Duke K. Bahn, MD – “Color Doppler and Ultra Sound for PC Staging and DX Dr. Bahn is a ratiologist who has had extensive experience with prostate cancer while working with Dr. Fred Lee of the Crittenton Hospital group in Michigan. He has performed many cryosurgery procedures in Dr. Lee’s group and is very experienced in the use of color Doppler ultrasound techniques for diagnosing PCa. He discussed the issue of missing a significant percentage of PCa when the cutoff PSA was set at 4.0. Within the range of 2.5 -4.0. he reported, the incidence of PCa is as high as 24.5%. In quoting from two separate papers that identified this high proportion of PCa in what earlier would have been considered a “safe” PSA range, he said that 68 to 80% of these tumors were clinically significant. He showed data from a publication of Dr. William Catalona that identified organ confined disease at 80% for PSAs between 2.6 and 4.0, 70% for PSA range of 4.1-10, and only 50% for PSA>10. The balance of his lecture dealt with the diagnostic gains that result when color Doppler ultrasound is used to attempt to map the locations of tumor sites in the gland. Because of its better sensitivity and specificity more PCa can be diagnosed at earlier stages than with convention black and white ultrasound. Dr. Bahn made the point that an optimum PCa diagnosis will present 10 facts: Tumor Location (as in transition/peripheral zones, base, apex, mid) Tumor Size (<3 cc, >3 cc) Gleason Grade (s)(especially %age of grade 4) Ploidy Results (diploid, aneuploid, tetraploid) Perineural Invasion Extraprostatic Extension Stage (as in T1, T2, T3, etc.) Prostate Volume Prostate Configuration Pubic Arch Interference Dr. Bahn presented a second lecture entitled: “Cryo-ablation Therapy for Prostate Cancer”. In this lecture, Dr. Bahn reviewed the early history of cryo-ablation and reported on the problems with the method that resulted in its gaining a negative image in the physician and patient communities. Major advances were made in the technology of the procedure and greatly improved results are being obtained. Dr. Bahn studied under Dr. Fred Lee of Crittendon Hospital in Michigan where Dr. Lee was an early student and practitioner of Cryo-ablation therapy. Among the major advances in the technology has been the introduction of urethral warmers to prevent freezing of urethral tisse, multiple probes to provide better control of the therapeutic iceball, and different rare gases to achieve better control of the freezing operation. Today's cryotherapy is being used with much greater frequency and with results claimed to be comparable to the other primary therapies of surgery and radiation. Five year survival rates are comparable especially when the therapies being compared are being used on similar stage tumors. Today cryo surgeons are performing prostate lumpectomies analogous to breast cancer lumpectomies. That is, they are just freezing those regions where exact tumor focii have been identified. (Ed note: because of the highly focal nature of PCa, it is difficult to say with certainty that a given focus is the only one in the gland. Other focci may be occult and thus recurrence may take place some time after the “primary focus” has been cryo-ablated. More data needs to be presented in support of this approach). Dr. Bahn showed how the effectiveness of CA varies with the relative risk group to which the cancer has been assigned (as in Low, Medium, and High). He also showed disease parameters that necessitated pre-treatment with hormonal ablation before the CA would be applied. As would be expected, the results correlated well with the risk classification groups: low risk groups having best results, etc. He presented 7 year Kaplan-Meier data supporting this conclusion. High overall disease free survival of greater than 70% was shown for all three risk groups. He discussed the complications of cryotherapy that included 100% impotence, urinary disfunction in range of only 2-4% when CA was primary tx, and 2-20% when the CA was for radiation salvage therapy. Dr. Bahn concluded that “CA was equal….or better than conventional treatments” and “complication rates are favorable compared with conventional treatment.” and “CA is a minimally invasive procedure and cost-effective option” [ed. for organ confined disease]. He devoted the last part of his lecture to the use of Cryo-Ablation as a salvage therapy for men who have failed a primary radiation therapy such as brachy or xbrt and have stages T1-T3 N0 M0. Depending on the Gleason Grade and PSA at the time of the salvage therapy, he reported success rates equal to the virgin group when the PSA=<10, and the stage was T1, T2. He also said that it is a highly operator dependent procedure with a “steep learning curve”. (Ed Note: we conclude that he was really saying be sure to use a physician who has done a great number of procedures to get the optimal results). For low risk patients, he showed a chart suggesting that with the exception of XBRT, all the other modalities of therapy had equal 5 year biochemical disease free survival periods. Surgery was the highest followed closely by cryo, brachy, 3-D conformal and lastly XBRT. For the medium risk group, he reported cryo (61-89%) as better than RP (37-77%) and XBRT having 26-60% five year BFDS. The preceding data were for the period 1992-2002. When he included the high risk group, there was an even greater separation in favor of cryo than either RP, brachy, or XBRT. Dr. Bahn made another important point: “…the efficacy of cryoablation is independent of DNA Ploidy type”. This is an important point because he hypothesizes that the method of tissue destruction by freezing, does not allow for any resistance from cells whose Ploidy would normally be considered as potentially radiation resistant. Michael J. Dattoli – Advances in Radiation Therapy Dr. Dattoli is a widely known and recognized pioneer in the use of brachytherapy for primary PCa. In this long, comprehensive review of the field of radiation therapy he made some startling pronouncements. His most challenging conclusion was “ BRACHYTHERAPY IS THE NEW GOLD STANDARD FOR PROSTATE CANCER”. He presented 13 year data confirming that Kaplan-Meier survival curves showed significant longer term disease free survival after brachytherapy than for any other treatment modality. This was a highly significant claim because surgery has heretofore been called “the gold standard”. ED NOTE: Because this paper by Dr. Dattoli is so comprehensive and all encompassing we will make it the subject of a separate article to be published on this web site. We will review the entire paper pointing out its highly significant and interesting results for those who have to deal with prostate cancer therapy. Keep watching the site for this article. NPC Program Review, 6/05 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.