“Article from The Smithtown News March 17th, 2011 By David Ambro”
Intensity-Modulated Radiation Therapy improves prognosis for prostate treatment.
When Lawrence Gray, 66, of Kings Park, was diagnosed with prostate cancer last year, there was at first a feeling of dread—he had battled cancer before and it wasn’t easy—but as he worked with his doctor on a state-of-the art radiation therapy strategy, anxiety turned to hope.
For three years, from 1985 to 1988, Mr. Gray fought off lymphoma, cancer of the lymphatic cells of the immune system. “It was three years of torture,” he said. He underwent extensive surgery, which included the removal of his spleen, followed by extensive chemotherapy treatment that left him debilitated and facing a lifetime of side effects.
Mr. Gray won his bout with cancer in the 1980s, but one of the side effects of that medical triumph is that he has to have a kidney stint periodically replaced, a procedure performed at St. Catherine’s of Siena Medical Center in Smithtown by Dr. Thomas Harrington, of Island Urological Care, P.C. When the stint was replaced February 22, 2010.
Dr. Harrington advised Mr. Gray that his prostate-specific antigen (PSA) level was elevated, an early indicator of the onset of prostate cancer.
Dr. Harrington referred Mr. Gray for additional PSA screening, which confirmed the level was elevated. He was screened again three months later, and again the PSA count was elevated. So, in August 2010 Dr. Harrington performed a biopsy and found a cancerous growth on Mr. Gray’s prostate.
Mr. Gray said that he sat with Dr. Harrington and discussed his options. Given his age and medical history, Mr. Gray was not a candidate for surgery, and Dr. Harrington recommended against the surgical implant of radioactive seeds, which can causes side effects. Instead, Dr. Harrington recommended that Mr. Gray undergo an extensive nine-week program of image-guided, intensity-modulated radiation therapy (IMRT) at Advanced Radiation Centers of New York (ARC) in Hauppauge.
Mr. Gray began the treatment January 14 and he goes to ARC every weekday, Monday to Friday, where he walks in felling fine, spends 10 to 15 minutes on a high-tech machine which uses fiduciary markers implanted in his prostate by Dr. Harrington to direct lazar-guided doses of radiation to treat the cancerous growth in the body while not damaging any other nearby cells. He will continue the daily treatments until the end of this week, Friday, March 18.
“So far everything has been textbook perfect. I think I’m doing the right thing,” Mr. Gray said during recent tour of the ARC facility. “There is no reason for a man to die of this anymore. The prognosis, from what I am told is excellent. You just have to go get your PSA tested.”
During an interview in his Smithtown office Tuesday, March 8, Dr. Harrington was encouraged by Mr. Gray’s optimism. “His prognosis is very good at this point,” Dr. Harrington said of Mr. Gray. Dr. Harrington added, however, that there are still cases of prostate cancer that are diagnosed early and incurable.
The PSA testing, which came into existence in the 1980s is an early and important indicator. It is recommended that men over 50 have their PSA tested annually; and men with a family history of prostate cancer and African American men should be tested at 40 and 45 years old and then annually after 50. Dr. Harrington said before there was PSA testing the only method of prostate cancer diagnosis was a rectal exam and 50% of the time it was incurable. “PSA testing gave up a jump on early diagnosis,” he said.
Dr. Thomas Harrington, the Chairman of Surgery at St. Catherine’s, went on to explain that beyond the PSA test there is a one-to-ten Gleason Grading System used to evaluate the aggressiveness of the cancer, one being the least aggressive and 10 the most aggressive. Next in the diagnostic process is a biopsy, in which 12 samples from various parts of the prostate are tested. If all 12 are cancerous, the prognosis is not good.
Mr. Gray had a Gleason grade of 7 and the biopsy found eight of 12 samples to be cancerous, a difficult prognosis, but one in which the cancer was still considered to be curable. Dr. Harrginton said that in a younger man of 40 to 50 years old he would still have recommended surgery and removed the cancer, but that Mr. Gray was a prime candidate for IMRT.
At ARC Mr. Gray is strapped onto a mechanical table in a radiation proof room.
Technicians help him into position then leave the room closing a large vault-like door behind them. The technicians operate the equipment from a control panel in an adjacent room. They perform a CAT scan,which identiﬁes and locks on to the ﬁduciary markers Dr.Harrington inserted into Mr. Gray’s prostate.
Once locked on, a large mechanical arm moves slowly in a 360 degree circle around the table delivering radiation waves to only the affected areas of the prostate using the markers as their guide. The entire process takes about 15 minutes.
“It is a nice, precise therapy where the energy is delivered more speciﬁcally,” Dr. Harrington said. “Basically what you want to do is put the radiation only where it is needed and hit less body structure.”
During the tour of ARC’s Hauppauge ofﬁce, Dr. Jigna Desai Jhaveri said the image-guided IMRT system at ARC is the latest advancement in cancer treatment. Dr. Harrington, who is a member of the Integrated Medical Professionals with ARC, said the IMRT equipment has been at ARC for two years and is the ﬁrst of its kind in the region.
With IMRT, Dr. Harrington said there are fewer side effects and less often. He said the IMRT process is still to modern to provide an in-depth conclusion about its efﬁcacy, but all available data seems to indicate that it is just as effective as surgery. He said too, that he has not had a patient that has been treated with IMRT who has had a reoccurrence of prostate cancer.
Dr. Jigna Jhaveri explained that as the IMRT machine rotates around the patient, using a lazar guidance system to direct the radiation at speciﬁc targets, the level of radiation is modulated depending on what is in its path—lower doses to normal cells and higher doses to cancerous tissue.
Dr. Jhaveri said the development of PSA testing in the late 1980s was probably the biggest advancement in the ﬁght against prostate cancer. Since that time, she said, image-guided IMRT is one of the most signiﬁcant advancements in combating this proliﬁc form of cancer, which affects one out of six men. She said the image guidance and the modulation features allow higher does of radiation to be administered without damaging the bladder or the rectum.
“This is a much less invasive way to treat prostate cancer,” Dr. Jhaveri said. “This is an excellent option as a non-invasive treatment
technique.” “So,” Mr. Gray asked at the end of a recent interview, “when are you getting your PSA tested?