Prostate Cancer in Young Men – Long-term Outcomes Study

 

Dr. HoppeMen age 60 and younger treated with proton therapy for prostate cancer at the UF Health Proton Therapy Institute report excellent long-term outcomes related to cure rate and health-related quality of life.

A long-term, prospective clinical study followed 254 low-, intermediate-, and high-risk prostate cancer patients for seven years. Outcomes for cancer recurrence were charted as well as incidence of side effects impacting sexual, urinary and bowel health. Results from the study were published last month in Acta Oncologica.

Median follow-up was 7.1 years and 97.8 percent of men had no evidence of cancer. Cancer-free survival was 99.2 percent and 97.7 percent for low- and intermediate-risk prostate cancer patients respectively.

Potency (erections firm enough for sexual intercourse) was 90 percent at baseline and declined to 72 percent at the first-year follow-up, but declined to only 67 percent at five years. Only two percent of patients developed urinary incontinence requiring pads. The bowel habits mean score declined from a baseline of 96 to 88 at one year, which improved over the following years to 93 at five years.

Men who are 60 years old or younger when diagnosed with prostate cancer have a life expectancy of more than 10 years. The treatment decision – most often surgery or radiation – can significantly impact quality of life depending on the risk of side effects.

“Since similar local control and overall survival have been observed for surgery and radiation, health-related quality of life has emerged as an increasing focus in men considering their treatment options. Several investigations have reported fear of incontinence was a decision-making factor in men, while a more recent study reported that younger men placed more importance on sexual function when choosing treatment options,” said Bradford S. Hoppe, MD, MPH, James E. Lockwood, Jr., Endowed Chair of Proton Therapy at the University of Florida Health Proton Therapy Institute. “Our study provides meaningful information for clinicians and patients to consider when evaluating treatment options that may minimize the risk of erectile dysfunction.”

 

Florida Cancer Center of Excellence Designation Renewed

 

Florida Cancer Center of ExcellenceThe University of Florida Health Cancer Center, including the UF Health Proton Therapy Institute, has once again been recognized as a Cancer Center of Excellence by Governor Rick Scott and the Florida Department of Health.

The UF Health Cancer Center is one of four centers in the state to receive this designation. The UF Health Proton Therapy Institute is the only Cancer Center of Excellence in Jacksonville that treats patients with proton therapy – an advanced form of radiation therapy.

“More than an honor, the Cancer Center of Excellence designation is an important assurance for patients and their families seeking the best possible cancer treatment,” said Stuart Klein, the UF Health Proton Therapy Institute executive director. “Each of our 165 staff members is committed to serving patients with high-quality, compassionate care every day.”

The Cancer Center of Excellence designation was created by the Florida Legislature in 2013 to recognize exemplary patient-centered coordinated care and to help Florida providers be recognized nationally as a preferred destination for quality cancer care — while simultaneously attracting and retaining the best cancer providers in the state, according to the Florida Department of Health website.

The three-year designation is awarded to hospitals and treatment centers that meet strict performance standards in three areas: health care organization, health care team members, and patients and family members. Scores are based on rating standards created by a joint committee of members from the Cancer Control and Research Advisory Council and the Biomedical Research Advisory Council, two advisory groups mandated by the Florida Legislature.

Receiving this designation once again is a testament to the UF Health Cancer Center’s dedication to innovative and collaborative patient-centered care, said Jonathan Licht, MD, the director of the UF Health Cancer Center.

“We continue to strive toward excellence in our mission to save lives and to provide the highest level of care across the cancer spectrum,” said Licht.

COMPPARE Workshop Kicks Off National Prostate Cancer Study

 

COMPPARE Workshop


Researchers, physicians, scientists and patient advocates convened at a workshop on Amelia Island, Fla., to discuss and plan implementation of the national prostate cancer study recently funded by the Patient Centered Outcomes and Research Institute (PCORI). The study, A Prospective Comparative Study of Outcomes with Proton and Photon Radiation in Prostate Cancer (COMPPARE), aims to accrue 3,000 men, 1,500 treated with proton therapy and 1,500 treated with conventional photon (X-ray) radiation.

The meeting established best practices for treatment and patient safety, data gathering protocols, and patient recruitment including an ethnically diverse population. The clinical trial will begin accruing patients from 42 participating clinical settings across the country within the next 12 months.

Raising Awareness of Proton Therapy

 

Raising Awareness of Proton Therapy Prostate cancer is the most common non-skin cancer diagnosed in men, and African-American men are at greater risk of diagnosis and death from the disease, according to the American Cancer Society. Raising awareness of the risk is one way to encourage screening and early detection and to potentially improve patient outcomes. Once diagnosed, understanding the treatment options available, the cure rates and potential for side effects, is an important part of the treatment decision-making process.

The UF Health Proton Therapy Institute recently held an information session and tour of the facility for the Upsilon Lambda Chapter of Alpha Phi Alpha Fraternity, Inc., a black fraternity chapter in Jacksonville. Nancy Mendenhall, MD, medical director, led the tour and presented an overview of the prostate cancer treatment program. She described the new national prostate cancer clinical trial, led by the Institute, to compare conventional radiation and proton therapy. The study aims to include a diverse population, including African-Americans, to accurately document treatment outcomes.

Proton therapy’s impact on African-American prostate cancer patients has been an area of interest for the research program for many years. A study published last year by the Institute in the American Journal of Clinical Oncology1 suggests that African-American and white patients had similarly excellent results following proton therapy for prostate cancer. There was no difference detected between the two groups in their cure rates or in their sexual, urinary or bowel function following proton therapy.

1Bryant, Curtis et al. “Does Race Influence Health-Related Quality of Life and Toxicity Following Proton Therapy for Prostate Cancer?” American Journal of Clinical Oncology. 39.3 (2016): 261–265. PMC. Web. 24 Mar. 2017.

 

Philanthropists Jane and Mike McLain Make Major Gift to Pediatric Program

 

Jane and Mike McLain

The UF Health Proton Therapy Institute has named the pediatric recovery room in honor of philanthropists Jane and Mike McLain to acknowledge their support of the pediatric program. The McLains’ $200,000 gift will fund clinical research and the many support services designed to ease the treatment process for patients.

The Jane and Mike McLain Pediatric Recovery Room is an essential area of the clinic where children under the age of 5 are prepared for and recover from daily proton therapy. Staffed by full-time pediatric oncology nurses and pediatric anesthesiologists, the room is equipped with child-sized furniture and other medical devices designed specifically for children.

Proton therapy is a cancer treatment that delivers radiation precisely to the treatment area with minimal or no radiation to normal, healthy tissue. For optimal results in proton therapy, it is necessary for the patient to lie in exactly the same position without moving during treatment each day to ensure the proton beam is focused on the targeted treatment area. Most patients over the age of 5 who receive daily proton therapy do not require sedation. However, the youngest patients – infants and those under the age of 5 – are often unable to remain completely still during the 30- to 45-minute daily treatment. For them, sedation is necessary for accuracy and safety.

“We are very grateful for this generous and compassionate gift from Jane and Mike McLain,” said Nancy Mendenhall, MD, medical director of the UF Health Proton Therapy Institute. “The value of their contribution to the comfort of our youngest patients and their families is beyond measure. And the research their gift enables will impact generations to come.”

The Jane and Mike McLain Pediatric Recovery Room was recently renovated to provide additional privacy for patients and families and a décor designed to promote healing.

“The soft lighting and soothing color palette and design has transformed the space that was formerly sterile and clinical into a tranquil area that is child friendly, welcoming and calming,” said Amy Sapp, director of pediatric nursing. “The space has a positive impact on both the medical and psychosocial well-being of the children and their families by decreasing anxiety and stress related to the various medical procedures encountered on a daily basis as well as providing an area for play and distraction.”

The comprehensive renovation was made possible through the generous support of many donors who are recognized on a newly unveiled sign in the recovery room. “Thanks to all who contributed in large and small ways through the UFHPTI For the Children Fund. And thanks to our volunteers, many of whom are alumni patients, who have championed this fundraising effort,” said Stuart Klein, executive director.

 

Executive Director Message

StuartKlein.pngThis month I had the opportunity to travel to China to participate in two lectures and the signing of a Memorandum of Understanding to help bring pediatric patients from China to Jacksonville for proton therapy (more on the MOU below). In addition, I was invited to a dinner hosted by a Chinese family whose teenage son we treated last year. Their son, YS, has had a very difficult road. He was initially diagnosed at three years old with leukemia. He was successfully treated with chemotherapy but subsequently relapsed. He was treated again with chemotherapy and all seemed to be going well until he was diagnosed with a base of skull Ewing sarcoma. At this point he was 17 years old and required radiation treatment. YS and his mother traveled to Jacksonville to receive his proton treatment. YS was clearly not happy with having to go through treatment. He was understandably depressed and withdrawn, but managed to come out of his shell towards the end of his treatment course.

At last week’s dinner I had the opportunity to spend time with YS and his extraordinary family. Although their English was very limited, they were able to convey their thanks and appreciation for the treatment YS received at the UF Health Proton Therapy Institute. YS was outgoing, engaged and looking forward to applying for college. He had zero indications that he was treated with protons. This was clearly a family who had gone through great angst and trauma. They now had the opportunity to relax and once again function as a family unit by thoroughly enjoying each other’s company. It was truly inspirational to observe the impact that we had on a family that lives 8,000 miles away. Despite our language, cultural and political differences we were able to help mend and heal this family. It was a privilege and honor to observe our impact first hand.

 

Stuart L. Klein

Executive Director

UF awarded $11.9 million for prostate cancer research comparing proton and X-ray therapies

Dr. Nancy Mendenhall

A University of Florida research team has been approved for a five-year, $11.9 million award to directly compare the potential benefits and harms of proton therapy to standard radiation therapy when treating prostate cancer.

Nancy Mendenhall, M.D., medical director of the UF Health Proton Therapy Institute, leads the team that received funding from the Patient-Centered Outcomes Research Institute, or PCORI, for a large-scale pragmatic clinical study on prostate cancer — the most common non-skin cancer afflicting men in the United States, according to the American Cancer Society.

Mendenhall, also a professor and associate chair in the department of radiation oncology at UF, and Ronald Chen, M.D., an associate professor in the department of radiation oncology at the University of North Carolina at Chapel Hill, are the study’s principal investigators.

“This is a critically important study that will compare outcomes between proton and conventional radiation in cohorts of 3,000 men with prostate cancer,” said Mendenhall. “It will determine whether there are differences in disease control, toxicity and quality of life in survivors — providing much-needed answers to patients, families, medical teams, hospitals, insurers and policymakers.”

The study will compare 1,500 patients treated with proton therapy with 1,500 patients treated with standard radiation therapy from a total of 42 treatment centers across the United States. The study will collect information on patient-reported quality of life, physician-reported and patient-reported side effects, and prostate cancer recurrence. Some participants receiving proton therapy will also be randomly assigned to receive eight weeks of treatment at a lower intensity or four weeks at a higher intensity, to determine which regimen has a greater impact on cure rates and side effects.

“This large, multi-institutional PCORI-funded study led by Dr. Mendenhall represents a concrete opportunity to move the field of radiation oncology toward the best approaches to reducing suffering and curing this oftentimes devastating disease,” said Paul Okunieff, M.D., a professor and chair of the department of radiation oncology at UF.

Mendenhall’s team collaborated with several stakeholders to design this study, including patients, caregivers, prostate cancer advocacy groups, insurers and minority engagement groups — because, according to the American Cancer Society, the disease occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races.

Mendenhall’s study was selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a diverse range of patients and care situations and can be more quickly taken up in routine clinical practice. It was one of 14 studies selected through a highly competitive review process in which patients, caregivers and other stakeholders joined scientists to evaluate the proposals.

“Dr. Mendenhall is a visionary clinician and research scientist who’s a driving force in this country in advocating for less-toxic radiation therapy,” said Jonathan Licht, M.D., director of the UF Health Cancer Center. “This is the type of leading-edge, pragmatic clinical study that we at the University of Florida want to be known for.”

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that provides patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions. The UF award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

UF Health Proton Therapy Institute takes steps to formalize agreement in China for patient treatment and clinical research

UF Health Proton Therapy Institute in China

On January 12, 2018, in Beijing, China, leaders with GlobalMD Network Corporation and the UF Health Proton Therapy Institute, Jacksonville, Florida, signed Memorandums of Understanding (MOUs) to establish a Sino-American Pediatric Neuro-Oncology Program.

UF Health Proton Therapy Institute Executive Director Stuart Klein along with Tim Shi, MD, PhD, Chief Officer for GlobalMD, China Office, represented their respective organizations at the signing, held at the Chinese Academy of Sciences Automation Institute in Beijing. Following the signing, key Chinese opinion leaders and oncologists met with the group from Jacksonville to learn more about proton therapy for children who have cancer.

The initiative will formalize relationships between the Proton Therapy Institute and children’s hospitals across China to enhance and develop new treatments for children for life-threatening brain, skull-base and spinal tumors.

The Sino-American Pediatric Neuro-Oncology Program will include collaboration in:

  • Advanced training of physicians and nurses in pediatric neuro-oncologic and other pediatric health conditions

  • Teleconsultation for pediatric patients in China referred through GlobalMD and the UF Health Proton Therapy Institute

  • Provision of gold-standard treatment protocols for referred pediatric patients, including proton therapy, chemotherapy, neurosurgery and other treatments for these complex disorders

  • Tele-monitoring and evaluation of the outcomes of post-cancer treatment patients once they return home

  • Neuro-oncology research in China and Jacksonville

Dr. Indelicato
Daniel J. Indelicato, M.D.

This program falls under the joint mission of the Sino-American Collaboration Project on Clinical and Translational Medicine, established in 2010.

UF Health Proton Therapy Institute’s Executive Director Stuart Klein said the program, when fully executed, will build on successful agreements with other countries, including the United Kingdom, Norway and the Canadian Provinces of Quebec and Ontario.

“Since opening in 2006, the Institute has seen patients from more than 30 countries, including China, and is the largest pediatric proton therapy program worldwide,” said Klein. “In the past two years since organizing a symposium on radiotherapy in China, the number of patients from China has grown to the point that we have added a staff person who helps Chinese families with communication, transportation and housing needs.”

New research from UF sheds light on pediatric patient outcomes following proton therapy for ependymoma.

Dr. IndelicatoEpendymoma is one of the most common brain tumors in children under 10 years old. Proton therapy can reduce the low and intermediate radiation dose delivered to uninvolved brain tissue in children with intracranial tumors, which may improve functional outcomes and reduce second malignancies in survivors. Based on this rationale, ependymoma is the most common pediatric tumor treated with proton therapy in the United States.

The authors from the study Outcomes Following Proton Therapy For Pediatric Ependymoma, published last month in Acta Oncologica, report a 3-year survival exceeding 90% in the first 178 children with ependymoma treated with proton therapy at the University of Florida. This series represents the largest single-institution report of intracranial pediatric ependymoma outcomes treated with any radiation modality – proton or x-ray therapy. Therefore it contributes useful information for overall disease management, patient and family counseling, and surveillance guidance for pediatric radiation oncologists worldwide. Moreover, this cohort provides the foundation for continued follow-up studies quantifying the reduction of late toxicity with proton therapy.

“These are encouraging results,” said lead researcher Daniel J. Indelicato, M.D., who holds the Mendenhall Endowed Chair of Pediatric Radiotherapy and serves as associate professor in the UF Department of Radiation Oncology. “We demonstrated that protons are at least as effective as X-rays, in the short term, at reducing the risk of tumor recurrence. Our data further validates the experience reported in smaller groups of patients at other proton therapy centers.”

 

Red Coats Grant fuels rides for patients

Patient TransportTHE PLAYERS Championship is one of Jacksonville’s premier events. It features the PGA Tour’s top talent in a high-stakes golf tournament, not only for the competition in the field but also for the challenging course at TPC Sawgrass including the famed Island Green on the 17th hole. It attracts avid golf fans and casual spectators alike from the local community and beyond.

Each year, THE PLAYERS gives back to the community through charitable donations. A portion of sales, including event tickets and sponsorships, is distributed via a program called Red Coat Grants. The grants program is named for the distinctive red jackets worn by the volunteer chairmen of the current and past tournaments who are called Red Coats. Thanks to the efforts of the UF Health Proton Therapy Institute’s friend and supporter Hugh Dunn, we prepared and submitted a successful grant request to help fund our patient transportation program.

Our driver, Mitch Kubaki, and van transports 25-30 patients and their families to and from treatment each day, traveling approximately 650 miles each week. The fuel costs alone average $100 per week, and the Red Coat Grant will help defray this expense.

“We are grateful to THE PLAYERS and the Red Coats for this generous grant,” said Stuart Klein, executive director of the UF Health Proton Therapy Institute. “The transportation program eases the burden for many of our patients and their families. Having access to a free, safe and comfortable ride for doctor appointments, errands and group outings is one less worry.”

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About This Newsletter

The Precision Newsletter is an electronic-only publication that is distributed by email. Each issue is sent monthly to patients, alumni patients and friends of the University of Florida Health Proton Therapy Institute. As the official newsletter of the Institute, the content is compiled and prepared by our communications representative and approved by the editor Stuart Klein, executive director of UF Health Proton Therapy Institute. Special bulletin newsletters may occasionally be prepared when timely topics and new developments in proton therapy occur. If you would like to send a Letter to the Editor, please click here.

 

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