Physicians
   

Prostate Cancer

Cancer of the prostate is the most common non-skin cancer in the United States. It will affect an estimated 209,900 men in 1997. While there is no doubt that undiagnosed prostate cancer is often found in men during autopsies, and that the cancer is often indolent, the disease remains a vexing problem: 40,400 men are expected to die of prostate cancer this year.

The treatment of prostate cancer is highly controversial as well as topical. Last year the disease made the covers of many magazines (including Time and Fortune) and was the subject of countless TV and newspaper reports. There is a lot of good information out there but also a lot of misinformation. Experts in different specialties often disagree about the most appropriate treatment for an individual patient. This makes decision-making enormously difficult for patients and their families. The options vary from radical surgery to doing nothing (watchful-waiting). Even with radiation there are a variety of ways of tackling the problem: there are external beam treatments, conformal radiotherapy, proton treatments, radioactive implants, combinations of the above, as well as using hormones and radiation together.

The physicians of Valley Radiotherapy Associates Medical Group (VRA) are all seasoned experts at dealing with prostate cancer at all stages. We are very aware of the dilemma many men are experiencing when trying to reach a decision that they - and their doctors - feel comfortable with. We are also very sensitive to the fact that all of the treatments for this disease can effect a man's quality-of-life. At stake is not just his survival but his potency, his continence, his ability to have normal bowel movements and his ability to continue working - both during the treatment and afterwards. Every man we see with prostate cancer has a comprehensive examination and consultation with one of our physicians. At that time we explain the benefits and risks of radiation, compare radiation to the other treatments available (with regards to efficacy and side-effects), make our best recommendations and answer all the patient's - and his family's - questions. We consider our approach to prostate cancer to be unique in that we offer not only the finest in technical proficiency available, but also extreme sensitivity to the difficult decisions our patients are making.

Conformal radiotherapy is the most modern, up-to-date form of external beam radiation treatments. Until recently, this form of treatment was available only at large cancer hospitals like Memorial Sloan-Kettering Cancer Center. VRA was the first group to bring this cutting edge technology to our communities. The treatment involves the use of sophisticated immobilization devices, CAT scans, powerful computers and advanced treatment machines to make the radiation beam more precisely "conform" to each individual prostate. This improved targeting and delivery system allows us to avoid irradiating normal, healthy parts of the body better than ever before. These treatments also allow us to deliver a higher dose of radiation to the prostate. It's a "win-win" situation where more cancer is killed and less healthy tissue is harmed. Already, this newer form of treatment has been shown to have fewer side-effects than conventional radiation. Conformal radiation is not for every man with prostate cancer, and VRA physicians are experts at selecting the best treatment for each individual man.

Radioactive implants into the prostate are another exciting, new treatment for prostate cancer. VRA physicians are expert in selecting men for these procedures, and performing the operations. Radioactive seed implants have become extremely popular with both patients and doctors in the past few years. This form of treatment is often the most convenient available (a one-hour, out-patient procedure with little - or no - recovery period). Some evidence also suggests that this treatment may have fewer side-effects (impotency or incontinence) than either external radiation or radical surgery. Again, not all men are suitable for the procedure and it's extremely important that patients consult with doctors who have a large experience in both counseling patients and performing these procedures.

Unfortunately, the disease is occasionally so advanced that attempts to cure it are not possible. The good news is that the disease is often slow growing even when advanced. There are many ways that even an advanced cancer can be treated with radiation to remove symptoms and improve the quality-of-life. For example, cancer that has spread to the bones often causes pain or fractures. Radiation can eliminate the pain or prevent the fractures. Unlike chemotherapy, this form of radiation usually does not cause nausea, vomiting or hair loss. There are also injectable forms of radiation (Strontium-89) that can be given to remove the pain of tumor spread to bone and improve the quality-of-life in our patients. Removing pain in our patients is as important a mission to the physicians of VRA as curing cancer.

References:

1. Detection and Treatment of Early Stage Prostate Cancer, The Journal of Urology, Vol 152 No 5, Part 2 of 2 (pages 1677-1940), November 1994

2. Kupelian et al, External Beam Radiotherapy versus Radical Prostatectomy for Clinical Stage T1-T2 Prostate Cancer: Therapuetic Implications of Stratification by Pretreatment PSA Levels and Biopsy Gleason Scores, Cancer J Sci Am, Vol 3 No 2, pages 78-87, 1997

3. Prostate Cancer: A Non-Surgical Perspective by Kent Wallner M.D., SmartMedicine Press, Canaan, New York, 1996

4. The Prostate: A Guide For Men and the Women Who Love Them by Patrick Walsh, MD and Janet Farrar Worhtington, Warner Books, Inc, New York, New York, 1997

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