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hopeful and optimistic
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edited September 2013 in Prostate Cancer #1

  Click here to go directly to the article: (AOL users click here.) Note: This article is only accessible through the above link for 7 days from the date of this e-mail. After that it can be found in Ivanhoe's archive using the "Search Reports" box on the left side of every page of P.S. Would you like to be the First to Know about breakthroughs in medicine? Sign up for our FREE weekly e-mail at /scripts/p_firsttoknow.cfm (AOL users click here). Click here for a print-friendly version of this report Click here for a print-friendly version Reported September 23, 2013 New Therapy for Prostate Cancer

PITTSBURGH, Pa. (Ivanhoe Newswire) -- Doctors have used stereotactic ablative body radiation therapy to treat brain, lung, and pancreatic cancer in the past- but now researchers at the University of Pittsburgh Medical Center are testing the effectiveness of this treatment on patients with early-stage prostate cancer. Submit SubmitSixty two year old pilot Randy Hass feared his prostate cancer would ground him. Incontinence is a common side effect of surgery, and a serious issue for a pilot. “The top priority is being cured. Everything else is secondary after that. But lifestyle, after you get done with treatment, is the next biggest,” Randy Hass told Ivanhoe. Surgery and conventional radiation would have meant months of recovery time. Instead, Hass recovered in weeks. He opted for an experimental therapy for early- stage prostate cancer- called stereotactic ablative body radiotherapy. Doctors use advanced imaging- like CT scans, pet scans, and MRI’s- and fuse them with a patient’s radiation scans.Submit “We can target tumors inside the body, even tumors that are moving with breathing and respiration, with the accuracy of a tip of a pin,” University of Pittsburgh School of Medicine Chairman of the Radiation Oncology Department, Doctor Dwight E. Heron, told Ivanhoe. During the therapy, tiny radiation beams hit the tumor from multiple angles, passing safely through healthy tissue. Patients need only five treatments, instead of the standard forty or more. “This is the cutting edge of cancer treatment,” Hass said. Doctors say so far, the success rate of SABR mirrors the traditional treatments for early stage prostate cancer. This treatment is for patients with low and intermediate risk cancer, which means a PSA level of 20, or less; a Gleason score of seven or less, and no evidence that the cancer has spread. MORE eported

September 23, 2013

New Therapy for Prostate Cancer --

Research Summary BACKGROUND: Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. (SOURCE: Estimated new cases and deaths from prostate cancer in the United States in 2013: New cases: 238,590 Deaths: 29,720 (SOURCE: SYMPTOMS: Prostate cancer that is more advanced may cause signs and symptoms, such as: Trouble urinating Decreased force in the stream of urine Blood in the urine Blood in the semen (SOURCE: TREATMENT: Stereotactic ablative radiotherapy (SABR) is a specialized type of radiotherapy. It is sometimes called stereotactic body radiotherapy. This treatment uses scans and specialized equipment to precisely target radiotherapy to treat certain cancers accurately. SABR is usually given over a shorter time than standard radiotherapy. SABR may be an alternative to surgery for people who can’t have surgery or where the tumor is in a difficult area to operate on. It can also be used to treat secondary cancers in the lung, liver, lymph nodes, spine and other sites. It is also being used to treat prostate cancer in a clinical trial. (SOURCE: Reported September 23, 2013

New Therapy for Prostate Cancer

Dwight E. Heron, MD, FACRO, FACR, specializes in stereotactic radiosurgery at the UPMC/University of Pittsburgh School of Medicine, talks about a new method for treating the prostate. What does SBRT stand for and what is it? Dr. Heron: SBRT stands for Stereotactic Body Radiotherapy.

One way to think about it is like a GPS (global positioning satellite) for the body. It allows us to pinpoint tumors, frankly, anywhere in the body using a coordinate system. This is the same technology that UPMC pioneered for the treatment of brain tumors nearly 30 years ago. Now we’re re-pioneering this process for the treatment of a variety of different cancers throughout the body, including prostate cancer.

You describe it as a GPS system. What happens?

Dr. Heron: It’s sort of a navigation system for the body. The GPS system really is the fundamental basis for your navigation system in your car or on your cell phone. It allows you to get from point A to point B by markers essentially using these satellites. Essentially we’ve deployed a virtual satellite system around the patient’s body and everything is in reference to one another. With our machines, I can say the tumor is in the lung, and it even may be moving in the lung. However, with this system, I can tell where that tumor is at every point in space and time. Unlike things in the prostate or in the brain, tumors in the lungs can move. The technology we’re using, called SBRT, Stereotactic Body Radiotherapy, is highly focused and has the accuracy frankly of a tip of a pin. You want to be certain that the tumor is exactly where you expect it to be at every time point, if the beam is going to hit the tumor and destroy it. This GPS navigation type system, which is called stereotaxy, allows us to really focus the beam on the tumor and in doing so we can spare a lot of the normal healthy tissue and that reduces toxicity and side effects from treatment; which leads to better quality of life.

Can you describe for me again just how focused is it?

Dr. Heron: Stereotactic Body Radiotherapy uses very small focused radiation beams from multiple angles that allow us to focus the beam on the tumor. When the beams passes through normal tissue, they see very little radiation dose, but the tumor that’s at the intersection of the beam sees all of the radiation dose. That’s how the tumor is in fact destroyed. We can target tumors inside the body, even tumors that are moving like with from breathing and respiration with the accuracy of a tip of a pin. That’s how accurate Stereotactic Body Radiotherapy is.

How are you able to be so accurate?

Dr. Heron: We’re able to target these tumors with that degree of accuracy because we use advanced imaging. The University of Pittsburgh Medical Center pioneered, in fact, developed the PET/CT Scanner. We use very advanced imaging such as PET/CT’s and MRIs and we can fuse them with our radiation planning scans. Because we can see these tumors with great detail, which is what’s required, we can target them with a great degree of accuracy. It’s not just targeting the delivery side, you have to be able to image and see the tumor well. We’ve pioneered the use of this technology and the combination of these technologies, really for the advancement of this treatment paradigm, which is Stereotactic Body Radiotherapy (SBRT). What is the benefit to the patient with this kind of therapy as opposed to your traditional? Dr. Heron: There are a number of advantages for SBRT as follows: One, we just talked about is the highly focused nature of reducing the side effects to the uninvolved nearby tissues; it’s potency in destroying tumors themselves. However, unlike conventional radiation treatments, these treatments are usually delivered in one to two weeks; one to five treatments as opposed to traditional radiation, which may be 35 or 40 treatments. With the new technologies that we have here at UPMC CancerCenter, even SBRT treatments that would have taken an hour to an hour and a half in the past are now delivered in as little as five to ten minutes. When you talk about comfort to the patient laying on the table for one hour and laying on the table for five or ten minutes, there are huge differences. That’s what we do routinely every day here at UPMC CancerCenter.

You had mentioned that this therapy had been used for other kinds of cancers, but now we’re talking about prostate cancer, which is a very common cancer. How have you gotten to the point in being able to use it for these different cancers, specifically for prostate?

Dr. Heron: UPMC pioneered stereotactic radiosurgery back in the late 1980s. We have now brought the same concept to treatment of tumors outside the brain, such as in the head, neck, and lung, abdominal and pelvic areas. We’ve certainly learned over the last five or seven years that prostate cancer is an ideal disease to be treated with this technology.

Why is prostate cancer the ideal cancer for this kind of a treatment?

Dr. Heron: Prostate cancer is the ideal candidate for this kind of treatment for a number of reasons. One, it’s a very common cancer. It happens to also be one of the cancers that takes the longest to be treated with radiation; it’s 45 treatments. So that’s nine weeks worth of treatment which, for a lot of men, is a problem. A lot of these men are still continuing to work. The side effects sometimes last as long as, if not twice as long as, the actual treatments course. There’s a quality-of-life issue that happens with that as well. There are also some biological reasons. From the research that a number of institutions like ours have done over the years, we have recognized that prostate cancer cells themselves behave differently from say a head-neck cancer or a lung cancer. By giving these larger although focused doses of radiation, we believe we can actually destroy these tumors with greater efficacy than the traditional approaches to prostate cancer. Having said that, we have 10 to 12 years worth of data on using something called IMRT, Intensity- Modulated Radiation Therapy for prostate cancer. We really only have about five to seven years worth of data using SBRT for prostate cancer. At least the preliminary data seems to trend very nicely with what we would have seen with IMRT at the same time point a few years ago. It appears to be just as good with fewer side effects and therefore that’s the advantage for using SBRT. If the outcome is the same, and the toxicities are in fact less, than here’s a therapy that really needs to be explored. We’re currently doing that in the context of a clinical trial. Obviously the first goal is to get rid of the cancer.

What are you seeing again in terms of success rates?

Dr. Heron: The success rates appeared to mirror our traditional approaches. They appear to follow what we would expect in terms of outcome for patients treated with non-operative approaches. Whether it’s prostate seed implantation or IMRT, or the combination of the two, it appears that men with early-stage prostate cancers, treated with Stereotactic Body Radiotherapy have similar outcomes in terms of disease control. There is a difference in terms of side effects. In fact, the treatments with SBRT appear to have fewer side effects then treatment with IMRT or other therapies such as surgical resection. Who is the best candidate for the SBRT? Dr. Heron: The perfect candidates for Stereotactic Body Radiotherapy are men with low- or intermediate- risk prostate cancer, which is defined as men who have a Gleason score of seven or less; have a PSA of 20 or less and who have no evidence of what we call distant metastatic disease (cancer hasn’t traveled to other parts of the body or the lymph nodes in the pelvis). Those are the candidates for SBRT, which happens to be the majority of men that are diagnosed with prostate cancer in the United States.

Tell me a little bit about the clinical trial.

Dr. Heron: We’re the lead institution, amongst several other institutions, around the country, enrolling men with early-stage prostate cancer; so-called, low- and intermediate- risk. Fiducial’s are placed (tiny gold markers) in the prostate which allow the system to track the tumor in the prostate, with that high degree of accuracy. Following the MRI, five treatments are delivered on an every other day basis. The treatments are delivered in about five to ten minutes. After the patients have completed treatment, we continue to see the patients at 1, 3, 6 and 9 months intervals and thereafter to keep a close monitor on the PSA, which is the test that we use to follow how well these patients are doing. I can tell you in the nearly 35 patients that have been treated so far, we have seen dramatic drops in PSA, of over 75 to 80% within the first three months. How efficacious has the treatment been? It’s been rather dramatic. This data is just supporting what we’ve known, and what other folks have published in a retrospective fashion. We’re doing this in a very rigorous way in a prospective clinical trial format. I think our patients who have gone through these treatments can tell you what the experience has been like. Overall, they have had far fewer side effects than they would have anticipated. The data in terms of control appears to be similar to what’s been published in the literature.

If a patient has the SBRT and there’s a recurrence of cancer, can they get this treatment again or then do you have to move to another form of treatment?

Dr. Heron: This is still a very relatively new form of therapy. There’s not a large body of literature on retreatment of prostate cancer with SBRT. However, we’ve certainly had patients who’ve had prostate seed implants or external beam before that have been retreated with SBRT. Theoretically speaking, because the distribution is so tight around the prostate and the other tissues are getting so little radiation, it’s possible to retreat these patients. I think more commonly than not, there are some centers around the country, ours is one of them, where our urologists are experienced enough that they could go and perhaps remove the prostate. Again, the data is not mature enough at this point to be able to say how efficacious retreatment is with SBRT, but it is certainly on the table.

Are there any risks or side effects to SBRT?

Dr. Heron: The side effects for SBRT are relatively similar, although the incidences are less than the other forms of radiation therapy. Because the bladder sits right on top of the prostate, there can be irritation of the bladder and bladder neck which could lead to them having to go to the bathroom more frequently. Right behind the prostate is the rectum so there can be rectal irritation, looser bowel movements and sometimes patients can have blood in their stools. Those are self-limited and usually resolve within the first 30 days. By the time patients return to me for their first follow-up, a lot of these side effects have settled down and dissipated. Many of our patients are able to get these treatments in a very short period of time allowing them to get back to their baseline and back to their way of life. That’s one of the most attractive things about this treatment strategy for prostate cancer.

The face of cancer really changes every year doesn’t it?

Dr. Heron: Yes, it does. And it’s exciting because what we’ve been able to do with these kinds of technologies is really to make treatment, not a scary thing, but rather to make our therapies kinder, gentler, and more effective. That’s what we strive for in the cancer centers here and with the technologies of treatment designs that we’ve come up with.

In terms of the clinical trial are you still enrolling? How many men are you hoping to enroll and how long is the period of the clinical trial before we see any kind of results?

Dr. Heron: We’re starting to see initial results already. We track these patients very carefully. We’re planning on enrolling 111 men in this clinical trial. There are other centers across the United States that are participating. Certainly we’re also looking for other centers that would be willing to participate. We anticipate that we will close this trial within the next year or so. We believe that this will be one of the first clinical prospective trials that allows us to evaluate this therapy in a really rigorous fashion. However, the early data seems to suggest that we’re having the intended effect.

Is there anything that I didn’t ask you that you would want people to know?

Dr. Heron: Patients that have a diagnosis of prostate cancer should ask their physicians what options are available. One of the options that should be on the table now is SBRT. SBRT has been used for things like lung cancers, recurrent head and neck cancers, pancreatic cancers and a host of other cancers where in the past, we would have said that there’s nothing else we can do, or that we can only give you chemotherapy. We now have the ability, even with patients who have metastatic disease, to cure them. So I think that the opportunity to have this comprehensive discussion is important. Therefore ask your doctors about stereotactic radiotherapy (SBRT). Am I a candidate? If so, ask to be seen or referred to a center that has this capability.



This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.


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