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Advanced imaging, vessel-sparing radiation techniques help in prostate cancer treatment

A University of Michigan Health Minute update on important health issues.

As more men are cured of disease, focus shifts to quality of life
--added 9/7/05

Ann Arbor, MI. -- Even with a family history of prostate cancer, 42-year-old Ray Harvey was stunned when he was diagnosed with an aggressive form of the disease.

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“I kind of expected it because my father and grandfather had it, but I thought I would be 60 or 55 or something like that,” says Harvey, who was diagnosed after receiving a prostate cancer screening during a routine physical.

Fortunately, Harvey's diagnosis came at a time when new advances and more sophisticated imaging techniques have led to as many as 90 percent of prostate cancer patients being cured.

“For 90 percent of the men I see, they're going to be cured of their prostate cancer. They're detected early, and we have great treatment. Now the goal is for 90 percent to have no side effects or no long-term complications,” says Patrick W. McLaughlin, M.D., clinical professor of radiation oncology at the University of Michigan Comprehensive Cancer Center and the Providence Hospital Assarian Cancer Center.

Harvey chose an intensive type of treatment called brachytherapy, in which tiny radioactive seeds are implanted within the prostate where they emit high doses of radiation to kill the cancer.

“If you put these seeds within the prostate, you get this tremendous dose right where the cancer resides and very little dose around the prostate, which fulfills our goal of trying to cure cancer and limit doses,” McLaughlin says.

The seeds are implanted using small needles, similar to those used in an IV. Doctors use ultrasound and X-rays during the implanting to monitor where the seeds are placed. After, MRI and a CT scan help them see down to the millimeter what dose they were able to give the prostate and what dose will affect nearby healthy tissue.

“Imaging has been the key in our progress toward improving quality of life over the past few years. We've been able to image these different structures and limit dose. As we do our surveys and objective analysis of what symptoms men experience and how their function changes over time, there's a very clear correlation,” McLaughlin says.

prostate imaging Researchers at the U-M Comprehensive Cancer Center have used advanced imaging techniques to develop an improved method of delivering radiation therapy. By more clearly defining the bottom of the prostate, the U-M oncologists are able to avoid delivering radiation to the blood vessels that control erectile function. They equate this vessel-sparing radiation technique to advances in surgery that led to nerve-sparing prostatectomy that helped men preserve their sexual function.

One of the dilemmas patients face after a prostate cancer diagnosis is choosing from several treatment options. Studies have not shown any of the options lead to greater survival rates. What it comes down to for most men is a choice between side effects.

“No treatment available right now, whether it's surgery or radiation therapy or seed implants, is without side effects. The long-term side effects, though, with all these treatments have dramatically changed. We've known for years that if we give dose to those structures down below the prostate that it can lead to problems that can go on for years. As we've begun to avoid those structures or limit dose to those structures, we are beginning to see a dramatic difference in these side effects and long-term effects, and that's probably the most exciting advance,” McLaughlin says.

Ray Harvey had some discomfort right after his treatment but says he now hardly notices he was treated for prostate cancer.

“Now everything's pretty much the way it was before. I go to the bathroom the same, I have sex the same, walk and talk. I'm not having any incontinence and just everything's about the same. Sometimes when I move a certain way, I can kind of feel the implant or that something has happened there. That's about the only time I'll get reminded,” Harvey says.

Some 232,000 men will be diagnosed with prostate cancer this year, according to the American Cancer Society, and about 30,000 men will die from the disease.

Early detection saves lives

“As an oncologist, I'm often asked ‘Will there ever be a cure for cancer?' And I actually can say with a straight face, with regard to prostate cancer, there is a cure. It's called screening. Screening allows us to find these cancers earlier than we ever had before, and modern treatment allows us to cure them 90 percent of the time,” McLaughlin says.

Screening recommendations vary by risk. African-American men, for example, should begin screening earlier – a guideline that led Harvey to an early diagnosis.

Current screening methods include a digital rectal exam and a blood test to look for a protein called prostate specific antigen, or PSA, that is often elevated when prostate cancer is present.

Screening recommendations are for yearly exams beginning at the following ages:

  • Men with average risk – age 50
  • African-American men – age 45
  • Men whose father, brother or son had prostate cancer – age 45
  • Men with two or more first-degree relatives with prostate cancer – age 40

Resources

U-M Comprehensive Cancer Center:
prostate information

National Cancer Institute:
www.cancer.gov/cancertopics/types/prostate

American Cancer Society:
www.cancer.org (under “choose a cancer topic,” select prostate cancer)

U-M Cancer AnswerLine™: 800-865-1125

 

Written by Nicole Fawcett

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This article is part of the Cancer Center's News Archive, and is listed here for historical purposes.

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