Prostate Cancer: More Men are Benefiting from Advances, Many Options

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September 5, 2019

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Prostate cancer is the second-most common and the second leading cause of cancer death among men in the United States. But the U.S. rate of prostate cancer diagnoses and deaths are on the decline. That’s mostly attributed to the growing options available to treat most types of prostate cancer.

For men over 50, there have been significant advances in diagnosing and treating prostate cancer, including drug and radiation therapies and a range of targeted strategies.

The survival rate for prostate cancer can be very good — with the right treatment. This is partly due to early diagnoses of cancers that are slow to develop.

“The vast majority of prostate cancers are slow growing,” said Marcio Fagundes, M.D., medical director of radiation oncology at Miami Cancer Institute. “That means a patient has days, weeks, and sometimes a few months to make a decision.”

The Multimodal Approach
The key to successful treatments is combining diverse expertise — or what’s known as a multimodal approach. A patient can expect the best and most advanced care at a facility that offers all possible resources.

“For example, in our center we have every single modality in radiotherapy,” says Dr. Fagundes. “So we can select the best modality, as opposed to offering only the technology that we have — because we have all of them.”

Leading edge surgeries using fast-evolving technologies should be available to men with most types of prostate cancer.

“Advanced robotic systems can do a robotic prostatectomy and also maintain the quality of life,” says Murugesan Manoharan, M.D., chief of urologic oncology surgery and director of robotic urologic surgery at Miami Cancer Institute. “We also have other newer technologies available, such as hydrotherapy and cryotherapy.”

It comes down to the multimodal strategy, he stresses.

“Prostate cancer is quite a wide range of disease,” explains Dr. Manoharan. “In the past, we either offered surgical removal of the prostate or we offered radiation and hormones, and none of these treatments on their own provided the best cure rate. Today, we can combine the best of the treatments to make every attempt to cure the patient.”

Robotics, Proton Therapy and Other Advances
The multimodal approach is further enhanced by robotic systems; new diagnostic blood tests; MRI fusion biopsies, which provides a more precise biopsy. Also available are newer scans, such as the Axumin PET/CT and the PSMA PET scan, which are very sensitive to cancer; and new radiation therapies, such as stereotactic body radiotherapy (SBRT), and intensity-modulated radiation therapy (IMRT).

Another key new weapon against prostate cancer is proton therapy, which helps minimize side effects that can seriously affect a patient’s quality of life is vital.

“A proton is a particle,” explains Dr. Fagundes. “Unlike X-rays, which go through the body and imprint an image on film, they’re heavy. They go in and they abruptly stop in the body at a controlled depth. And that’s where most of the radiation energy is deposited. Thus, we can minimize the exposure of normal organs and minimize side effects.”

Dr. Fagundes was the pioneer user of rectal spacer in the United States, also known as SpaceOAR (OAR stands for organ at risk), in the treatment of prostate cancer with proton therapy, which was only approved by the U.S. Food and Drug Administration a few years ago.

“When you use high doses of radiation to the prostate,” he explains, “there is a small risk you could irritate the rectum. SpaceOAR is a liquid that is injected between the prostate in the rectum that displaces the rectum away from the prostate enough to lower the dose of radiation on the rectum by about 10 times, essentially eliminating the risk of any serious rectal irritation.”

Both doctors say new technologies and the multimodal approach has provided new hope for prostate cancer patients — and contributed to the overall declining death rate from this disease.

“Cancer treatment should be personal and individualized,” says Dr. Manoharan. “We want to provide total care, a combined approach to do what is best for the patient. And this is possible because we have everything under one roof. We can choose whatever is best for the patient.”

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