Radiation Therapy

April 20, 2017

PSA test gets a new grade: a gentleman’s C

A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms: The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes healthnewsreview.org.

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

November 16, 2016

As cancer care advances, costs and concerns keep rising, too

by Patrick A. Malone

Although doctors and hospitals report potentially sunnier news by the day about novel cancer treatments, it’s also worth keeping in mind that difficult obstacles like data misinterpretation still must be worked out to avoid endangering patients. The therapies themselves as well as cancer care overall can be crushing in their costs. And some experts also are raising questions about Big Pharma and the independence of advocacy groups that patients and families often turn to when diagnosed with different cancers.

Let’s start with the ray of optimism that the Washington Post reported for patients with advanced lung cancer. It kills more than 160,000 Americans annually, and isn’t diagnosed often until it reaches late stages. Lung cancer, the Post says, retains its stigma because of its proven link to smoking. Both smokers—and nonsmokers who also may develop the disease for many other complex reasons—are blamed for causing their own illness.

Oncologists have begun to look at this cancer not as one but many different disease, and the paper says immunotherapy may improve outcomes for a slice of late-stage patients, halting the disease’s spread and without the significant side-effects of current chemo or radiation treatments. In immunotherapy, patients’ cancers are tested to determine which drugs may best target and destroy tumors by unleashing the bodies’ own disease-fighting (immunity) systems.

September 18, 2016

Ten-year study on prostate cancer suggests “watchful waiting” is a reasonably safe option

by Patrick A. Malone

A study involving more than 80,000 men followed for 10 years gives some important clues, but no final answers, on what patients with a diagnosis of prostate cancer should do. It’s long been a puzzle because prostate cancer is one of the most common and deadliest cancers for men, yet in many cases it’s so slow to grow that men die with, not from, prostate cancer.

Here’s the bottom line, which the researchers emphasized needs to be continued for an even longer time for its findings to be more authoritative:

At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

September 15, 2014

Breast-Sparing Surgery Shows Better Results in Some Cancer Patients

by Patrick A. Malone

A preliminary report shows that surgery that spares the breast in patients with a certain kind of early-stage breast cancer has better survival rates than mastectomy.

The study findings, reported Consumer Affairs, “defy the conventional belief that the two treatment interventions offer equal survival, and show the need to revisit some standards of breast cancer practice in the modern era, …”

Breast-conserving therapy (BCT), according to a paper presented at the Breast Cancer Symposium earlier this month, involved lumpectomy plus radiation for patients with early-stage, hormone receptor-positive breast cancer. Lumpectomy is the removal of only the mass with the tumor, not the whole breast (mastectomy). Hormone receptor-positive breast cancer (HR+) is when the cells have receptors for either estrogen or progesterone, which invites growth. Hormone receptor status is a primary factor in how a patient’s breast cancer is treated.

November 3, 2013

Urologists Who Own Radiation Equipment Use it More … and Probably Unnecessarily

by Patrick A. Malone

A couple of weeks ago, we wrote about urologists who, according to clinical guidelines, use too much radiation to treat prostate cancer pain. Here’s some related have-you-no-shame prostate cancer news brought to you by your local urologist.

According to a study in the New England Journal of Medicine, (NEJM) an awful lot of urologists are making decisions about treatment for their prostate cancer patients based on whether or not they own intensity-modulated radiation therapy (IMRT) facilities. One-third of men whose doctors own such equipment get that therapy for about $35,000 per treatment course. But before they were financially invested in radiation equipment, the same doctors prescribed that therapy for only 13 of 100 of their patients.

As discussed in Bloomberg Businessweek.com, prostate cancer is the most common tumor diagnosed in the U.S.; nearly 240,000 men will get a diagnosis of prostate cancer this year. As we’ve blogged often (here and here), a diagnosis of prostate cancer presents a complicated scenario; the range of appropriate treatment moves from watchful waiting (no intervention unless and until the pathology changes in certain ways) to hormone therapy to surgery, chemotherapy and radiation. As Businessweek summarizes, “While only about 12%, or 29,270 men, will die from it this year, all will have to decide how, and whether, they want to treat the cancer.”

October 22, 2013

Too Many Doctors Use Too Much Radiation to Treat Prostate Cancer Pain

by Patrick A. Malone

Although radiation can be a vital diagnostic tool and a life-saving cancer treatment, its dangers are well-documented (see our backgrounder on radiation overdose injuries).

A recent study published in the Journal of the American Medical Association (JAMA) suggests that doctors might be using radiation therapy too often for patients with advanced-stage prostate cancer. That puts them at risk of normal cell damage, skin irritation, diarrhea, bleeding and other problems. It also adds to the cost of their treatment.

Radiation therapy is prescribed to treat pain in patients whose prostate cancer has spread to their bones. This intervention is not for improving chances of survival in these advanced-stage cases, only to address severe pain. Radiation treatment of 10 sessions or more is recommended only in fewer than 10% of cases, and only if the patient’s cancer also might have spread to nearby soft tissue.

March 27, 2012

Radiation Treatment for Some Breast Cancer Patients Is Outdated

by Patrick A. Malone

Old habits die hard, and in this regard the medical profession is no different from any other. Researchers at the Yale School of Medicine were surprised, though, at the results of their study showing that despite the fact that radiation has limited benefit for some older women with breast cancer, the treatment is still being prescribed.

A large clinical trial conducted by the National Cancer Institute (NCI) concluded that radiation for some women older than 70 with early stage, low-risk breast cancer offered limited benefit. So significant was the 2004 NCI trial that breast cancer treatment guidelines were changed to place radiation therapy in the “optional” category for these patients.

But the Yale researchers found that in the years following implementation of the new guidelines, there has been minimal change in the clinical care of older women with breast cancer. Their report was published in the March Journal of Clinical Oncology along with an editorial echoing our feeling that the perpetual motion treatment machine needs to be overhauled.

October 30, 2011

Annual Chest X-Rays Don’t Help Smokers Beat Lung Cancer

by Patrick A. Malone

A new study might add to the perception that U.S. medical care is uncontrollably expensive thanks in part to unnecessary tests. “Screening by Chest Radiograph and Lung Cancer Mortality” concludes that people who have an annual chest X-ray do not have a significantly lower mortality rate than people who don’t.

The study, whose lung data are part of a larger investigation into cancers of the prostate, colon/rectum and ovaries, examined people who were given either annual chest X-rays (chest radiography) or standard medical care without screening. In the 13 years’ of the study, 1,696 lung cancers were detected in chest radiograph group and 1,620 lung cancers in the control group. The radiograph group reported 1,213 lung cancer deaths, and 1,230 in the control group.

The results weren’t really a surprise; researchers said the study confirmed expectations rather than setting new ones.

March 8, 2011

The Coming Cancer Epidemic from Overuse of CT Scans

by Patrick A. Malone

The medical community is waking up to an enormous problem with radiation – mainly X-rays and CT scans – used to diagnose disease and injury. Patients are getting too much radiation, and the excess itself causes injuries, many years down the road, in a big uptick in the risk of cancer.

Even a “routine” CT scan of the abdomen, ordered thousands of times every day in the United States for patients with belly pain, carries a large risk of downstream cancer, just from that single scan.

Dr. Rebecca Smith-Bindman, MD, of the University of California San Francisco, estimates a 20-year-old woman who undergoes a CT scan of the abdomen and pelvis has a one in 250 chance over her lifetime of getting cancer just from that single dose of radiation. This number was in a talk she gave recently at UCSF, as reported by her colleague Bob Wachter, MD, a patient safety expert at UCSF.

March 1, 2011

Doctor who botched prostate cancer brachytherapy procedures at VA hospital sanctioned

by Patrick A. Malone

A physician who gave nearly 100 veterans with prostate cancer incorrect doses of radiation has been sanctioned by the Nuclear Regulatory Commission (NRC). The errors involved the incorrect placement of iodine-125 seeds in patients to treat prostate cancer.

Out of 116 such brachytherapy procedures performed at the facility between 2002 and 2008, the VA reported that 97 were carried out incorrectly. The NRC investigation found that Dr. Gary Kao, a radiation oncologist at the VA Medical Center in Philadelphia, took part in 91 of the 97 incorrect procedures. In several cases, the incorrect doses were caused by Kao having implanted the seeds in nearby organs or surrounding tissue.

As a result, the NRC ruled that Kao cannot take part in agency-related activities without undergoing more training. The NRC also issued a separate order requiring Gregory Desobry, a medical physicist who worked at the same facility, to notify the agency if he accepts employment in that capacity involving NRC-regulated activities within 20 days of beginning such work. Last year, the NRC fined the Philadelphia VA hospital $227,500 over the incidents.