Transcript: Web chat on prostate health and available therapies

Readers: Welcome to our Wednesday Health chat — every wednesday at noon. Today’s topic is prostate health.

Our expert today is Dr. Allan Thornton with the Proton Therapy Institute in Hampton. Dr. Thornton – please let readers know when you’re ready to answer their questions.

Our region — Hampton Roads — has a very high incidence of prostate cancer. I’m wondering what the cause is of that?

Welcome Dr. Thornton. Please let our readers know your areas of expertise and what the primary focus of your work is.

Readers: This is your opportunity to ask questions IN COMPLETE ANONYMITY about your prostate health.

First off, like all of the United States, as a population, we are aging. Prostate cancer is generally a cancer of older men. We also have a significant population of African-American citizens, and there is a higher incidence of prostate cancer in this population.

At what age do you recommend that people should be screened for prostate cancer? And I say cancer, but are there other diseases of the prostate?

Ms. Salasky; My area of expertise is oncology. I am a radiation oncologist with over 20 years clinical experience in proton therapy, starting at Harvard, and most recently as the founder of the nation’s 3rd proton therapy center in Indiana.

Generally, we recommend all men over the age of 50 commence annual routine screening, excepting if their is a family history. In that case a man should start at age 40.

There’s a question from Anonymous which I think is probably at the top of the list for a lot of people.

Readers: We are talking to Dr. Allan Thornton of the Proton Therapy Institute in Hampton. He is a radiation oncologist and an expert in prostate health. Ask your questions now in complete ANONYMITY.

Great question. There was just a report from the Dana Farber in Boston on this subject. Basically, the report indicated that sexual function was impacted significantly in over 70% of men after surgery, and a similar number after hormone therapy. Conventional irradiation also had a 60% impact. The report did not include proton therapy, which in my experience is far, far less impacting on sexual function.

Do you have any sort of percentage with proton therapy? Could you explain how proton therapy differs from other types of therapy.

It is important to realize that “impact” can be everything from complete loss of erectile function, to a relatively mild decrease, easily correctable with pharmaceuticals.

To follow up on those questions. If the cancer is more advanced is it more likely that the patient will lose sexual function?

If you are asking about the cure rate, the cure rate depends on the size and stage of the tumor. For most men, the cure rate is over 90%. Now the difference with proton therapy lies in the physics of the beam – unlike conventional therapy, protons can be controlled and stopped with literally 1-2 mm precision. I have used proton therapy for 20 years for my brain and pediatric patients. The same advantage allows us to treat less of the nerves going to the prostate to maximize sexual function, as well as less of the rectum. The rectum is our main dose limiting structure that must be carefully avoided when treating with radiation.

Readers: We are talking to Dr. Allan Thornton, radiation oncologist and expert in prostate health. Ask your questions now.

Regarding the question about watchful waiting: Very debatable topic. My training is in Canada where we undertook such a trial way back in the 1980’s. Basically, if your survival is less than 3 years due to other medical conditions (bad heart, lungs, etc.), provided you have an early prostate cancer, I feel justified in watchful waiting. But prostate cancer is a very painful disease when it grows locally, and men do not die quickly of this tumor. Please, please consider local treatment. My father died of recurrent prostate cancer – I know this personally.

The Proton Therapy Institute in Hampton opened last year. It’s one of just a handful in the country. If anyone who has been treated there is following the chat, please let us know your experience. Thanks.

About the testicular cancer: Totally separate tumor

How does someone qualify for treatment at the Proton Therapy Institute?

Readers: We have just a few more minutes with Dr. Allan Thornton, radiation oncologist and proton therapy expert. Ask your questions now.

Let me follow up on the testicular cancer. Basically depends on whether it is seminomatous or non-seminomatous. The treatment may involve just irradiation, in which case protons are ideal. For non-seminomatous types, chemotherapy is used first, then radiaiton. Very, very different tumor than prostate cancer.

Could you explain the term “seminomatous”. Thanks.

Possibly we treat testicular cancer – we really need to discuss the case in private.

Seminomatous means originating from the germ cells of the testes, as opposed to a different cell line.

These questions tie into mine about who ‘qualifies’ for proton therapy treatment.

About the waiting list…

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Re waiting list: We are rapidly ramping up. Right now we are treating in 2 of our 5 rooms, treating 35 patients per day, soon to be 50 per day. For prostate cancer there is no waiting list. For more complicated cases, there is some wait because this is so specialized and I have a relatively small crew of dedicated folks we work with. We are growing.

Readers: You have just a couple more minutes to ask Dr. Thornton your questions about prostate cancer and proton therapy

Who qualifies for proton therapy? Basically anyone with a solid tumor (as opposed to a leukemia) especially a tumor next to a critical structure (eye, brain, spinal cord, rectum, etc.). Children are a focus of our center.

Dr. Thornton — I have another question. You’ve addressed the issue of impotence, but I also understand that one of the potential side effects from prostate cancer treatment is incontinence. Does this occur at the same rate? Is it different for proton therapy patients.

I should add that I have retreated a number of men who have recurred after surgery for prostate cancer or who have been treated for rectal cancer and now have prostate cancer.

Also, could you answer the second part of Anonymous’ question about whether insurance covers proton therapy treatment.

Incontinence: The risk is relatively small. Proton therapy treats on average 50% less of the bladder than the most elegant of conventional irradiation. Folks who smoke however are at risk for bladder bleeding and dysfunction.

Insurance does usually cover proton therapy. If not, I am more than willing to help with appeals.

This is my last question! How does proton therapy differ from “cyber knife” therapy that I’ve seen advertised by other health centers.

Dr. Thornton — when you’ve answered my last question, could you let readers know how they can contact you. Do local physicians refer to the Proton Therapy Instititute or do patients contact you directly? Thanks so much for your expertise and time.

Cyberknife is a machine that uses conventional xray therapy mounted on a robotic arm. It is a machine developed for treating brain lesions, similar to gammaKnife therapy. The radiation can not be stopped, so the machine must treat from many different angles. My concern with CyberKnife is the fact that it treats in only 5 fractions – I am a strong, strong believer in longer fractionation to spare the rectum and bladder.

Folks can contact either me or my partner, Dr. Sinesi, at 757 251-6800 at the Hampton University Proton Therapy Institute.

About the referral community:

Yes, many of my patients come from local and international physicians that I have worked with over many years. It always gratifies me to communicate with referring physicians who understand the benefits of proton therapy – it is a learning process, just like I have to learn about their respective disciplines.

Dr. Thornton. Thank you again for your time and expertise. I”m closing the chat now.
Readers: Please join us every Wednesday for a live chat on a health-related topic with our area’s experts.

Thanks and bye!