Jonathan Yamzon, M.D., assistant clinical professor of surgery in the Division of Urology and Urologic Oncology, explains his approach to what’s known as “active surveillance” of men with prostate cancer. Patients need to be educated about their treatment options, he writes.
Active surveillance eligibility
Active surveillance is an option offered to patients with “low-risk” prostate cancer. It entails forgoing any immediate treatment, and instead monitoring a patient’s cancer to ensure it shows no signs of worsening. If there are any signs of disease progression, the option for curative treatment can still be offered. Active surveillance attempts to avoid unnecessary treatments for patients with prostate cancers that may not become clinically significant or impactful to a man’s life.
Such treatments have potential risks for side effects. Those considered low-risk have a prostate specific antigen (PSA) value of less than 10, a biopsy Gleason of six or less, and a rectal exam that reveals nothing beyond a small nodule confined to one side of the prostate. When one of my patients embarks on active surveillance, I repeat the PSA, rectal exam and biopsy to ensure that their tumor is in fact truly low-risk. The success of this strategy is predicated on recurring follow-ups and reassessment to detect worsening changes of the tumor grade, volume or stage. It is important to understand that if there are signs of cancer progression, we can still offer treatment with curative intent.
Currently, our ability to stratify who is low-risk is based on clinical parameters of the PSA, Gleason score and clinical stage, which is detected by a rectal exam. Newer biomarkers are being studied to improve risk stratification, including the use of novel markers in serum, urine, biopsy tissue and radiographic test like magnetic resonance imaging (MRI).
For most prostate cancer patients, surgery or radiation therapy is the initial and primary treatment against the disease. But some patients can benefit from chemotherapy and hormone therapy too, especially if there are signs of a relapse or if the cancer has spread beyond the prostate gland.
Here, Cy Stein, M.D., Ph.D., City of Hope’s Arthur & Rosalie Kaplan Chair in Medical Oncology, explains the role of drug therapy in treating prostate cancer, as well as recent and upcoming drug breakthroughs against the disease.
When is hormone therapy and/or chemotherapy an appropriate treatment for prostate cancer?
In many ways, when to start hormone and drug therapies for a prostate cancer patient is an art. That is because clinicians have to account for numerous factors, including the patient’s age and health, the cancer stage and biology and the disease response to other therapies. For example, hormone therapy may be considered if a patient relapses following surgery and radiation therapy. Meanwhile, chemotherapy may be prescribed for a cancer that has metastasized to other organs or one that does not respond to other treatments.
Additionally, hormone therapy and chemotherapy protocols for prostate cancer are constantly evolving with new research findings. For example, a recent major study showed that combining hormone therapy with chemotherapy early on is significantly more effective against prostate cancer than hormone therapy alone, thus changing clinical guidelines and standards of care.
In short, both hormone and drug therapies can become an integral part of prostate cancer treatment by preventing relapse, slowing its growth and even driving it back into remission. But these treatments also require meticulous planning by medical oncologists in collaboration with others in the patient’s care team and in alignment with the latest evidence.
What are some recent drug breakthroughs against prostate cancer? » Continue Reading
Cancer research has yielded scientific breakthroughs that offer patients more options, more hope for survival and a higher quality of life than ever before.
The 14.5 million cancer patients living in the United States are living proof that cancer research saves lives. Now, in addition to the clinic, hospital and laboratory, there is another front for the fight against cancer: The battle for funding to keep this research ongoing.
City of Hope joins the American Association for Cancer Research in support of the Rally for Medical Research on Capitol Hill on Thursday, Sept. 18. Hundreds of organizations and individuals – comprehensive cancer centers, research advocacy groups, clinicians, business leaders, survivors and others – are joining the call to members of Congress to make funding for the National Institutes of Health a priority and stop the chronic decline of public funding for science.
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Advances in cancer treatment, built on discoveries made in the laboratory then brought to the bedside, have phenomenally changed the reality of living with a cancer diagnosis. More than any other time in history, people diagnosed with cancer are more likely to survive and to enjoy a high quality of life.
However, much work remains to be done. On average, one American will die of cancer every minute of every day this year, according to the American Association for Cancer Research, which today released its annual Cancer Progress Report. Following a year that saw six new cancer drugs approved, an estimated 14.5 million cancer survivors living in the United States, and considerable research breakthroughs, now is the time to continue fueling lifesaving cancer research through investment in the National Institutes of Health, National Cancer Institute and other organizations and agencies devoted to cancer research.
While gains in cancer research have been impressive, the pace of progress has been slowed due to years of budget cuts at the NIH and NCI.
“Incredible strides have been made in advancing our understanding, enhancing prevention and improving therapy of cancer,” said Steven Rosen, M.D., provost and chief scientific officer at City of Hope and director of the Comprehensive Cancer Center. “To maintain momentum with the ultimate goal of maximizing cure of these devastating diseases, the necessary funds must be available.”
While health care reform has led to an increase in the number of people signing up for health insurance, many people remain uninsured or are not taking full advantage of the health benefits they now have. Still others are finding that, although their premiums are affordable, they aren’t able to see the doctors they want.
Just because health care is more accessible than before, doesn’t necessarily mean it’s less confusing, says Joseph Alvarnas, M.D., director of Medical Quality and Quality, Risk and Regulatory Management at City of Hope.
“You have to realize we’re in un-navigated waters,” Alvarnas said. “We’re here to serve not only as health care providers, but educators. We need to empower people to be active participants in their care.”
Thyroid cancer has become one of the fastest-growing cancers in the United States for both men and women. The chance of being diagnosed with the cancer has nearly doubled since 1990.
This year an estimated 63,000 people will be diagnosed with thyroid cancer in the United States and nearly 1,900 people will die from it. These numbers may sound alarming, but thyroid cancer is still relatively rare compared to other cancers. Even better, it’s highly treatable at all stages.
Here, Robert Kang, M.D., assistant clinical professor in City of Hope’s Division of Otolaryngology/Head and Neck Surgery, presents a fuller picture of thyroid cancer and explains what you should know about the disease.
1. Thyroid cancer is one of the most treatable cancers.
“Thyroid cancer is treatable at all stages,” said Kang. “Five-year survival outcomes for well-differentiated thyroid cancers approach 100 percent for both Stages 1 and 2. Stage 3 papillary thyroid cancers have demonstrated a five-year survival rate of 93 percent.”
Older teenagers and young adults traditionally face worse outcomes than younger children when diagnosed with brain cancer and other central nervous system tumors. A first-of-its-kind study shows why.
A team of researchers from the departments of Population Sciences and Pathology at City of Hope recently examined the cancer registry, looking at the entire Los Angeles County population of older adolescents and young adults — collectively known as AYAs — and children diagnosed with central nervous system (CNS) cancers, which include tumors of the brain and spinal cord.
The study included nearly 1,350 patients: children 14 years old and under and AYAs, who fall between the ages of 15 and 39. The National Cancer Institute (NCI) has determined that AYA patients form a special group because of unique challenges they face in cancer treatment, and this study was the first to assess the impact on survival of where an AYA patient receives care.
The scientists, led by Julie Wolfson, M.D., M.S.H.S., assistant professor, and Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences, found that both children and AYAs with a select group of CNS tumors who were treated at NCI-designated comprehensive cancer centers such as City of Hope fared better than those seeking care at adult community facilities. In some cases, the difference in five-year survival rates was more than 10 percent. Of special note, the AYAs with these cancers fared worse than the children, but by receiving care at an NCI-designated comprehensive cancer center, this difference was wiped away.
Cancer treatment can take a toll on the mouth, even if a patient’s cancer has nothing to do with the head or throat, leading to a dry mouth, or a very sore mouth, and making it difficult to swallow or eat.
Here’s some advice from the National Cancer Institute (NCI) on how to ease cancer-related discomfort of the mouth.
Chemotherapy and radiation to the upper body can damage the salivary glands, reducing the production of saliva and making it harder to talk, chew and swallow food. Some medications can also be cause dry mouth. Try these tips to alleviate dry mouth: » Continue Reading
Radiation oncology is one of the three main specialties involved in the successful treatment of cancer, along with surgical oncology and medical oncology. Experts in this field, known as radiation oncologists, advise patients as to whether radiation therapy will be useful for their cancer – and how it can best be safely and effectively delivered.
Here, Jeffrey Y.C. Wong, M.D., chair of radiation oncology at City of Hope, shares what he sees as the future of radiation oncology and the importance of this type of therapy in the treatment of cancer.
How and why did you decide to become a radiation oncologist?
I’ve always had an interest in the math, physics and engineering fields. I almost became an engineer, but decided to switch to oncology with a focus in medicine, and radiation oncology is a good blend of both. Radiation oncology is a blend of engineering, computer sciences, physics, biology and medicine, with the primary goal of helping people.
What inspires you daily to do the work you do?
I, along with my colleagues at City of Hope, have the opportunity to make a difference in patients” lives every day. For many patients, our therapies can help result in a cure of their cancer. We also have the opportunity to make a contribution to cancer research and advance the field of oncology. » Continue Reading
There’s more to cancer care than simply helping patients survive. There’s more to cancer treatment than simple survival.
Constant pain should not be part of conquering cancer, insists Betty Ferrell, Ph.D., R.N., director of nursing research and education at City of Hope. She wants patients and caregivers alike to understand, and act on, this principle.
Ferrell, an international expert in palliative care, and her colleagues have spent years investigating pain management and the barriers that prevent patients from receiving the help and medication needed to manage their pain. Overcoming these barriers starts with understanding that pain management is vital. Even when people are fighting cancer, their day-to-day lives should not hampered by physical pain.
“Patients and caregivers need to understand that pain is important,” she said. “Pain has a tremendous impact on quality of life. There is an urgency. If pain is not controlled, their lives are out of control.”