Baylor offers new tactics to fight prostate cancer

A routine physical exam and clear thinking may have saved Steve Schmidt's life. Schmidt, of Lantana, Texas, expressed surprise when his primary care physician detected a suspicious prostate lump and referred him to a urologist. The 53-year-old had never experienced difficulty urinating, which can be a sign of prostate problems.

When a biopsy revealed cancer, the urologist recommended a traditional open surgery. With the cancer confined to his prostate, Schmidt's prognosis looked good. Yet he took the time to research his options.

"When you hear the results of the biopsy and you are told it's cancer, it is the individual's responsibility to learn as much as you can," Schmidt says. "That's key to making a decision you are most comfortable with."

Schmidt read about robotic surgeries performed at Baylor University Medical Center at Dallas. The technology allows surgeons greater visibility and dexterity during surgery.

One meeting with Matthew Shuford, MD, a urologist on the medical staff at Baylor Dallas, persuaded Schmidt to proceed. He has no regrets and remains cancer-free.

"It gave me the opportunity to have advanced equipment and technology currently available," Schmidt says of the robotic approach.

Whether at the point of diagnosis or at a later stage in dealing with prostate cancer, men have gained more convenient and life-prolonging options thanks to medical innovations practiced at Baylor Dallas.

Like Schmidt, many patients newly diagnosed with prostate cancer choose surgery to remove the gland. Robotic-assisted prostatectomy helps them avoid a lengthy recovery period. Physicians, using the da Vinci^® Surgical System, make several half-inch-long incisions in the abdomen. They insert a camera and small instruments to carry out the procedure.

"It's a tool that lets us perform standard prostate removal surgery without a large incision," Shuford says. "It has advantages in terms of short-term outcomes. It is less invasive, allowing shorter hospital stays, fewer days with a catheter and earlier return to normal activity."

The da Vinci camera magnifies and produces a three-dimensional image, making the internal organs, nerves and blood vessels appear 10 times larger than normal. The instruments also provide greater range of motion than a human wrist, Shuford says. These two features offer surgeons better control and allow more precise tissue removal. The robotic technique does not, however, reduce the risk of incontinence and impotence associated with surgical prostate cancer treatment.

With a few exceptions, any patient who is a candidate for an open procedure could have the surgery done with robotic assistance, according to physicians. Prior abdominal surgeries may preclude use of the da Vinci technology. But Shuford says there are no absolute restrictions.

Patients normally spend one night in the hospital and typically return to regular activities faster than with the traditional surgery, which is usually a few days in the hospital and several weeks until full recovery after an open procedure.

Schmidt spent two nights at Baylor. And just five days after his postoperative visit with Shuford, he was feeling well enough to prepare for a prostate cancer 5K fund-raising event.

Techniques known as external-beam radiation and radioactive seed implants offer additional primary treatment options for prostate cancer. In addition, physicians on the medical staff at Baylor are participating in a clinical trial investigating the use of CyberKnife^® radiosurgery to treat early-stage prostate cancer.

"Our goal is eradicating prostate cancer by delivering traditional radiation doses over a much shorter period of time — five days instead of 40 days for conventional radiation therapy," says Troy Scott, MD, a urologist on the medical staff at Baylor Dallas. Scott expects the trial to show survival rates comparable to traditional radiation and surgery.

"CyberKnife has the ability to wrap the radiation dose tightly around the prostate and monitor the prostate and patient motion in near real time," Scott says.

"We're very excited about using radiosurgery for prostate cancer. It allows a much more convenient treatment course," adds radiation oncologist Brian Berger, MD, associate medical director of the Radiosurgery Center and a physician on the medical staff at Baylor Dallas. "And there is radiobiological evidence that prostate cancer may respond better to larger doses administered over a shorter time."

During the first phase of the trial, physicians on the medical staff at Baylor will enroll 10 men with early-stage adenocarcinoma of the prostate. They will undergo a short procedure to place four gold markers in the prostate. Those markers will help the CyberKnife's positioning system to continuously and accurately identify and track the tumor.

A CT scan and X-rays will be taken about one week later to confirm the markers are in the correct location. At that time, the patient will begin a radiation treatment plan and therapy the following week.

The CyberKnife system tracks a tumor throughout each treatment session. If any movement is detected, it immediately adjusts the beam's location accordingly. This protects normal surrounding tissue from exposure to radiation. Every time a patient returns for a visit — each CyberKnife session lasts about one hour — he will be placed in the same position and secured in a special device. Doctors will monitor patients' response to treatment.

Physicians on the medical staff at Baylor also are researching better treatments for men with advanced prostate cancer. The U.S. Food and Drug Administration appears close to approving Provenge^® (sipuleucel-T). If approved, it will be the first immunologic treatment for prostate cancer.
The therapy begins with a process to draw blood and remove specific immune cells from the patient. The cells are then stimulated so they are more active against prostate cancer cells. Once stimulated, the cells are returned to the patient's body.

"As we followed the patients who were treated, it became increasingly clear there was a positive impact on survival," explains John Nemunaitis, MD, executive director of the Mary Crowley Medical Research Center and a physician on the medical staff at Baylor.

Nemunaitis enrolled patients in a phase II trial that ended two years ago. He is currently accepting patients whose cancer has progressed while on hormone therapy for a phase III trial. Patients will receive either Provenge or a placebo three times during a one-month treatment regimen.

Provenge will offer men a treatment for battling cancer with fewer side effects than chemotherapy, Nemunaitis says. Current regimens produce too many unpleasant and potentially life-shortening side effects, he adds.

Nemunaitis anticipates the treatment will open the door to more immune-based cancer therapies. Trials for similar agents to fight other forms of cancer are already under way at Mary Crowley and Baylor Dallas.

"Now that science is enabling a better understanding of the immune system, treatments such as Provenge are coming about in clinical investigation," Nemunaitis says. "This is the tip of the iceberg. Opportunities in research today will become reality tomorrow."   : :

Disclaimer: Baylor Research Institute and Mary Crowley Cancer Research Centers are not affiliated. Each reviews, approves, and conducts clinical trials independently. Their clinical trials are listed together, in this publication, for the convenience of patients and physicians.

Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instruments, S.A., Geneva, Switzerland.


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