What is the Most Exciting New Treatment for Prostate Cancer?

BY MARK SCHOLZ, MD

As a medical oncologist specializing in prostate cancer, the question I am asked by patients almost daily is, “What new treatments are coming for prostate cancer?” Fortunately, there are so many new developments I am able to give answers that vary depending on the stage (or Shade, to use PCRI terminology) of the person asking, since they are usually interested in developments relevant to their specific situation.

However, if I am asked a slightly different question—“What type of new technology has the greatest potential for saving lives?”—my answer will always be the same for every patient: Immune therapy.  Let me explain why.

Before the intricate complexity of cancer biology was recognized—through the amazing work of thousands of biochemical researchers—people were hoping a single magic bullet could be discovered that would cure cancer.  That hope has been dashed because we now know there are innumerable variations of what we call “cancer.” Waiting for the discovery of a single type of treatment universally effective against all types of cancer is quite naive.

However, there is one intrinsic capacity in our bodies that successfully parries millions of different attacks on our health: the immune system. Therefore, if a cure for the myriad of different cancer types exists, it will probably result from successfully harnessing this incredible system.

One fallacy believed by almost all patients is that their cancer is the result of a weak immune system. Their logic is that their immune system somehow has to be weak considering that the cancer has not been kept under control. Actually, if we are going to speak figuratively about the immune system, the problem is better characterized as an issue of blindness rather than one of weakness.

Early success in using the immune system to overcome scourges such as polio caused cancer researchers to study vaccine type methods for stimulating the immune system to attack cancer,unfortunately with only modest results. The problem is that cancer cells have mechanisms that enable them to hide from the immune system.

The fairly recent discovery of this capacity for cancer to cloak itself represents both good news and bad. Without a specific target to attack, simply making the immune system “stronger” is useless. The good news is that a properly directed immune system can and will eradicate cancer.

Prostate cancer is one of the few types of cancer for which an immune therapy has been approved by the FDA. Dendreon, the company that manufactures the immune treatment called Provenge, has developed technology to remove and purify dendritic cells, the specific immune cells in the body that can detect cancer.  Once in the lab the dendritic cells are “force fed” with a cancer-specific protein. After being reinjected into the body, these invigorated immune cells recruit additional cells of the immune system that specifically focus their attack on the cancer cells displaying that cancer-specific protein.

Double-blind, placebo-controlled trials show Provenge slows cancer progression and prolongs survival just as well or even better than other standard treatments such as chemotherapy or second-line hormonal therapy. None of these treatments consistently eradicate cancer.  They do, however, act to keep it in check for a period of time.

To obtain better results the next logical step is combining one form of immune therapy—Provenge—with some other immune therapy with the hope of further enhancing the anti-cancer effect. My next blog will discuss a new study we are conducting in my clinical practice at Prostate Oncology Specialists using Provenge in combination with “Yervoy,” a monoclonal antibody from Bristol-Myers Squib. Generically Known as ipilimumab, Yervoy is an FDA-approved immune treatment shown to prolong life in people with metastatic melanoma.  Yervoy functions by “taking the brakes” off the immune system.

Sound exciting?  We think so.               

Third Dispatch from the Front--IMRT

BY RALPH BLUM

In my last blog, I said that after all this time living with prostate cancer the uncertainty was beginning to wear on my nerves.  At this point, and having thoroughly researched all my options, the idea of having my prostate fried by electrons doesn’t seem quite so alarming, and as four-letter words go, “cure” has a sweet ring to it.

I’m talking about IMRT, which is short for Intensity Modulated Radiation Therapy. IMRT is a precisely targeted procedure that allows the physician to control the intensity of the radiation beam within a given field. This means that a much higher dose may be given to a tumor within the prostate without an increase in radiation to the surrounding tissue or organs. And if the cancer has spread through the wall of the prostate gland into the seminal vesicles (as in my case) the target field and dosage can be adjusted as necessary.

The big advantage of IMRT over regular external beam radiation is that the beam can be shaped to the exact dimensions of the area to be radiated. And instead of a solid beam of uniform intensity, it utilizes a variety of small independent beams known as “multileaf collimators” that can be turned on or blocked during treatment, varying the radiation beam intensity across the targeted field.

Because of the complexity of the treatment plan, radiation oncologists employ special high-speed computers, treatment-planning software, diagnostic imaging, and positioning devices molded to fit the precise contours of the individual patient. Typically a patient will be required to have several scans, and a team consisting of a radiation oncologist, a medical physicist, a dosimetrist (who sets the radiation dosage), a technician (who does the set-up session), a therapist and a radiation oncology nurse will oversee the treatment.

As with conventional radiation therapy, multiple treatments are required, but with IMRT, the eight-to-nine weeks of treatments (lasting about twenty minutes each) significantly lower the risk of adverse side effects, and the chance of a cure is substantially higher. When I first saw the twelve-foot tall linear accelerator in the treatment room I have to admit I found the idea of having a mountain of energy shot at my pelvis from this giant ray gun--the muzzle of which would be situated barely two inches from my pecker--extremely daunting. And the matter of “rectal burn” cannot be ignored.  However I have been assured that with IMRT rectal irritation is generally temporary, and can be relieved with medication.

So it’s decision time again. I still wish I could safely stay on Active Surveillance, but with IMRT the odds are favorable for a cure, Dr. Bahn has advised me to go for it, as has Dr. Scholz. Even I, the ultimate “Refusenik,” suspect it is time to act.

I’ll keep you posted!

The Leaders of the PCRI

BY MARK SCHOLZ, MD

Recently a donor to the Prostate Cancer Research Institute (PCRI) asked me about the composition of the board of directors. As I was relating details about board members, I noticed my swelling pride in these wonderful individuals who have been so instrumental guiding the management and development of the PCRI.  What follows is a brief bio of the twelve board members who govern the PCRI.

Chester Swenson (President) is the Chairman/CEO of Marketing and Financial Management Enterprises, Inc., a company that has pioneered the development of corporate cause-related marketing programs designed to access the lifestyle interests and activities of targeted customer segments.  He was formerly CEO of College Enterprises, a premier outsourcing provider of ‘on demand publishing’. He has a BA in political science with a minor in economics from California State University Northridge. He is the author of Selling to a Segmented Market: The Lifestyle Approach, as well as numerous articles in the Journal of Business Strategy, American Demographics, Management Review and the Los Angeles Business Journal.

Jerome Seliger, PhD (Vice President) is a Professor of Health Administration and Public Health in the Department of Health Sciences at California State University with experience in ambulatory care, managed care, community-based health services, community mental health services, behavioral health services and grants management. He has authored numerous scholarly articles on community development, health care and methods for training professionals. He is Co-Founder/CEO, Bienvenidos Children's Center, Co-Founder, Health Compliance Systems PPO and Founding Director, Institute for Communication and Professional Studies.  He has a BA from the University of Minnesota and a PhD from USC.

Barry L. Friedman, Esq. (Secretary) is a family law mediator and former member of panels of arbitrators, American Arbitration Association and Los Angeles County Bar Association. He was formerly a member of  the panel of judges pro tem of the Santa Monica Municipal Court, and family law judge pro tem, Los Angeles Superior Courts. He graduated from the University of Pennsylvania in chemistry and economics as a National Science Scholar and Foundation Fellow. He received his law degree from the University of California with honors.

Kent Graham (Treasurer) is the Founder and Chief Executive Officer of Wellness Ideas Network (“WIN”), a private company specializing in designing, delivering and directing customized health and wellness plans to both organizations and individuals. Prior to WIN, Mr. Graham was a senior executive in the financial services industry for 30+ years. He holds a Bachelor of Arts degree from Dartmouth College and a Master of Business Administration degree from Drexel University.

Mark C. Scholz, MD. (Executive Director) is the Medical Director of Prostate Oncology Specialists in Marina del Rey. He received his medical degree from Creighton University and internal medicine residency and Oncology fellowship from USC.  He is the co-author of Invasion of the Prostate Snatchers and has written and produced extensive educational material on the subject of prostate cancer in various medias which include DVDs, blogs, newsletters and pamphlets. He is also an educational speaker on behalf of Amgen, Dendreon and Sanofi-Aventis. Dr. Scholz has authored or co-authored over 90 scholarly articles and abstracts in his area of expertise.

Duke K. Bahn, MD is the Director of the Prostate Institute of America in Ventura California and is Board Certified by the American Board of Radiology. Dr. Bahn is the preeminent world expert in color Doppler ultrasound imaging of the prostate as well as being one of the original researchers who documented the effectiveness of cryotherapy for prostate cancer, work that ultimately led to Medicare approval for cryotherapy. Dr. Bahn has many academic and professional appointments including Clinical Professor of Urology, Keck School of Medicine, University of Southern California.

Stanley Brosman, MD graduated from Indiana University Medical School. His Urology training was at UCLA where he conducted extensive basic research into the immunology of prostate and bladder cancer. He is a Clinical Professor of Urology at UCLA. He has been involved in numerous studies including the development of the PSA test as well as a variety  of modern therapies currently used in the management of prostate cancer such as Lupron, Firmagon, Casodex, Nilandron, Flutamide, Xgeva, Prolia, Zometa and Zytiga. He is currently practices in Santa Monica and is affiliated with St John's Hospital.

Scott Cohen is CEO of 180 Fusion, a Search Engine Marketing and Search Engine Optimization Company recognized as the leading local SEO Company in North America. Mr. Cohen served in key executive management roles in start-up and high-growth software companies. Most recently, he took PSS Systems from pre-revenue stage to market leader before being acquired by IBM. He currently holds advisory and board member positions at several privately held companies in the technology sector as well as being Co-Founder of TeleHealth America.  He holds a Bachelor of Arts degree from the University of Arizona.

Arthur N. Lurvey MD, FACP, FACE is a board certified internist and endocrinologist, and has been a Medicare Contractor Medical Director for 16 years working for Transamerica Occidental Life Insurance Company, National Heritage Insurance Company and National Government Services; and most recently for Palmetto GBA.  He received his MD from the University of Illinois and had his post doctorate and fellowship training at Los Angeles County-USC Medical Center.  He is a Fellow of the American College of Physicians and the American College of Endocrinology. He is also a CMA surveyor for both the Joint Commission hospital survey program and the CME accreditation program in California.

Jerry Peters is an American songwriter, record producer, multi-instrumentalist, conductor and arranger. He is best known for writing the hit song Going In Circles by The Friends of Distinction. This became his first gold record. Peters also recorded his album, Blueprint For Discovery.  Peters is an in-demand composer, songwriter, arranger and producer. Peters has worked with Earth, Wind & Fire, Aretha Franklin, Quincy Jones, Marvin Gaye, Natalie Cole, The Emotions, The Jacksons, Diana Ross, Deniece Williams, Gladys Knight, Al Green and Lionel Richie.  He won a Grammy for co-writing the “Gospel Song of the Year” with Kirk Whalum, “It’s What I Do.”

Claudia Sangster is an expert in estate, gift, and charitable tax planning having published extensively on topics dealing with ways to prolong family wealth. She speaks extensively at professional conferences and client events, including participation as a panelist at the Milken Institute Global Conference where the discussion focused on philanthropy’s role in improving the lives of global communities.  She has a BA in sociology from Pepperdine University, graduating summa cum laude. She later graduated magna cum laude with a JD from University of Houston Law Center.

Michael L. Steinberg, MD, FASTRO, FACR, FACRO is Professor and Chair of the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA, Director of Clinical Affairs for UCLA’s Jonsson Comprehensive Cancer Center and Chair of the Clinical Chairs of the David Geffen School of Medicine, and also, Chair of the Electronic Health Record Oversight Board (EOB).  He is the founding Chair of the Health Policy Council of American Society for Radiation Oncology (ASTRO) and is currently ASTRO’s Chairman of the Board.   Dr. Steinberg graduated from Occidental College, Phi Beta Kappa, was elected to AOA at University of Southern California School of Medicine, and did his radiation oncology residency and fellowship at UCLA. 

The PCRI board members have wide ranging experience in the healthcare world, charitable endeavors, the arts, as well careers as physician specialists from all the important specialties including oncology, urology, radiation therapy and radiology. Several have had to deal with prostate cancer in their own lives. PCRI is truly fortunate to have such excellent and diverse leadership.

Another Dispatch from the Front

BY RALPH BLUM

In my Blog “Nervous Moments” I wrote about the sinking feeling in my gut—half panic, half “Oh s--t!”—when I learned that my PSA had spiked to 26. Since then I have done a course of Cipro, in order to determine whether the hike was a result of an infection (Jeanne and I had both had the flu). And I made an appointment with Dr. Duke Bahn for a color Doppler MRI.

If I had a significant bout of the flu, it wasn’t severe enough to effect my PSA which, on re-checking after the course of Cipro, was undiminished. The result of Dr. Bahn’s test showed a small but discernible progression of the cancer. Not what I wanted to hear, and as a result of his findings (pointing out on the images the enlarged dark cancer patches) I began to entertain serious thoughts of finally getting treated. But before determining the type of treatment I had to determine that the cancer hadn’t spread to my lymph system, or to my bones.

So it was back into the clickety-clack, thumpa-thumpa-thump of the MRI machine, with Vivaldi’s “The Four Seasons” soothing my ears. I admit, I rather enjoy the contrast: flutes and strings and kettle-drums. Directly following the MRI, I went next door for a bone scan.

The first results were provided by the same dayfollowed  the next afternoon by the results of the bone scan (“No evidence for any spread of cancer.”)  The news was great. Both were clear. Big sigh of relief. Thank you, God! So now the question is: to treat or not to treat? I started this journey back in 1990 when I was 58 years old, and apart from 15 months on hormone blockade (a single drug protocol with Lupron when my PSA last spiked in 2003), I have monitored my cancer with Active Surveillance. And now, at eighty I still have options.

I’m still in the process of decision-making. But I’m getting tired of the uncertainty, and I’m leaning toward placing myself in Dr. Lisa Chaiken’s competent hands. Dr. Chaiken is the chief radiation oncologist at the Santa Monica Treatment Center, a state-of-the-art facility for Intensity Modulated Radiation Therapy (aka IMRT) at St. John’s Hospital in Santa Monica.

So, finding myself at the decision point once again, in my next Blog, I will take a closer look at IMRT.  The odds are that it will become my treatment of choice.