Glouscester Daily Times online

A new 'gold standard' against cancer?
By Tom Hallsted
Special to the Times

TThe U. S. Health and Human Services Administration projects that nearly a quarter of a million men in America will be diagnosed with prostate cancer in 2008, and more than 27,000 will die from it. It also tells us that 1.8 million men are now being treated for the disease or living with it.

It's hard to get your mind around such numbers, but suppose you applied the ratio of that nationwide total of 218,000 men with prostate cancer out of a U. S. population of 301 million to the town you live in. Gloucester has a population of about 30,000 people. That means that, within the next 12 months, 22 men in Gloucester, more or less, are likely to get the bad news, there will be 22 more the year after that, and so forth.

You know 22 men in Gloucester, or might be married to one of them, or be the son or daughter or mother or father of one of them. Or you might be one of the 22 who get prostate cancer yourself.

Last year I was one of them. This is what I did about it.

The prostate gland, about the size of a walnut, is located deep within the abdominal cavity, buried in a cat's cradle of nerves, tendons, blood vessels, and other organs. It plays an important role in sexual reproduction.

Since 1992, I have had a PSA test (a blood test that offers a rough indication of the likelihood a man will get prostate cancer) at least once every year. Between August and November of 2006 it started to shoot up, after remaining fairly steady for the previous six years.

Recognizing that something was changing, Chris Doyle, my urologist at the Brigham and Women's Hospital in Boston, asked me last March to come in for a biopsy, a procedure in which he takes a dozen threadlike cores out of the prostate, six from each side. Two teams of pathologists examine the samples independently of each other. In my case each team found that six of the 12 cores — three on each side — were cancerous.

When Chris gave me the news that my biopsy was positive, I was terrified. Cancer? Other people get cancer, not me. But he assured me there was no mistake.

My first instinct was to get rid of the disease as quickly as possible, even if it would mean a lifetime of incontinence and impotence — the risks you run if you have surgery (the so-called "gold standard" for prostate cancer treatment), or most other common ways to try to cure the cancer.

Like many newly diagnosed cancer patients, I sought second opinions from other doctors. Most of them told me I was a "poster boy" for their particular specialty, and assured me they could get rid of my cancer — wasn't that what I wanted? They tended to dismiss my concerns about side effects, telling me, "almost everyone gets some side effects." I was not reassured. I had no interest in wearing a diaper and having no sex for the rest of my life.

I began to seek out patients who had undergone the most frequently used therapies — surgery, both conventional and robotic; radiation, both conventional and seed implants; hormones, cryosurgery, and chemotherapy — and found that many of them wished they had tried something else.

But the patients who had experienced proton therapy were almost uniformly pleased with the results. Their cancer was gone, and they often had no side effects whatsoever. Most of them had received their treatment at Loma Linda University Medical Center in Southern California.

Both protons and conventional radiation work by damaging the DNA in the cells they attack so the cells cannot reproduce. Unlike conventional X-rays, proton beams can be controlled to deposit their energy in the cancerous tumor alone, leaving surrounding tissue virtually untouched. Conventional X-rays destroy healthy cells as well as cancerous ones, from the moment they enter the body until they leave it.

Joy and I explored many alternatives before deciding I should have my cancer treated at Loma Linda. We flew to California in late September, rented an apartment steps from the hospital, and had our car shipped out (cheaper than renting one). I met my doctor the next day, had a few tests, and began treatment a week later.

There were 45 days of treatment, taking a little over nine weeks. Each treatment lasted only a minute, with about 15 minutes needed for preparation, and was painless and noninvasive. It was all covered by Medicare and our supplemental Medigap policy (it's also covered by most commercial health insurers), and our travel and living expenses were tax-deductible. We returned home in early December. I have no side effects of any kind and expect that when I have my first follow-up examination next month (in Boston), my cancer will be gone.

Loma Linda University Medical Center was the first hospital in the United States to use protons to treat cancer patients, and has treated nearly 9,000 prostate cancers — many more than any other facility. Four more proton treatment centers are in operation in the United States today, with seven others under construction and nearly two dozen more abroad. Worldwide, nearly 50,000 cancer patients have been treated with protons.

With the number of proton treatment facilities expanding each year, and the high success rate proton beam therapy is achieving, it will soon replace surgery as the "gold standard" for treating prostate cancer, and for many other common forms of cancer as well.

The quarter of a million men who are newly diagnosed with prostate cancer in the United States each year deserve the best treatment they can get. For many of them, protons may be the answer.

Tom Hallsted lives in Gloucester and is a Times columnist.

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