things that I love to do," Rick said.

He tried a new radiation system called the Calypso. It works like a GPS, tracking the prostate's location during the entire treatment. The prostate's considered a moving target during radiation because it changes position when the bladder and rectum are empty or full. With the calypso, doctors can pinpoint the exact location.

"We know exactly where the car is with a GPS device. We know exactly where the prostate is with this device," Howard Sandler, M.D., MS, fastro, Ronald H. Bloom Chair in cancer therapeutics, and professor and chair of the department of radiation oncology at Cedars-Sinai Medical Center, explained.

Three tiny transponders are implanted in the patient's prostate. They emit radio-waves that allow doctors to track exactly where the prostate is at any given time, in real time. The system is so precise the beams only hit the prostate, sparing surrounding organs. Studies show it reduces gastro-intestinal side effects and doctors expect it could reduce sexual side effects too.

"It's like having a movie, a continuous read-out where the prostate is throughout the entire treatment," Dr. Sander said.

Rick continued his grueling workouts even while undergoing radiation. He said the treatments didn't interfere with his active lifestyle. Now, he pushes even harder.

"I just don't want it to win," Rick said.

The new system allows doctors to know where the prostate is within one-millimeter throughout the entire treatment. So far, it's been used on about 6,000 patients in the U.S.

RESEARCH SUMMARY

BACKGROUND: Prostate cancer starts in the prostate gland; and it occurs when cells in the prostate gland grow out of control. Prostate cancer is the most common form of cancer found in men and about one in every six men will be diagnosed with this disease sometime during his lifetime.
SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth); (www.webmd.com

RISK FACTORS: African American men are at a much higher risk of being diagnosed with prostate cancer as well as men who have had a brother or father diagnosed with the disease. Men who are over the age 60 are also at a greater risk, along with those who maintain a diet high in fat, especially animal fat. Other risk factors include: the amount alcohol consumed and one's occupation. 

THINGS YOU DIDN'T KNOW: Men under the age of 40 are rarely diagnosed with prostate cancer as well as vegetarians.

DETECTION: A biopsy is needed to detect prostate cancer. Doctors may recommend a biopsy exam if PSA levels are high or if a rectal exam shows an enlarged prostate. The results are reported using what is called a Gleason grade and a Gleason score. The Gleason grade shows how fast the cancer might spread. It grades tumors on a scale of 1 - 5. Men may have different grades of cancer in one biopsy sample. The two main grades are added together; this gives the Gleason score. The higher the Gleason score, the more likely the cancer is to have spread past the prostate to other organs. SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth)
 
TREATMENTS: There are many factors taken into consideration when treating prostate cancer, including Gleason score and one's overall health. For men in the early stages of the disease treatment may include: surgery (radical prostatectomy) and radiation therapy, including brachytherapy and proton therapy. If a man is in the late stages of prostate cancer, treatment may include: hormone therapy (medicines to reduce testosterone levels), surgery, and chemotherapy. SOURCE: (www.ncbi.nlm.nih.gov/pubmedhealth)

SIDE EFFECTS TO TREATMENT: Men who have had surgery or were treated with radiation or hormone therapy often experience difficulties with urine control. Treatment can affect a man's sexual desire or performance.

LATEST BREAKTHROUGHS: A new monitoring system, called Calypso, is now being offered to men undergoing radiation therapy. Calypso utilizes a precise GPS-like system to track prostate cancer tumors. It provides accurate, precise, real-time tracking to keep radiation focused on the tumor, not surrounding healthy tissue. The result? More radiation reaches the target to better fight the cancer and patients report experiencing fewer side effects in the following areas: bowel urgency and frequency, fecal incontinence and urinary irritation. Also, patients not receiving hormonal therapy experienced slightly fewer sexual side effects. SOURCE: (www.cedars-sinai.edu); (www.calypsomedical.com/)

INTERVIEW

Dr. Howard Sandler, Radiation, Oncology, Prostate Cancer, Chairman of Radiation Oncology at Cedar Sinai Medical Center, discusses a new device for tracking prostate cancer during radiation sessions to reduce side effects.

Prostate cancer is a secret for many men; they don't like to talk about it.

Dr. Sandler: Prostate cancer is a disease people know about but they don't like to talk about. You get a couple of guys together they're not talking about prostate cancer or how their prostate is doing. But prostate cancer is a big problem; it's the most common cancer among US men. Each year, September is prostate cancer awareness month and we're hoping that men will have even a brief conversation with their physician about whether they are a candidate for screening for prostate cancer.

Do the signs just go ignored for a while?

Dr. Sandler: Often prostate cancer is detected by a blood test and physical signs only occur when the disease is very advanced. So we hope to detect prostate cancer before any signs occur. It's detected with a PSA blood test or with a rectal examination.

What is the treatment now for prostate cancer?

Dr. Sandler: There are different kinds of treatments so if a man is diagnosed with prostate cancer, he should meet with a surgeon to talk about surgery and a radiation oncologist to talk about the radiation options.

We're talking about radiation and specifically how to track the tumor?

Dr. Sandler: Radiation is a very precise treatment for prostate cancer. It's so precise that it's very important to know where the prostate gland is during every radiation session. And so one technique for tracking the prostate during a treatment is called "GPS for the body" and it uses small radiofrequency tracking devices to pinpoint the prostate gland and show us where the prostate is throughout the entire treatment. This kind of technology really helps us target better and by targeting better we can reduce the side effects that are potentially a problem from treatment.

What would those side effects be?

Dr. Sandler: The side effects can include sexual dysfunction or urinary problems and those effects can be reduced by careful tracking.

With the tracking with this GPS device does it cut down on radiation to other organs and tissues?

Dr. Sandler: Side effects from radiation occur when other organs that aren't cancerous get some radiation. By tracking the prostate and minimizing the exposure of other organs we can reduce the exposure and thus reduce the side effects.

How does the Calypso work?

Dr. Sandler: The Calypso device uses radio waves, the kind that we listen to in the car, so they're totally innocuous. These radio waves hit a very small device called a transponder that's inserted into the prostate. When the device gets hit by these radio waves, it emits another radio wave which allows us to track exactly where it is. It's like the GPS device in your car.

Is this the first time you've had real time tracking?

Dr. Sandler: This is the first time we've had real time tracking. I've done some research using a more static tracking technology using tiny gold seeds that allowed us to take a snapshot at an instant in time and know where the prostate was. But if the prostate moves right after we take the picture, we couldn't detect it with the old technology. With the new Calypso technology, it's like having a movie, a continuous readout of where the prostate is throughout the entire treatment. The treatment could be as long as fifteen minutes and over that entire fifteen minute time we know exactly where the prostate is.

It seems like technology for prostate cancer is changing every year.

Dr. Sandler: You're exactly right and this just doesn't happen accidentally. Today's technology is a result of research and planning. It took a number of years for this particular technology to be developed and marketed. But there are new technologies that are coming along all the time, new drugs, new surgery, and new radiation devices. At Cedars-Sinai, we're happy that we can offer this latest prostate tracking technology to our patients.

Prostate cancer is one of the more survivable ones.

Dr. Sandler: It is. Prostate cancer is very, very common and so unfortunately, a lot of men get it. But the good news is that if it's detected and treated early, the cure rate is very high.

Do you think this technology in prostate cancer is very well thought out because of the aging population?

Dr. Sandler: I think that new discoveries in medicine that improve things are a result of a little bit of chance and a little bit of foresight. I think it's hard to make plans for the future and so you do the best you can and with some good planning and a little bit of luck we make things better every year.

Do you think this technology has made your life better and easier?

Dr. Sandler: This technology has made our patient's lives better and easier. If we can treat a man's prostate and reassure them that their chance for side effects is less during treatment and afterwards, they're satisfied.

Have you changed anything in your lifestyle knowing and treating prostate cancer every day?

Dr. Sandler: I've had discussions with my own physician about prostate cancer screening and I've had my prostate checked annually for the past several years. I think it's important for me as a doctor who takes care of prostate cancer patients to monitor my own prostate for potential prostate cancer.

FOR MORE INFORMATION, PLEASE CONTACT:

Simi Singer
Senior Media Specialist
Cedars-Sinai Medical Center
(310) 423-7798
SusanSimi.Singer@cshs.org

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