Cutting Out Surgery
New advances limit the number of side effects
Of all the U.S. men diagnosed with cancer this year, the largest number -- 33% -- will have the disease in the prostate, according to the American Cancer Society.
The Dattoli Cancer Center's On-Board Imager produces a low-dose X-ray beam used to fine-tune patient positioning for treatment.
For many, the first reaction is to ask a doctor to cut out the cancerous cells. But other options can offer better results, says Dr. Michael Dattoli, a radiation oncologist who founded the Dattoli Cancer Center & Brachytherapy Research Institute in Sarasota, which exclusively treats prostate patients.
Operating on the prostate, whether with a knife or laser, is more likely to cause side effects, including partial or complete incontinence, impotence or both, Dattoli says. And although prostate surgery has made major advances in recent years, it can leave behind traces of cancer that aren't visible to the eye.
"You can't remove microscopic elements that branch out," says Dattoli, who has worked with prostate cases for about 20 years, formerly at Memorial Sloan-Kettering Cancer Center in New York. "A lot of what I do today came from what I learned from the shortcomings of surgery."
Dattoli favors radiation, especially highly targeted techniques that send treatment to the diseased area and don't destroy surrounding tissues. These are some of the latest advances:
Brachytherapy involves implanting seeds or pellets that contain a dose of radiation, giving continuous treatment to the prostate for three or four months or a year, depending on the type of material used. Dattoli, who has performed the procedure more than 12,000 times, prefers Palladium-103 because it doesn't remain active as long as Iodine-125. The seeds can be temporary and removed by a doctor or permanent, which means they remain in the body after the radiation is expended.
Color-flow Doppler ultrasound uses transrectal ultrasonography to project sound waves off the prostate and surrounding organs to create real-time color images. Doctors then study these to determine where the cancer is located and how it's reacting to treatment or to place the seeds during brachytherapy.
Intensity modulated radiation therapy, or IMRT, uses a machine that X-rays the prostate and adjusts to follow the patient's movements. Doctors use this to aim radiation precisely into the diseased area without damaging sensitive adjacent tissue. Like other doctors in his field, Dattoli is seeing younger patients than he did a decade ago. Early detection is crucial because initial stages of the disease usually show no symptoms. Another recent development has the medical community concerned. Doctors used to recommend a biopsy if a PSA blood test showed a score of 4 or higher. But a 2004 study showed tests of prostate specific antigens do not accurately reflect whether a man might have the disease. Patients have to be more proactive, Dattoli says. If they're diagnosed with the disease, they should study all options. Get a second and maybe even a third opinion. And check for seminars in their community, including those offered by the American Cancer Society's Man to Man programs or Us Too International, which has 320 support group chapters worldwide.
CANCER FACTS The Numbers
> One in every six men will get prostate cancer.
> The chances that you'll contract the cancer are one in three if you have a close relative with the disease. If you have three relatives with the disease, your chances of getting it are 97%.
> African-American men have the highest rate of prostate cancer in the world -- 60% higher than white males and double the mortality rate of whites.
> Prostate cancer is the third-leading cause of male cancer death in the U.S., behind lung and colorectal cancers.
> An American man dies every 18 minutes from the disease.
> In 2006, the disease will kill an estimated 27,350 men in the U.S. and 2,110 in Florida.