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Advances in radiation for prostate cancer give patients new options

Today’s radiation treatments are safer, more precise and more effective than ever before. Sometimes they can even be used in place of surgery

Steve Oakley doesn’t mince words when he describes his radiation treatment for prostate cancer. 

The 72-year-old actor/writer/producer with decades of reality show credits (14 years in multiple production roles for MTV’s “The Real World” for example) paints a vivid picture:

“You’re inside this room,” he recalled, “and the gurney you’re on goes in all different directions, while this team outside a window is watching their scopes, pushing buttons and firing!”

Sounds like the stuff of Star Wars. Oakley’s radiation oncologist uses more technical language:

“He received IMRT with daily cone beam CT for image guidance,” said Jekwon Yeh, M.D., M.B.A., assistant clinical professor in the Department of Radiation Oncology. “The ‘gurney’ he is referring to is our linear accelerator” (radiation machine).

Whichever terminology you prefer, the bottom line is that Oakley received some of the most advanced prostate cancer treatment available, delivered by sophisticated machines that have made today’s radiation treatments safer, more precise and more effective than ever before.

Jekwon Yeh
Jekwon Yeh, M.D., M.B.A.

Oakley has battled numerous medical challenges in his life. At 18, he was stricken with a pulmonary embolism. Over the next decades, his weight increased and his health deteriorated. In 2019, when Oakley was 70, he was morbidly obese — weighing over 275 pounds — and he suffered a pair of strokes, one of which put him in a coma for six days. Doctors treating him discovered an elevated PSA level, indicating prostate cancer, which brought him to City of Hope.

Barely out of the coma and arriving with the aid of a walker — the strokes had impaired his mobility — Oakley met Yeh and instantly saw something that both impressed and reassured him.

“I come from showbiz,” Oakley said. “And Dr. Yeh, he’s a movie star. He’s the Carl Sagan of City of Hope. He walked me through everything, all the modern marvels he would use. And he said to me, ‘If we rock and roll, we can take it, but we have to move now.’” 

Treating With Radiation Alone

The meaning was clear. Oakley’s cancer was still in an early stage, and Yeh believed he could treat it successfully with radiation alone. That belief was backed up by data. In early stages, “radiation can be an alternative to surgery, with a similar cure rate,” he said. “The overall survival rate is very similar.”

Part of that success is due to the evolution of the older, more traditional external beam machines, such as the linear accelerator, which are noninvasive and deliver radiation aimed at a specific part of the body. Although the basic technology has existed since the 1950s, the last two decades have witnessed major improvements.

Oakley received several weeks of daily intensity modulated radiation therapy (IMRT). In use since the 1990s, IMRT adapts the strength of the radiation beam to match the precise contours of a tumor and minimize the damage to surrounding tissue. The IMRT is guided by computed tomography (CT) imaging, which maps those contours and pinpoints the cancer. 

A 3D View

The newer cone beam CT deployed by Yeh “sees all of the anatomy” by rotating around the patient, capturing data with a cone-shaped X-ray beam. This provides a comprehensive, three-dimensional view of the area.

Beyond those big, room-sized machines, Yeh is also enthusiastic about some smaller, yet equally powerful, tools: radiation therapy in which the patient is treated literally from the inside out.

Starting as early as 1911, doctors have employed various forms of brachytherapy (“brachy” means “short” in Greek), in which radioactive devices are implanted inside the body, directly targeting cancer cells without damaging nearby healthy tissue. 

Low dose rate brachytherapy, the method most commonly used today for prostate cancer, involves inserting numerous so-called radioactive “seeds” into the prostate and leaving them in place, sometimes for several days, sometimes permanently. 

Yeh sings the praises of a newer alternative: high dose rate brachytherapy (HDR). It employs about a dozen needles delivering a much stronger dose of radiation, but for a shorter time; the needles are removed after about 20 minutes. A computer program guides the entire robotic procedure, determining where the seed in each needle goes and how long it stays there.

“The side effects, like increased urination and a burning sensation, can be intense at first,” admitted Yeh, while adding that the symptoms pass and that, overall, HDR achieves results in less time and with fewer long-term problems.

Irradiating prostate cancer while avoiding healthy tissue is a uniquely difficult challenge because of the prostate’s location, flush against the rectum. That’s why Yeh is excited about a product called SpaceOAR, an injected hydrogel. Originally used by neurosurgeons, SpaceOAR creates a crucial, one-centimeter gap between the rectum and prostate. “And, when it comes to pinpointing radiation, a centimeter is a country mile,” said Yeh.

Detecting and Treating at Once

A previous City Stories article detailed what Yeh calls “the next big thing”: detecting and eradicating prostate cancer at the same time using the PSMA system. A specially modified positron emission tomography (PET) scan detects areas displaying a prostate-specific membrane antigen. A radioactive isotope can then immediately deliver a cancer-killing attack to those targeted cells. Yeh is also watching the progress of another PET scan detection method, this one using Axumin, an advanced diagnostic imaging agent, or radiotracer, which may pick up cancer cells missed by other methods. 

Yeh’s enthusiasm for all of this progress is personal. Several of his relatives have succumbed to cancer. He entered radiation oncology to find nonsurgical ways to make a difference.

“Every patient,” he says, “is like a family member to me.”

It certainly felt that way to Oakley who, after a course of radiation treatments, went into remission and has remained cancer free. Along the way, he’s also made changes to his diet and exercise regimens. He’s dropped some 140 pounds, enabling him to bring renewed energy and passion to the production company he runs with his wife, Melanie Grunder.

“If you’re lucky enough to get to City of Hope, you are truly lucky,” he said. “They are the reason I’m alive. Dr. Yeh took a guy not destined to be around and made him a person with purpose.”