"Systemic Prostate"

Date: Tuesday Evening, March 16, 2004
Location:  Texas Cancer-Sherman, 2800 Highway 75 N.

6:30 PM - Social & Coffee
7:00 PM - Program

Speaker:  Dr. Mary Hebert, Texas  Cancer Center - Sherman and Denison.

Program: We will tour the Cancer Center facilities and see the radiation therapy area.  We will learn the latest results from radiation therapy treatments for prostate cancer.
 At the end of the program, Dr. Hebert will be available to discuss your particular options.  Also we will have a few minutes to discuss prostate cancer treatments of interest to you based on members' experience who have had radiation, brachiotherapy, or radical prostatectomies.  
Speaker: Dr. Hebert is a long time speaker at our meetings, and is well versed in the latest treatments for prostate cancer.

Old Business

 None

New Business

 None.

Program:  "Systemic Prostate Cancer: Current Treatments and Controls"
Dr. Barker also briefly discussed the new prostate cancer vaccines now entering Phase III trials.

Speaker:  Dr. Larry Barker, Texas Oncology, Sherman Cancer Center and Denison Cancer Center

Program:  Dr. Barker did an excellent review of prostate cancer and the various treatments.

The meeting adjourned about 9 PM.

Henri Plunkett, Program Chair/by the Editor

When would radiation for PC not be advisable?
Palliative radiation therapy
Gleason grading and scoring

WHEN WOULD RADIATION FOR PC NOT BE ADVISABLE

During the 1980's whole pelvic radiation was done routinely on high grade prostate cancer patients. The rationale was should the cancer have escaped  the gland, radiation of the whole pelvis would accomplish a cure. Then later, the PSA test led to the discovery by doctors that patients formerly thought cured, indeed were not. WHY?

Obviously the cancer was not just in the pelvic regions. Closer studies, over time, indicated the high Gleason scores of 8, 9, 10 usually meant that this cancer had already spread to distant areas such as to the bones, liver, lungs, or lymphatic system. DOCTORS then realized that cancers growing outside of the prostate, and that remained after radiation therapy were not curable (to date). In modern forms of radiation the fields of target for radiation have been narrowed to reduce the collateral damage to nearby tissues such as rectum and bladder. Therefore radiation, such as a 3d conformal beam or IMRT (Intensity Modulated Radiation Therapy) beam or proton beam or neutron beam, can't kill PC cells outside the prostate --where the cancer is but the radiation isn't.

Here is the catch, those cells must still be in the prostate fossa, or bed, meaning very nearby the prostate gland.  Now when should a doctor not advise radiation. Obviously if one has a high Gleason score and associated high PSA, and clinical staging that indicates bulky disease one would consult closely with his doctor to satisfy himself as to the probability of a satisfactory outcome. Just were to exactly draw this line to where radiation therapy has high odds for success is not well known to the medical field today.  My opinion,  a rather young man in a estimating scenario as     described above, might want to take a chance - provided his oncologist or urologist agrees.  An
 older weaker male with a shorter life expectancy would probably be advised against radiation by his doctor.  Please remember, other therapy options remain should radiation not be advisable.  Thee alternate therapies include androgen deprivation therapy ( hormonal therapy).

If any of this is confusing to you, be glad that this is not be your field of study.  HOWEVER here at USToo! Texoma, we try to keep abreast of the most current information as well as ask our speakers to keep us up to date. We therefore  hope you will attend our seminars to stay abreast of your treatment options. Or email us, and we will do our best to get you the info you are seeking.

...........................  Henri Plunkett

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PALLIATIVE RADIATION THERAPY               

 In the context of treating a pc patient with advanced disease, sometimes doctors use radiation on specific target areas of the body to hopefully alleviate pain (this treatment is sometimes referred to as palliative treatment). As PC metastasizes to bone, sometimes a patient reports tremendous pain. Usually this pain can be controlled with a small amount of radiation to that specific area. This therapy would be the external beam form, not seeds or HDR (High Dose Radiation, usually external) forms of radiation. Also external beam radiation is used in prevention of male gynemastia, (breast enlargement). Occasionally a PC patient placed on hormonal therapy will encounter breast enlargement as a side effect, usually this situation can be alleviated with about three treatments of external beam radiation to the breast areas.

Obviously radiation has many useful applications in the field of prostate cancer therapies. One must get the right information on the various forms of this therapy for his individual pc problems. One can ask his doctor and also get great information at our PC seminars from our speakers or others. Also you can call or e-mail us, we will get you the right info for your needs, however the final decision will be yours, so do your homework.....................................Henri Plunkett

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HORMONAL THERAPY BEFORE RADIATION

The administering of testosterone reduction before radio therapy is a topic of debate among PC Physicians. Testosterone is most important for the growth and function of prostate cells whether they are normal healthy cells or cancer cells. Most doctors agree that without testerosterone, one's prostate cells start to atrophy, slow their growth and some cells achieve apoptosis, (cell death). However some prostate cells seemingly learn to adjust and survive without this favorite food. This is why most doctors do not believe a man can ever be cured of PC by   hormonal therapy treatment, alone. Now where the PC is not diagnosed as organ confined, the use of hormonal therapy before radiation may be useful since radiation beam therapies alone don't kill cancer outside the radiation field (confined to the prostate gland area).

Since the object of radiating the prostate is to target enough radiation to kill all the prostate cells and therefore not just stun them, one would like to weaken or stun them before radiation therapy. The pre-radiation weakening is thought by some to be possible through the use of hormone therapy. However there some controversy here (I go on the theory that if the benefits offset the disadvantages-do it. Editor). Some doctors cite studies that show overall survival benefits are never seen for such pre-radiation use. Now my opinion is this, most of these studies never compare   apples to apples to apples, such as A) treating 100 men with radical prostatectomy (surgery) with any Gleason score and finding the percent failed and cured to B) the same outcomes for studies with radiation or C) radiation plus pre-radiation hormonal therapy.  (If you want to explore this issue further, please question our speakers at the appropriate time in one of our meetings. Editor).  One does not see studies on 100 men with the same Gleason sums, same clinical staging and similar PSA's. When these scientists configure and finish such studies and report, one might see the benefit of pre- hormonal therapy verified. Until then, common sense dictates, if you want to try everything in your power to try and cure oneself of PC, then the consideration of hormonal therapy might give you that extra edge to help eradicate and kill all PC cells. At least, talk this pre-therapy treatment  over with your doctor and leave the equation of costs out of counseling. The medieval concept of  your money or your life is not acceptable in this great American society, and,  hopefully to you................................Henri Plunkett

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News You Can Use

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Jerry Bylander - Newsletter Editor