BATAVIA ??When Ron Lewen turned 50, he began having an annual test for prostate cancer.
In February, when he turned 55, Lewen had his fifth PSA test, the prostate-specific antigen test, and it showed an elevated PSA. The Batavia man?s doctor first treated him with antibiotics to rule out an infection, but when the PSA level stayed high, the doctor suggested a biopsy that confirmed he had prostate cancer.
?The doctor called and left a message that he wanted to see us in his office on Thursday,? said Amy, Lewen?s wife of 28 years. ?Right away, we knew that it was not good news. They don?t tell you to come to the office to tell you good news. We broke out crying.?
The prostate is a walnut-shaped gland located below the bladder. It produces fluid that makes up a part of semen. Among American men, prostate cancer is the second most common cancer after skin cancer, and the second leading cause of cancer death after lung cancer, according to the American Cancer Society.
Because it was at such an early stage, Lewen and his wife began a five-week search for treatment options.
?The good thing about the Chicago metro area, we have a lot of choices,? Lewen said. ?The bad thing was we had too many choices.?
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At 6 feet 2 inches and 350 pounds, Lewen said his urologist ruled out surgery because of his size. Still, he looked at it and shuddered.
?Surgery is they cut you from your belly button down to your crotch ? and remove your prostate,? Lewen said. ?I?m a big guy, and that is too much collateral damage. ... It can cause incontinence and damage to the nerves can stop male functionality. It did not seem like a good choice.?
He considered traditional radiation and rejected that, as well.
?Traditional radiation affects everything outside of the body on one side, goes all the way through and exits the other side,? Lewen said. ?Anything in that path will be affected by radiation.?
Another option was brachytherapy, also known as internal radiotherapy, in which radioactive ?seeds? are implanted near the area of the cancer.
?We didn?t think that was a good option,? Lewen said. ?You still need general anesthesia, there is still the risk of infection and they use long needles to insert them.?
The Lewens chose proton therapy at Central Dupage Hospital?s ProCure center in Warrenville.
Proton therapy involves aiming a beam of protons ??which are subatomic particles ? at a tumor to deliver an increased dose of radiation to kill cancer cells. Proton therapy reduces radiation exposure to surrounding healthy tissue.
Lewen took 44 treatments Monday through Friday from June 19 to Aug. 20 and graduated as the two-year-old center?s 575th patient. He did not get sick, nauseous or lose his hair. He worked the whole time but felt more tired than usual in the evenings, he said.
The most uncomfortable part was having to drink a lot of water because a full bladder lifts the prostate and makes it an easier target, Lewen said. Treatments took about 10 minutes, but each visit was about 90 minutes because of prep time.
?We won?t know it?s 100 percent gone until they do follow-up tests,? Lewen said. ?They still rely on the PSA level in the blood. My first test will be in November, just before Thanksgiving.?
And there is much to be thankful for, his wife said.
?We made the best choice,? Amy Lewen said. ?It was nice there was no surgery, even though it was a longer process. If it had been life or death in a month, we would have done the other one, but because it was not that advanced, we had time. Some men die and [don?t] even know they have prostate cancer.?
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Dr. John Han-Chih Chang, a board certified radiation oncologist at the ProCure center, said treating prostate cancer with proton therapy limits collateral damage to the bladder, urinary tract and rectal area.
ProCure has treated more than 600 patients since it opened in October 2010. About half are for prostate cancer.
?It?s obviously too early to say that all are going to do well,? Chang said. ?At this point, all of them have done well.?
He said data from Loma Linda University Medical Center in California and Massachusetts General Hospital, which have had proton centers since the 1990s, includes patient results from 10 years after treatment and longer. Chang said for localized prostate cancers ? those that have not spread ? the cure rate is 85 to 90 percent.
Leonard Arzt, executive director of the National Association for Proton Therapy, said the Lewens did what many younger cancer patients are doing these days.
?They do their own research and their own homework,? Arzt said. ?And they come to this [proton therapy] on their own for the most part and refer themselves.?
The association is a nonprofit group that advocates for the advancement of proton therapy. The first experiments on proton therapy were done in the 1940s, and the first treatment center at a hospital was opened in 1991 at the Loma Linda in California, according to a timeline provided by ProCure.
Proton therapy is used for prostate cancer, brain tumors, melanoma of the eye, pediatric cancers, head and neck tumors, tumors at the base of the skull or on the spine, in the lungs, the gastrointestinal system?and arteriovenous malformations ? which are a malformed web of arteries and veins that occur in the brain, brain stem or spinal cord.
Arzt said half or more of the proton therapy centers? treatments are for prostate cancer. In terms of all radiation treatments for cancer, it amounts to 1 percent.
There are 10 proton therapy centers in the U.S. and seven being built, according to the association. The Mayo Clinic is also building two proton therapy centers in Minnesota and Arizona.
Though it appears to be a promising treatment, proton has critics that question the cost and outcomes. Massachusetts General announced it was going to launch a five-year study into proton therapy centers to determine whether the expensive treatment was worth it.
Arzt said proton therapy costs a third more than more traditional treatment, which generally costs about $50,000.
An analysis by the American Society of Clinical Oncology found proton beam therapy did not significantly improve outcomes compared to intensity modulated radiation therapy ??another therapy involving directing beams of radiation at a tumor.
However, the International Journal of Radiation Oncology Biology Physics and the American Society for Radiation Oncology?s official scientific journal reported this year that two other studies found proton therapy ?to be a safe and effective treatment for prostate cancer.?
Arzt dismissed the critical studies as either flawed, unfair or incorrectly reported.
?If all hospitals could afford to have proton therapy, they would all have it,? Arzt?said.
While researchers pursue the finer points of proton therapy, the Lewens say they made the right choice ??and were lucky enough to live near a center for the daily treatments.
?We met other couples at the center, people from Israel, from Canada and Michigan ? and a gentleman from Springfield, all there for proton treatment,? Amy Lewen said. ?After we graduated, we got together and took a train downtown to go to Navy Pier for a dinner cruise.?
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Source: http://www.kcchronicle.com/2012/09/05/fighting-prostate-cancer/aww1ivu/
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