May 27, 2020 by John Fernandez
Survivor’s Message: ‘Get Checked Early’ With A Family History of Prostate Cancer
Michael Justiz is a man in constant motion. His work as an independent commercial producer, a regular workout schedule, and family life with his wife and two kids keep him busy – but never too busy to take care of his health.
“My family history is extensive when it comes to prostate cancer,” he says. “My father had it, my grandfather had it, and my younger brother was diagnosed with it at age 42. It was something I was very cognizant of, and so I’ve been diligent about going to my doctor.”
(Watch now: The Baptist Health News Team hears from prostate cancer patient Michael Justiz and Marcio Fagundes, M.D., medical director of radiation oncology at Miami Cancer Institute. Video by Carol Higgins and Anthony Vivian.)
While the most common risk factor for prostate cancer is age, the second is family history. In fact, one study found that men with both a brother and father with prostate cancer had about three times the risk of being diagnosed as the general population. So Justiz and his urologist met regularly to monitor his status with physical exams and PSA (prostate-specific antigen) level tests.
After years of watchfulness, in 2018, Mr. Justiz heard the words he’d hoped to escape: “You have cancer.” If there was a bright side to this news, it was that the disease had been diagnosed early, while still confined to the prostate.
“Once I went through the denial phase, I ended up going into the ‘okay, what the heck are my options’ phase,” he says.
Surgery was the first option presented to Mr. Justiz. But having seen the difficulties his brother went through after surgery, he was determined to find a less invasive alternative.
“When I started researching, I had no idea there were so many radiation options out there. I heard about 40-day regimens, 20-days, and then I heard about a five-day and I said — wow, that’s got my interest. I asked everywhere and found out that Miami Cancer Institute offered the five-day as an option if you qualify. My amazing wife, Joanne, was the one who found Dr. Fagundes.”
“Radiation treatments can be delivered over a prolonged period of time, that would be the more conventional way of doing it,” says Marcio Fagundes, M.D., medical director of radiation oncology at Miami Cancer Institute. “Now, in many cases we can do five sessions, which is called SBRT: stereotactic body radiotherapy.”
After finding that Mr. Justiz was a good candidate for SBRT, the next step was determining which radiation modality to use.
“Miami Cancer Institute has all of the latest radiation treatment modalities including protons, TrueBeam, CyberKnife and MR Linac, so we can actually individualize the choice for each patient by determining which modality will produce the best radiation plan for the patient’s specific cancer,” explains Fagundes, who decided that MR Linac would be the best tool to use in this case. “These different modalities work in different ways. MRI Linac, for example will actually visualize the prostate as the beam is being delivered and if the prostate moves, the beam will be held until the prostate is back in the correct position and then the radiation delivery will continue.”
Mr. Justiz was intrigued by the technology behind the machine. “It’s an MRI machine with a radiation gun inside, so basically you’ve got smart bombing that can target specifically just the prostate and not damage the surrounding soft tissue, which to me sounds like a really smart thing to do. I think at the time there were only 5 of these machines in the country, and Miami Cancer Institute had one, right in my neighborhood.”
To further reduce the risk of damage to healthy tissue, Dr. Fagundes suggested the use of a soft gel-like material, called SpaceOAR, which is placed prior to radiation treatment and gradually absorbed by the body after treatment is completed.
“The results of stereotactic body radiotherapy are very good because we’re using very high doses in just five sessions,” says Dr. Fagundes “To do this in the safest manner, we use rectal spacer gel to push the rectum away from the prostate to further minimize dose to the rectum and essentially eliminate the risk of any severe rectal injury from the treatment.”
Says Mr. Justiz, “The thing about the MR Linac is the treatment is longer than the regular radiation treatment; you’re in the MRI tube for up to 45 minutes. But when you know that you’re only going to be doing five of them, it makes it much, much easier.”
Mr. Justiz’s radiation treatments didn’t slow him down a bit. Just days after finishing the five sessions, he was able to fly to Washington State for a long-planned family holiday celebration, something that would have been out of the question with a weeks-long treatment regimen or surgery.
Now, nine-months post treatment and cancer free, he’s passionate about sharing his experience with others.
“If there’s one word I can share with men out there with a family history of prostate cancer, it’s diligence,” says Mr. Justiz. “Run, do not walk to your urologist. You’ve got to get checked out, and if you’re diligent about it, you may just be early enough to get the easier treatment. The later it’s caught, the more difficult the treatment becomes and the less your chances of survival become. So get checked early because that could be the difference between life and death.”