Golden Gate Cancer Center

Is PSA screening helpful?

Dr. David Kornguth — Mon, 10 Oct 2011 20:29:03 +0000

I believe there is a clear benefit to screening men with PSA. I also believe that politics and policy colors the recommendations of groups that discourage screening for cancer. I screen PSA for myself and I strongly recommend it to men in my family.

PSA screening was analyzed in two large trials. The European Randomized Study for Screening of Prostate Cancer (ERSPC) was published in 2008. This study was twice as large as a similar, but flawed, US trial. The European trial had longer follow-up, and was a much cleaner trial (no PSA screening prior to entry on the trial, better compliance in the screened group, much less PSA screening in supposed non-screened group). It showed a clear and convincing 20% reduction of cancer deaths by the use of PSA screening. The study conclusions showed that by screening men 55-69 with PSA and offering regular follow-up, an increase in early detection was found, resulting in decreased deaths from metastatic disease.

The U.S-run Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was published around the same time. In this trial (N Engl J Med 2009;360:1310-1319), 76,693 men at 10 US screening centers were randomized to annual PSA and DRE screening versus no screening. The results showed that there was no reduction in mortality in the screened group at 7 and 10 years. However, only 85% of the screened group actually received PSA screening, and over 50% of the control group indeed were screened outside of the trial, blurring any possible results. Likewise, almost 50% of the subjects in both groups were screened prior to the trial, which most likely selected out cases of more significant cancer even before the trial began.

Why not just remove my prostate?

Dr. David Kornguth — Tue, 26 Jul 2011 15:55:00 +0000

Patients should understand that surgery, known as radical prostatectomy, does not always successfully remove all cancer cells. This is particularly true for High Risk and advanced stage prostate cancer. The reason that surgery can’t always cure people is that cancer cells are not visible nor can the surgeon remove cells that have spread beyond the prostate capsule without causing serious side effects. Even years after surgery, patients can have a rising PSA which can mean that the cancer has started growing again. When that happens, patients have several treatment options including radiation, surgery and hormone therapy. Discussing these options with your treatment team is critical so you understand the tradeoffs.

What happens to the prostate after radiation treatment?

Dr. David Kornguth — Fri, 24 Jun 2011 15:42:13 +0000

The cancer is replaced by scar tissue and most(or all) of the prostate is also replaced by scar tissue. Dead cells are cleaned up by your immune system during and after treatment. Cancer cells are more sensitive to the radiation because of the daily dose schedule. Cancer cells have less time to repair radiation damage and are typically less able to repair damage because they have impaired repair machinery.

Can Acupuncture help treat cancer?

Dr. David Kornguth — Thu, 23 Jun 2011 17:13:47 +0000

Acupuncture is an ancient Chinese technique used to treat a variety of medical conditions. I do not believe that Acupuncture can cure cancer, though I believe it might help manage some treatment related side effects like fatigue, discomfort and mental well being. Cancer cells are derived from our normal cells but grow in an uncontrolled way. Acupuncture cannot kill these cells nor does any data suggest it can.

Is this the same kind of radiation that spread in Japan, Chernobyl and Three Mile Island?

Dr. David Kornguth — Fri, 17 Jun 2011 16:32:59 +0000

No. The main health issue with industrial radiation accidents is that airborne radioactive particles can be swallowed or inhaled which can be absorbed into your body for long periods of time leading to multiple health problems.

Treatment of prostate cancer is a targeted treatment using a temporary emission of radiation using electricity to produce photons. There are no photons when the electricity is turned off. Therefore, you are never “radioactive.” Instead your prostate is targeted with high energy X-rays for about 90 seconds when you are being treated and there are no radioactive particles after that 90 seconds is completed.

How come I don’t feel sick even though my doctor told me I have prostate cancer.

Dr. David Kornguth — Fri, 17 Jun 2011 16:25:46 +0000

This is among the most common questions from my patients. In order to “feel” cancer, it has to have spread extensively to the nerves which surround the prostate or spread into the bone in other parts of the body. When either of these events occur, it is too late to completely cure you of your prostate cancer. Your best chance of being completely cured of prostate cancer is to treat it when it is small and before it causes symptoms. This seems strange to many people since they are treated when they feel perfectly healthy. This is part of the reason you should have a discussion with your primary physician during routine appointments.

Can a prostate biopsy make my cancer spread?

Dr. David Kornguth — Fri, 17 Jun 2011 16:16:55 +0000

The short answer is no. This has been examined in several different ways and there is certainly no evidence that a trans-rectal biopsy can make prostate cancer spread.

Can supplements be used to treat prostate cancer?

Dr. David Kornguth — Tue, 17 May 2011 21:03:51 +0000

Food supplements like vitamins or food products that have certain properties are sometimes marketed as treatments for prostate cancer. While I am skeptical that the supplements can eliminate prostate cancer completely, I do believe that supplements might improve your immune system’s ability to fight cancer. Examples of foods that have been suggested as prostate health items include: Vitamin D-3 (1000-2000 IU per day), Curcumin or Tumeric, and Omega -3 Fish Oil 1000 mg. Some supplements like Selenium have shown potential harm in recent studies. Chinese herbal remedies have been tried by many patients and might have benefits, but I recommend sharing the supplements you use with your physician team to ensure that all medications are safe.

Is PSA screening helpful?

Dr. David Kornguth — Mon, 09 May 2011 22:18:17 +0000

Yes, but it has limitations. PSA is a protein found in both normal prostate tissue and in prostate cancer. Men with a prostate gland usually have a detectable PSA whether or not they have prostate cancer. There are age based guidelines to help make recommendations of whether a certain PSA is worrisome and deserves further investigation. Physicians should use the PSA together with a comprehensive history and physical exam in order to make helpful recommendations. A high PSA that has remained stable for years can simply be the result of an enlarged non-cancerous prostate while a rapidly rising PSA can be more concerning. Talk with your PCP or a prostate cancer specialist to learn more.

What happens if I don’t treat my prostate cancer?

Dr. David Kornguth — Mon, 09 May 2011 15:56:04 +0000

If prostate cancer is not successfully treated when confined to the prostate, it can spread to lymph nodes or into to the bones of your body. We call this type of progression metastatic disease. If that happens, pain and disability can occur which influence the quality of life. It can also cause problems that can alter the length of life. There was a study published in the New England Journal of Medicine in 2011 that compared men with treated prostate cancer versus men with cancer who were placed on an active surveillance protocol. There was a benefit in life expectancy in the treated group. However, everyone’s situation is different and having a honest discussion with a prostate cancer specialist can help you decide on the best course of action in your particular case.

What is Proton Therapy?

Dr. David Kornguth — Fri, 06 May 2011 23:56:02 +0000

Using proton therapy for prostate cancer is controversial in the field of radiation oncology because the prostate is relatively deep inside the patient which diminishes or eliminates any potential benefit. Proton therapy for prostate cancer usually results in a plan which is slightly less conformal that IMRT and it usually costs 3 times the cost of IMRT. Protons have a some disadvantages over IMRT including a poor penumbra (the sharpness of the lateral field edges) and significant uncertainty of the path length of the proton (which requires a significant overshoot of the target to ensure adequate dose). The benefit of protons is not controversial for pediatric cancers because many pediatric tumors are ideally located to exploit the benefits of protons (they are more superficial). I was on faculty at the MD Anderson’s Proton Therapy Center in Houston, Texas and can discuss all potential benefits and disadvantages with interested patients. A good discussion about protons for prostate cancer can be found at http://jco.ascopubs.org/content/25/24/3565.full.

What is IMRT and Calypso?

Dr. David Kornguth — Thu, 14 Apr 2011 05:31:14 +0000

There are several basic principles in prostate radiation therapy: delivery technique and targeting. Delivery technique is analogous to the weapon used in warfare. IMRT or intensity modulated radiation therapy is the general term for the technique used for treatment delivery.

It allows us to deliver the radiation only to the area we want to treat. Targeting is analogous to the scope on the weapon. At GGCC, we used a combination of Calypso with a mini targeting CT scan (CBCT) on a daily basis.

Does radiation hurt, do I feel anything during treatment?

Dr. David Kornguth — Thu, 14 Apr 2011 05:29:20 +0000

There is no sensation during treatment. Radiation is given in small daily doses and if you get side effects, they typically gradually set in and gradually decrease after treatment is finished.

What is the purpose of the prostate – do I need it to have sex?

Dr. David Kornguth — Thu, 14 Apr 2011 05:27:55 +0000

The prostate is attached to the bottom of the bladder and it makes fluid that comes out during sex known as the ejaculate. If the prostate no longer is present or does not function anymore, men can still have erections and orgasms, but they have no ejaculate.

Won’t radiation oncologists recommend radiation and won’t most surgeons recommend surgery?

Dr. David Kornguth — Thu, 14 Apr 2011 05:23:42 +0000

In many centers, this is true. At GGCC, we empower patients with information to make their own decisions. Most of our patients have choices and only proceed with treatment when they are comfortable with the choices. With prostate cancer, patients usually have several good treatment options.

Should I get surgery or radiation or simply watch my prostate cancer?

Dr. David Kornguth — Thu, 14 Apr 2011 05:18:34 +0000

That is the biggest question patients face and there is no simple answer. Multidisciplinary care means that you speak with a surgeon (a urologist) and a radiation oncologist who specializes in prostate cancer treatment. Both treatment options are highly effective for most men, but you should speak with a specialist to learn more about the best options for your prostate disease. The good news is that most prostate cancers are highly curable and some can be safely monitored. Most patients weigh the risks of side effects with the likely benefits of treatment.

What is the Gleason Score?

Dr. David Kornguth — Thu, 14 Apr 2011 05:12:08 +0000

The Grade of cancer described how strange or aggressive the cancer cells appear under a microscope. For prostate cancer, the Gleason Score is the grade of the cancer. Gleason was actually a physician who described prostate cancer grades by giving all cancer specimens two scores (since many prostate cancers have a combination of two patterns). Therefore, the Gleason scores can be as low as 3 (2+1) all the way up to 10 (5+5). Pathologists only will consider prostate cancer when the score is at least 5(3+2). The Gleason score or grade helps to describe how aggressive the prostate cancer is.

What is the difference between stage and grade?

Dr. David Kornguth — Thu, 14 Apr 2011 04:40:59 +0000

When physicians talk about the stage of cancer, we are describing whether the cancer has spread beyond the initial area, like the prostate. In general, cancers that are Stage IV are those where the disease has spread to other sites in the body. It is usually very difficult or impossible to cure people who have stage IV (or metastatic) disease. The grade of the cancer describes how the cells look under a microscope. For prostate cancer, this is known as the Gleason Score.