 |
| |
Typical Prostate Cancer Advisory Session. |
| |
Patient |
May I speak with a Prostate Cancer Adviser_ |
|
| |
Receptionist |
Yes. Are you a member of ECPCP_ |
| |
Patient |
No, I am not. |
| |
|
If the caller is not a member,
the receptionist will ask for his name and address in order to mail him
an ECPCP information packet. The caller can also join ECPCP at this time. |
| |
Receptionist |
I will connect you with Dr. James Lewis, who will be
your Adviser. |
| |
Adviser |
This is Dr. Lewis, and I will be your Adviser for the
time being. Please be advised that I am not a medical doctor; my doctorate
is in philosophy. The information I have to share with you is for your general
information, and if you wish to share it with your physician, you are encouraged
to do so. If you wish to act on the information I give you, I advise you
to speak to your medical doctors. You may wish to get a second or third
opinion. Now, could you begin by telling me some particulars such as your
age, PSA level, Gleason score, stage (if known), general health, and anything
else you feel is relevant_ |
| |
Patient |
My name is John Doe, and my urologist has just told
me that my biopsy came back positive and that I have prostate cancer. I
am 55, my PSA level is 6.5, and I have a Gleason score of 6 and stage T1c
disease, which I understand, is an early stage. My doctor said that I have
a 90% chance of being cured with surgery. My friend said I should speak
to you folks before going any further with surgery. What advice can you
give me_ |
| |
Adviser |
Well, unfortunately, I am not as optimistic as your
urologist is. Dr. Patrick Walsh, a famous urologist at Johns Hopkins Hospital,
has done a 10-year statistical study on radical prostatectomy, and his cure
rate is 70% with selected patients. Some doctors have a lower cure rate.
Have you undergone any diagnostic tests yet_ |
| |
Patient |
Yes, I had a CT scan and a bone scan, and they were
both negative. |
| |
Adviser |
Your PSA was 6.5, so the CT and bone scans would be
expected to be negative. Usually, when PSA is under 10, the CT and bone
scans detect very little. I would like you to consider having a spectroscopic
MRI to determine if the cancer is confined to your prostate gland. Many
physicians are unaware of this test. This is the same diagnostic test that
Andy Grove, CEO of Intel, underwent after he found out that he had prostate
cancer. Unfortunately, there is only one medical center in the country that
is exploring early--staged disease, and it is located in San Francisco.
If, after you speak to your doctor about this conversation, he feels a spectroscopic
MRI is necessary, let me know. I will tell him who to contact in San Francisco
and/or send him some literature on this test.
Most doctors believe that radical prostatectomy has the highest "cure"
rate. There are two ways to perform this surgery. In one, known as perineal,
the operation is performed through an incision between the scrotum and
the anus. The disadvantages of this method are that it requires another
procedure for analyzing the lymph nodes, possibly a laparoscopy. In the
other approach, known as retropubic, an incision is made from the navel
to the pubic bone, which allows access to the lymph nodes. In terms of
side effects, surgery may be the worst of all. Side effects can include
incontinence, urethral stricture, and impotence.
When a radical prostatectomy is not warranted because your disease is
outside of your gland, most urologists usually recommend radiation. Conventional
external beam radiation uses photons to radiate prostate cancer. External
beam radiation has been improved over the years. It is a process in which
a beam of radiation is used to kill prostate cancer cells. Most of today’s
cancer centers use a linear accelerator and a three-dimensional conformal
approach to radiation. Usually, the dose of radiation used is from 6800
to 7000 rads. The side effects of this treatment may include urinary obstruction,
chronic diarrhea, and impotence. External beam radiation may include either
photon or proton beam. The latter doesn’t destroy healthy cells as much
as does the former. Both therapies may include combination hormonal therapy
and seed implantation. The cancer centers that use photon beam radiation
have produced 10-year scientific studies indicating that this therapy
is almost as good as surgery.
We recommend that if you are going to undergo external beam radiation,
you should consider undergoing at least 8 months of combination hormonal
therapy (CHT) at the same time. In fact, research has shown that a patient
undergoing 8 months of CHT has reduced marginal disease.
Today, one of the most popular forms of radiation is brachytherapy, or
seed implantation. This approach involves inserting tiny pellets containing
radioactive seeds (about the size of a grain of rice) into the prostate
gland to kill the cancer cells. There are three approaches to performing
this therapy:
- Single treatment: seed implantation alone (permanent or temporary
seeds)
- Separate treatments: external beam radiation followed by seeds
- Synergistic treatment: Iodine-125 seeds (that have a half-life cycle
of 60 days), along with external beam radiation.
The side effects vary based on the individual approaches; however, they
tend to be less than with surgery or external beam radiation. Basically,
the side effects include urinary problems, rectal problems, and impotence.
An option, which some doctors still maintain is experimental, is cryosurgery.
Cryosurgery is a 1- to 2-hour procedure that uses liquid nitrogen probes
to freeze the prostate gland, including any cancerous cells. The side
effects include incontinence, rectal bleeding, temporary numbness at
the tip of the penis, and impotence.
There are some other options that I have not mentioned because I would
not advise you to consider them. They include watchful waiting (that
is, doing nothing but watching the progress of your disease), or CHT,
or bilateral orchiectomy (surgical castration) to shut down the production
of testosterone in order to stop cancer growth. These options offer
patients a median survival time of only two years, and often they will
not put their disease in remission.
Some patients are interested in hyperthermia and neutron radiation for
treating prostate cancer, but I don’t think they have been used much
in this country.
Now that I have spoken to you about several of your options, I will
tell you the names of some world-renowned physicians. I would like you
to contact them by phone. Tell them Dr. Lewis referred you; that may
give you some leverage. You may wish to get some of their literature,
such as statistical studies, brochures, etc., to study before actually
speaking with them. Don’t forget to jot down questions as you read the
material. I am only giving you the name of one physician for each area
I have discussed with you. If, for some reason, you find it difficult
to get in touch with any of these doctors, call me back, and I will
recommend someone else. I consider all the doctors that I recommend
to be the "cream of the crop."
If you are interested in getting more information on the spectroscopic
MRI, contact Dr. John Kurhanewicz at (475) 476-0312. In terms of treatment
options, call Dr. William Fair at (212) 639-2000 for radical prostatectomy
information; Dr. Gerald Hanks at (215) 728-2940 for photon beam radiation;
Dr. Carl Rossi at (909) 824-4257 for proton radiation; Dr. Michael Dattoli
at (813) 972-7230 for information on seed implantation alone; Dr. Timothy
Mate at (562) 933-0300 for temporary seeds; Dr. John Blasko at (206)
548-7900 for external beam radiation plus seeds; and Dr. Frank Critz
at (404) 320-1550 for information on seed implantation with external
beam radiation.
I realize that you have a great deal of information to collect and understand,
but don’t fret; you have someone at The Education Center for Prostate
Cancer Patients who can help you to control your disease through knowledge.
|
| |
Patient |
Boy! This is a lot of information to gather and study.
I’m glad I have people like you folks to help me. When should I call you
again_ |
| |
Adviser |
When you have finished your homework. |
| |
Patient |
Thank you, James. |
| |
Adviser |
Not at all! Be well, my friend. |
|
|
|
