Prostate Cancer: More Men are Benefiting from Advances, Many Options

Prostate cancer is the second-most common and the secondleading cause of cancer death among men in the United States. But the U.S. rateof prostate cancer diagnoses and deaths are on the decline. That’s mostlyattributed to the growing options available to treat most types of prostatecancer.

For men over 50, there have been significant advances indiagnosing and treating prostate cancer, including drug and radiation therapiesand a range of targeted strategies.

The survival rate for prostate cancer can be very good —with the right treatment. This is partly due to early diagnoses of cancers thatare slow to develop.

“The vast majority of prostate cancers are slow growing,” said Marcio Fagundes, M.D.,medical director of radiation oncology at Miami CancerInstitute. “That means a patient has days, weeks,and sometimes a few months to make a decision.”

The Multimodal Approach
The key to successful treatments is combining diverse expertise — or what’s known as a multimodal approach. A patient can expect the best and most advanced care at a facility that offers all possible resources.

“For example, in our center we have every single modality inradiotherapy,” says Dr. Fagundes. “So we can select the bestmodality, as opposed to offering only the technology that we have — because we haveall of them.”

Leading edge surgeries using fast-evolving technologiesshould be available to men with most types of prostate cancer.

“Advanced robotic systems can do a robotic prostatectomy andalso maintain the quality of life,” says Murugesan Manoharan, M.D.,chief of urologic oncology surgery and director of robotic urologic surgeryat Miami CancerInstitute. “We also have other newer technologiesavailable, such as hydrotherapy and cryotherapy.”

It comes down to the multimodal strategy, he stresses.

“Prostate cancer is quite a wide range of disease,” explainsDr. Manoharan. “In the past, we either offered surgical removal of the prostateor we offered radiation and hormones, and none of these treatments on their ownprovided the best cure rate. Today, we can combine the best of the treatmentsto make every attempt to cure the patient.”

Robotics, Proton Therapy and Other Advances
The multimodal approach is further enhanced by robotic systems; new diagnostic blood tests; MRI fusion biopsies, which provides a more precise biopsy. Also available are newer scans, such as the Axumin PET/CT and the PSMA PET scan, which are very sensitive to cancer; and new radiation therapies, such as stereotactic body radiotherapy (SBRT), and intensity-modulated radiation therapy (IMRT).

Another key new weapon against prostate cancer is protontherapy, which helps minimize side effects that can seriously affect apatient’s quality of life is vital.

“A proton is a particle,” explains Dr. Fagundes. “UnlikeX-rays, which go through the body and imprint an image on film, they’re heavy.They go in and they abruptly stop in the body at a controlled depth. And that’swhere most of the radiation energy is deposited. Thus, we can minimize theexposure of normal organs and minimize side effects.”

Dr. Fagundes was the pioneer user of rectal spacer in theUnited States, also known as SpaceOAR (OAR stands for organ at risk), in thetreatment of prostate cancer with proton therapy, which was only approved bythe U.S. Food and Drug Administration a few years ago.

“When you use high doses of radiation to the prostate,” heexplains, “there is a small risk you could irritate the rectum. SpaceOAR is aliquid that is injected between the prostate in the rectum that displaces therectum away from the prostate enough to lower the dose of radiation on therectum by about 10 times, essentially eliminating the risk of any seriousrectal irritation.”

Both doctors say new technologies and the multimodalapproach has provided new hope for prostate cancer patients — and contributedto the overall declining death rate from this disease.

“Cancer treatment should be personal and individualized,”says Dr. Manoharan. “We want to provide total care, a combined approach to dowhat is best for the patient. And this is possible because we have everythingunder one roof. We can choose whatever is best for the patient.”