November 13, 2015 | by Alison Shore
A love of working with his hands as a boy is what ultimately led Clayton Lau, M.D., director of the Prostate Cancer Program at City of Hope, to a career in surgery. He credits gifted mentors in urology in medical school for his decision to specialize in the treatment of prostate cancer.
Approximately one of every seven men, most of them over the age of 65, are expected to receive a diagnosis of prostate cancer in 2015. Thanks to leading-edge treatment and a skilled medical staff, City of Hope boasts a nearly 100 percent survival rate at five years for men with localized disease. In patients with advanced cancer, the survival rate at five years drops, but the goal is still to prolong life.
Lau, who is passionate about City of Hope’s commitment to its highly-regarded Prostate Cancer Program, cites a culture of collaboration, one that ensures great care at all points in a patient’s journey, as crucial to the program’s success.
I think the experience of the surgeons and our teamwork, from the doctors to the nurses to the office staff, are outstanding features of our program. Every day, we see patients with both low- and high-risk disease, so there is a lot of familiarity with treating prostate cancer. From diagnosis to lower-grade disease to more advanced cancer, everyone’s goal is to be open and available to the patients from step one.
It starts with preventive care. We recommend that, beginning at age 45, men should schedule yearly exams, including a digital rectal examination and measurement of the prostate-specific antigen (PSA). For some patients, such as those who have a serious family history of the disease, screening at 40 is warranted. We’re looking at other markers of disease (besides PSA), so that we can detect disease as early as possible.
After treatment, we want to see patients every three months — more frequently for patients with advanced cancer — with follow-up consisting of monitoring PSA levels and recovery from surgery or radiation therapy.
There will always be a role for conventional surgery, for example, in patients who have undergone previous extensive abdominal surgery, which leaves scarring. But for many patients with localized cancer, robotic surgery is appealing because it’s less invasive, has a lower risk of complications and results in a quicker return to normal activities. City of Hope has been using it for a dozen years, and we have performed more of these surgeries than anywhere else in the western United States. But we’re always looking at ways to refine the procedure, with an eye to increased efficiency and lower cost. Prostate cancer treatment has definitely been at the vanguard of using more technology than other diseases, but treatment of other cancers — for instance, lung — now includes robotic-assisted surgery, too.
There’s a lot of excitement right now about high-intensity focused ultrasound, which kills cancer cells with targeted, heat-emitting sound waves. We are awaiting Food and Drug Administration approval, which may be in one to two years. If that happens, we’ll want to have the technology available at City of Hope.
We’re looking at an intra-optical imaging method that may help to detect microscopic disease outside the prostate. Patients are injected with fluorescence-containing antibodies that attach to the PSA and emit visible radiation. Using a special camera, we then have the potential to detect microscopic cancer cells. This in turn may enable us to provide even more complete resection of all disease.
Yes, the model for breast cancer awareness and funding is one we are working to adopt more fully. I would say that, historically, men have been reluctant to go to the doctor or talk about their health. This is certainly at play in prostate cancer. But these issues are definitely improving.
I do. Active surveillance in prostate cancer is used more these days, although we, of course, take into account a range of factors such as age of the patient, life expectancy, severity of the disease. But watching and waiting should be considered more in the United States as a valid approach.
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