Prostate cancer is one of the most common cancers among men.
Interventional Radiology (also known as IR or Special Procedures) is the section of the department that use imaging equipment to perform procedures ("intervene") that directly treat a disease.
Dr. Omar Yumen is here to discuss all the latest radiological advancements for the treatment of prostate cancer.
New Radiological Techniques To Tackle Prostate Cancer
Featured Speaker:
Learn more about Dr. Omar Yumen
Omar Yumen, MD
Dr. Omar Yumen, is the Chief of Radiation Oncology at GuthrieLearn more about Dr. Omar Yumen
Transcription:
New Radiological Techniques To Tackle Prostate Cancer
Bill Claproth (Host): The American Cancer Society predicts that over 220,000 new cases of prostate cancer will be diagnosed this year and new radiation techniques are available to tackle prostate cancer. Here to tell us more is Dr. Omar Yumen, Chief of Radiation Oncology at Guthrie. Dr. Yumen, first of all, thanks for spending time with us today and if you could, give us a quick overview, what is prostate cancer?
Dr. Omar Yumen (Guest): Prostate cancer is a form of cancer that effects men and it’s a cancer that we discover generally by measuring PSA and often requiring a biopsy of the prostate and when we look at the tissue in the prostate it shows malignant cells. So, that’s how the diagnosis is generally established. More often than not prostate cancer is silent. There are typically no symptoms associated with prostate cancer in the vast majority of circumstances.
Bill: What are the risk factors that promote prostate cancer? Are there things such as lifestyle or heredity or just plain old age? Or maybe it’s a combination of all of them?
Dr. Yumen: Well, I think you’re right. I think it’s a combination of all of these things but by far and away, the most important factor for prostate cancer is age. Some people would suggest that it’s a matter of time before men are diagnosed with prostate cancer and there are some factors that have been associated, some dietary factors which are a little bit soft in terms of cause and effect but by far and away, the biggest issue is aging and the other thing is family history. So, if you have a strong family history of prostate cancer, fathers, brothers, uncles, then your risk of prostate cancer is significantly greater.
Bill: What are the warning signs when they do happen that would point to problems with the prostate gland?
Dr. Yumen: Well, the typical symptoms that many men experience as we age are urinary issues. Difficulty with urination, slow stream, getting up at night more often to pass your urine, things of that nature. More often than not those are not necessarily symptoms of prostate cancer. Symptoms of prostate cancer, if they do develop, often are associated with advanced disease. Those types of symptoms or other symptoms, for example, bone pain or something like that, would suggest that the cancer has already spread. So, typically, as I mentioned before, prostate cancer is often times silent. It’s not necessarily associated with any symptoms that would bring someone to the physician. If you have these symptoms typical of aging, more often than not, they just happen to go hand in hand with the possibility of having prostate cancer but not necessarily as a consequence of prostate cancer.
Bill: What is it that you as a doctor says, “Okay, I think you may have an issue with your prostate gland? Not sure it’s cancer. It may be but now we need to check.” What is that warning sign that makes you do that?
Dr. Yumen: Well, typically, what often happens in a family practitioners office is the fellow will get a digital rectal examination which may show some abnormality which prompts evaluation of the so called PSA test. Some family practitioners will get a PSA test as an annual part of the screen and if elevated often will need to be pursued further. So, those are the typical findings that would prompt us to work up for prostate cancer.
Bill: When does radiation come into play? Who is a candidate for radiation prostate cancer treatment?
Dr. Yumen: Radiation is utilized. It can be utilized for many different stages of prostate cancer. For example, if you were a candidate for surgical removal of a prostate, you’re also a candidate for radiation therapy. Additionally, if you present with more locally advanced disease that might not be amenable to surgery, certainly radiation is useful in that circumstance. Thirdly, if you are older and you are diagnosed with prostate cancer and it needs to be treated, then oftentimes surgery is not the best option because of potential side effects. So, radiation becomes more of the treatment of choice in that situation.
Bill: How does radiation treatment work? Is it a one-time event? Or, does the patient come back a certain number of times? Is it outpatient? What’s the process?
Dr. Yumen: There are different forms of treatment for prostate cancer. The one form that many people associate with prostate cancer is multiple repetitive treatments Monday through Friday over the course of about 8 weeks. Generally, that’s often reserved for a bit more advanced prostate cancer. In addition to that, there is a technique called a “seed implant procedure” or a “prostate brachytherapy” which is a very effective treatment. The cure rate seems to be equivalent for having your prostate removed. It’s reasonable for men of any age group, even younger individuals and it’s a one-time situation under anesthesia where the radioactive seeds are directly implanted into the prostate. So, that’s a very effective technique. Additionally, there’s a technique called “SBRT” or “stereotactic body radiation therapy” which delivers very, very high doses of radiation per treatment and that’s usually given over 5 treatments, twice a week, for about 2 ½ weeks. So, that’s also a very effective and very convenient form of therapy for the patients.
Bill: Does radiation help eradicate it? Or cure the patient? Or put him into remission? Or is this just help stave it off a little bit?
Dr. Yumen: Well, any time I give radiation therapy, the vast majority of instances, the intent of treatment is curative. In some situations where radiation’s given, it’s being given directly from the outset with control or palliation in mind but the vast majority of situations where radiation is administered I’m giving it with the hope of curing the patient of their disease permanently.
Bill: Are there side effects and the risks of radiation techniques?
Dr. Yumen: There are but the good news is that with more modern techniques that are available to us the risks are reduced substantially, like damaging the rectum or damaging the bladder. So, permanent damage risk is much, much less than it was, say, a decade ago because of improvement in techniques that are available.
Bill: And this improves the recovery time, then?
Dr. Yumen: It improves the recovery time and it certainly improves the patient’s quality of life long term because sometimes these side effects from radiation can develop months or even years after the treatment is administered. So, by minimizing the potential side effects, we improve upon the patient’s quality of life.
Bill: Speaking of quality of life, I think this is an important question that all men would want to know. Prostate cancer is not the cause of erectile disfunction. Treatments for the disease can cause the problem. Do radiation techniques help reduce the effects of potential erectile disfunction?
Dr. Yumen: The risk of erectile disfunction is, unfortunately, a real concern no matter what technique is utilized, surgery or radiation, but there are some techniques which appear to be better at preserving erection capacity, at least for the short term and that can be years. Prostate seed implants or brachytherapy seem to have a particularly good track record with respect to control of erection capacity or maintaining erection capacity. When we have to use more extensive radiation techniques or certainly combine them with hormones, then the risk of erection disfunction certainly increases.
Bill: Although no one wants to hear a diagnosis of prostate cancer and it certainly can be serious and scary, many men, with proper treatment, live a long and normal life after prostate cancer. Is that correct?
Dr. Yumen: Absolutely. Absolutely. I think that prostate cancer therapy has come a long, long way over the last few decades and the most important thing is to make sure that if a diagnosis of prostate cancer is made, then you are seen, not only by a surgical specialist in urology but oftentimes, it’s important to be seen by a radiation specialist as well, just so that the patient is aware of the entire gambit of choices.
Bill: Why should someone choose Guthrie for their prostate care needs?
Dr. Yumen: Guthrie is fortunate in having state of the art radiation equipment. We have expert surgical staff who are very, very good surgically and are using robotic techniques with the da Vinci robot, which I’m sure our listeners have heard about. From the radiation perspective, we are very fortunate in having the best equipment and state of the art techniques so that we can try and cure folks with minimal long-term side effects related to treatment.
Bill: Doctor Yumen, that sounds great and thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Claproth. This is Guthrie Radio. Thanks for listening.
New Radiological Techniques To Tackle Prostate Cancer
Bill Claproth (Host): The American Cancer Society predicts that over 220,000 new cases of prostate cancer will be diagnosed this year and new radiation techniques are available to tackle prostate cancer. Here to tell us more is Dr. Omar Yumen, Chief of Radiation Oncology at Guthrie. Dr. Yumen, first of all, thanks for spending time with us today and if you could, give us a quick overview, what is prostate cancer?
Dr. Omar Yumen (Guest): Prostate cancer is a form of cancer that effects men and it’s a cancer that we discover generally by measuring PSA and often requiring a biopsy of the prostate and when we look at the tissue in the prostate it shows malignant cells. So, that’s how the diagnosis is generally established. More often than not prostate cancer is silent. There are typically no symptoms associated with prostate cancer in the vast majority of circumstances.
Bill: What are the risk factors that promote prostate cancer? Are there things such as lifestyle or heredity or just plain old age? Or maybe it’s a combination of all of them?
Dr. Yumen: Well, I think you’re right. I think it’s a combination of all of these things but by far and away, the most important factor for prostate cancer is age. Some people would suggest that it’s a matter of time before men are diagnosed with prostate cancer and there are some factors that have been associated, some dietary factors which are a little bit soft in terms of cause and effect but by far and away, the biggest issue is aging and the other thing is family history. So, if you have a strong family history of prostate cancer, fathers, brothers, uncles, then your risk of prostate cancer is significantly greater.
Bill: What are the warning signs when they do happen that would point to problems with the prostate gland?
Dr. Yumen: Well, the typical symptoms that many men experience as we age are urinary issues. Difficulty with urination, slow stream, getting up at night more often to pass your urine, things of that nature. More often than not those are not necessarily symptoms of prostate cancer. Symptoms of prostate cancer, if they do develop, often are associated with advanced disease. Those types of symptoms or other symptoms, for example, bone pain or something like that, would suggest that the cancer has already spread. So, typically, as I mentioned before, prostate cancer is often times silent. It’s not necessarily associated with any symptoms that would bring someone to the physician. If you have these symptoms typical of aging, more often than not, they just happen to go hand in hand with the possibility of having prostate cancer but not necessarily as a consequence of prostate cancer.
Bill: What is it that you as a doctor says, “Okay, I think you may have an issue with your prostate gland? Not sure it’s cancer. It may be but now we need to check.” What is that warning sign that makes you do that?
Dr. Yumen: Well, typically, what often happens in a family practitioners office is the fellow will get a digital rectal examination which may show some abnormality which prompts evaluation of the so called PSA test. Some family practitioners will get a PSA test as an annual part of the screen and if elevated often will need to be pursued further. So, those are the typical findings that would prompt us to work up for prostate cancer.
Bill: When does radiation come into play? Who is a candidate for radiation prostate cancer treatment?
Dr. Yumen: Radiation is utilized. It can be utilized for many different stages of prostate cancer. For example, if you were a candidate for surgical removal of a prostate, you’re also a candidate for radiation therapy. Additionally, if you present with more locally advanced disease that might not be amenable to surgery, certainly radiation is useful in that circumstance. Thirdly, if you are older and you are diagnosed with prostate cancer and it needs to be treated, then oftentimes surgery is not the best option because of potential side effects. So, radiation becomes more of the treatment of choice in that situation.
Bill: How does radiation treatment work? Is it a one-time event? Or, does the patient come back a certain number of times? Is it outpatient? What’s the process?
Dr. Yumen: There are different forms of treatment for prostate cancer. The one form that many people associate with prostate cancer is multiple repetitive treatments Monday through Friday over the course of about 8 weeks. Generally, that’s often reserved for a bit more advanced prostate cancer. In addition to that, there is a technique called a “seed implant procedure” or a “prostate brachytherapy” which is a very effective treatment. The cure rate seems to be equivalent for having your prostate removed. It’s reasonable for men of any age group, even younger individuals and it’s a one-time situation under anesthesia where the radioactive seeds are directly implanted into the prostate. So, that’s a very effective technique. Additionally, there’s a technique called “SBRT” or “stereotactic body radiation therapy” which delivers very, very high doses of radiation per treatment and that’s usually given over 5 treatments, twice a week, for about 2 ½ weeks. So, that’s also a very effective and very convenient form of therapy for the patients.
Bill: Does radiation help eradicate it? Or cure the patient? Or put him into remission? Or is this just help stave it off a little bit?
Dr. Yumen: Well, any time I give radiation therapy, the vast majority of instances, the intent of treatment is curative. In some situations where radiation’s given, it’s being given directly from the outset with control or palliation in mind but the vast majority of situations where radiation is administered I’m giving it with the hope of curing the patient of their disease permanently.
Bill: Are there side effects and the risks of radiation techniques?
Dr. Yumen: There are but the good news is that with more modern techniques that are available to us the risks are reduced substantially, like damaging the rectum or damaging the bladder. So, permanent damage risk is much, much less than it was, say, a decade ago because of improvement in techniques that are available.
Bill: And this improves the recovery time, then?
Dr. Yumen: It improves the recovery time and it certainly improves the patient’s quality of life long term because sometimes these side effects from radiation can develop months or even years after the treatment is administered. So, by minimizing the potential side effects, we improve upon the patient’s quality of life.
Bill: Speaking of quality of life, I think this is an important question that all men would want to know. Prostate cancer is not the cause of erectile disfunction. Treatments for the disease can cause the problem. Do radiation techniques help reduce the effects of potential erectile disfunction?
Dr. Yumen: The risk of erectile disfunction is, unfortunately, a real concern no matter what technique is utilized, surgery or radiation, but there are some techniques which appear to be better at preserving erection capacity, at least for the short term and that can be years. Prostate seed implants or brachytherapy seem to have a particularly good track record with respect to control of erection capacity or maintaining erection capacity. When we have to use more extensive radiation techniques or certainly combine them with hormones, then the risk of erection disfunction certainly increases.
Bill: Although no one wants to hear a diagnosis of prostate cancer and it certainly can be serious and scary, many men, with proper treatment, live a long and normal life after prostate cancer. Is that correct?
Dr. Yumen: Absolutely. Absolutely. I think that prostate cancer therapy has come a long, long way over the last few decades and the most important thing is to make sure that if a diagnosis of prostate cancer is made, then you are seen, not only by a surgical specialist in urology but oftentimes, it’s important to be seen by a radiation specialist as well, just so that the patient is aware of the entire gambit of choices.
Bill: Why should someone choose Guthrie for their prostate care needs?
Dr. Yumen: Guthrie is fortunate in having state of the art radiation equipment. We have expert surgical staff who are very, very good surgically and are using robotic techniques with the da Vinci robot, which I’m sure our listeners have heard about. From the radiation perspective, we are very fortunate in having the best equipment and state of the art techniques so that we can try and cure folks with minimal long-term side effects related to treatment.
Bill: Doctor Yumen, that sounds great and thank you so much for your time today. We really appreciate it. For more information visit Guthrie.org. That’s Guthrie.org. I’m Bill Claproth. This is Guthrie Radio. Thanks for listening.