Prostate cancer is the second-most common and second-most deadly cancer afflicting men in the United States, with 1 in 9 men diagnosed with the disease at some point in his life. However, the survival rate for prostate cancer can be very good— with the right treatment.
“The vast majority of prostate cancers are slow growing,” points out Marcio Fagundes, M.D., medical director of radiation oncology at Baptist Health’s Miami Cancer Institute. “That means a patient has days, weeks, and sometimes a few months to make a decision.”
A multimodal approach
Making that decision involves maximizing your options. “It’s very important to seek care at a facility that has all the possible or available resources,” says Dr. Fagundes. “For example, in our center we have every single modality in radiotherapy. So we can select the best modality, as opposed to offering only the technology that we have — because we have all of them.”
This comprehensive approach to treatment options extends to the surgical realm as well. “Advanced robotic systems can do a robotic prostatectomy and also maintain the quality of life,” notes Murugesan Manoharan, M.D., chief of urologic oncology surgery at Miami Cancer Institute. “We also have other newer technologies available, such as hydrotherapy and cryotherapy.”
Having different treatment modalities allows them to be combined in what’s known as a multimodal approach. “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.”
The cutting edge
The multimodal approach is further augmented by adoption of cutting-edge treatments, including the aforementioned robotic systems; new diagnostic blood tests; MRI fusion biopsies, which are a targeted and more precise biopsy; newer scans like the Axumin PET/CT and the PSMA PET scan, which are very sensitive to cancer; and new radiation therapies, like stereotactic body radiotherapy (SBRT), and intensity-modulated radiation therapy (IMRT). One important new weapon is proton therapy.
“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.”
Quality of life
Minimizing side effects that impact a patient’s quality of life is vital. Now practicing at Baptist Health, 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 FDA 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 agree that these new technologies and the multimodal approach benefits patients. “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.”