Prostate cancer treatment options depend not just on the cancer

In In The News by Barbara Jacoby

By: John Petrick


Getting through cancer treatments can be brutal. It can be like finishing a marathon. But for North Bergen resident and avid runner Francisco Vidal, emerging from his prostate cancer diagnosis and state-of-the-art proton radiation therapy with a clean bill of health was as exhilarating as running a 4-minute mile.

The fairly new and advanced radiation technology he opted for — in lieu of surgery or standard radiation treatments – was painless and minimized side effects like urinary incontinence or bleeding. Thus Vidal never had to interrupt his training regimen in preparation for a half-marathon he ultimately completed in Brooklyn last spring, just months after finishing a 44-visit proton radiation regimen, each lasting just a few minutes. With renewed stamina and clean-as-a-whistle Prostate-Specific Antigen levels, Vidal is now training for the New York City Marathon this fall.

“I never really felt weak,” he says. “Normally, my workout consists of some light weight training and then from there some distance runs. I would just build up my adrenaline. I think, too, when you keep a positive attitude and a good level of energy up, you definitely benefit from that. I just kept my head up,” he says.

September is Prostate Cancer Awareness Month. Vidal, 55, is not just a reminder that men of a certain age need to get their prostates examined (his cancer was detected during a routine screening last year). He’s a reminder of the importance of picking the treatment option that’s right not just for your kind of cancer – but for you.

“I heard about proton therapy on 1010 WINS,” he says of the local all-news radio station. “I immediately called the place because the options the urologist gave me weren’t options that I was looking for. There was just standard radiation, and taking out my prostate. I was very worried about the side effects of those options,” says Vidal, a quality technician for Polyner Extrusion Co. in Newark. “The place” he refers to is ProCure Proton Therapy Center in Somerset, one of only 14 proton therapy centers in the nation, according to Dr. Brian Chon, Vidal’s physician.

“The biggest obstacle to proton therapy is patient access and awareness. Proton therapy used to only be available at Harvard Medical School or Loma Linda University Medical Center in California,” Chon said. “Going forward in the next 10 years, there will be 500 centers across the country. This is a new technology that is evolving, and access is improving.”

If given in sufficient doses, standard radiation techniques will control many cancers. But because of the physician’s inability to adequately conform the irradiation pattern to the cancer, healthy tissues may end up as collateral damage. As a result, a less-than-desired dose is often used to reduce damage to healthy tissues and avoid unwanted side effects.

Higher doses of proton radiation can be used to control and manage cancer while significantly reducing damage to healthy tissue and vital organs, according to the ProCure Center.

“Part of the good news of today is more patients have more and more choices than ever before. But it can also become part of the problem because it can really confuse people if they are inundated with all these choices,” Chon said.

Which option to take depends on the patient. “I have patients come in and say, ‘I can’t stand the thought of this cancer being inside of me.’ Then surgery makes sense. Then I’ll have patients like Mr. Vidal, who is very active and has a very high quality of life. I told him the outcomes and cure rates between surgery and radiation is the same. His feeling was, ‘In that case, let’s go for something non-invasive, especially with proton therapy, which can minimize the exposure of healthy tissue to radiation.’ ”

Dr. Eric Margolis, chief of urology at Englewood Hospital and Medical Center, said no treatment option is completely side-effect free – even proton therapy. He also noted that there are other radiation choices besides just proton or traditional. “There’s a lot of different ways to administer radiation therapy to the prostate. The end results are all very similar,” he said. (Englewood does not currently offer proton radiation therapy, he said.)

“I think what’s most important is that you put together a good team to treat that patient’s particular prostate cancer – the urologist, the radiation oncologist, everybody involved,” Margolis said. “We tend to refer to prostate cancer as one disease when in fact there are many different types, risks and abilities to cause problems or not cause problems.

“Certain types of prostate cancer sometimes require, along with radiation therapy, hormonal therapy. In those cases, we typically give medication that brings your natural testosterone level to very low levels. We typically give that therapy for nine months, during the course of radiation therapy. That would be more likely to cure the higher-risk kinds of cancer.”

And while prostate cancer is one of the slowest-growing cancers and has a high rate of successful treatment outcomes (90 percent, when caught at a low stage, as most are), it is still the second-leading cause of cancer deaths in the United States because of its prevalence, according to doctors. “It’s extremely common,” Chon said. “But many people don’t follow up or take it seriously. If you don’t contain it, just like any cancer, it can grow and it can cause some major problems. This is not the common cold.”

Prostate cancer is very rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50. About six in 10 cases of prostate cancer are found in men over the age of 65, according to the American Cancer Society.

Prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man’s risk of developing the disease himself, the ACS says. The risk is higher for men who have a brother with the disease than for those with a father with it. The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found, according to the American Cancer Society.