By Jasmine Demers Arizona Daily Star, Sep 2, 2019 Updated Sep 2, 2019
For Dr. Curtis Mack, helping patients through cancer treatments is especially personal.
The Tucson-based radiation oncologist has been working with cancer patients for more than 20 years and makes it a point to urge men to take their health into their own hands, especially during Prostate Cancer Awareness Month, which is this month.
He speaks about the disease not just as a doctor but also a cancer patient, having gone through aggressive chemotherapy, total body radiation and a bone-marrow transplant after being diagnosed with acute leukemia in 2013.
“I was pretty empathetic previously, but I believe I am more so now having experienced many of the potential side effects of chemotherapy and radiation,” Mack said. “Certainly, when patients are down and not wanting to eat, I can relate to that. I can tailor my advice to help get them through those things and help them keep their eye on the target, which is finishing treatment. That can make the difference between a successful outcome and just slowing the disease down.”
While Mack, who works at Arizona Oncology, has treated a variety of cancers, he said prostate cancer is especially unique because it has a nearly 100% survival rate if caught early. If men are not getting regular checkups, however, the cancer can go unnoticed for a long period of time.
“Approximately 70% of prostate cancer patients have no abnormalities except an elevated PSA — a prostate specific protein — so if they are not speaking to their physicians about screening, most patients would never know they had prostate cancer until they developed advanced disease, which is much more difficult to treat,” Mack said. “If detected early, there are multiple treatment options, and in many cases, even observation is the right choice, but if we do not have the information we won’t be able to provide a proper course of action.”
Prostate cancer is the second most common type of cancer in men, next to skin cancer, and there are nearly 180,000 new cases each year. It typically affects men age 65 and older and is rare before the age of 40.
African-American men have an increased risk of developing prostate cancer and are twice as likely to die from it.
According to a 2018 Pima County health report, 62 out of every 100,000 men were impacted by prostate cancer in 2015.
“Patients should be aware that once the diagnosis of cancer is made ... there are multiple treatments,” Mack said. “They should seek out multiple opinions and settle on a treatment course that is best for them personally.”
EARLY SCREENINGS ARE KEY
Paul Boettcher, 84, was diagnosed with prostate cancer in 2009 and was treated by Mack with radiation.
“My general physician saw that my PSA level was going up rather quickly. So, I did a biopsy and cancer was detected and they gave me a few options,” he said.
“The first was do nothing, second was have the prostate removed, third was have a radiation seed inserted in the area and the fourth was to have radiation treatments. After evaluating all of my options, I decided that radiation would be the best one for me.”
Boettcher said he knew hardly anything about prostate cancer at the time and that there was no history of prostate cancer in his family.
“Before I did the biopsy, I had not been terribly faithful about going to the doctor for a yearly checkup,” he said. “It was a little scary. I had acquaintances who were diagnosed with prostate cancer, and the doctors said to them, ‘Well, because of your age, we don’t think you should do anything.’
“But all of my doctors said, ‘You’re probably going to live a long time and we think you should get it treated.’”
At the time, Mack and his team were conducting a clinical trial to determine the benefits of administering a higher dose of radiation over a shorter amount of time. This technique is called intensity modulated radiation therapy, or IMRT, and now serves as the new standard and most common type of external radiation treatment for prostate cancer patients.
Because Boettcher was in relatively good health at the time, he agreed to participate in the clinical trial and completed 28 rounds of IMRT by January 2010.
Five years later, he was declared cancer-free.
“There were a few symptoms that were uncomfortable, but overall it was good,” Boettcher said. “Dr. Mack and his staff were excellent at keeping me informed and making sure I was comfortable during the treatments.”
Boettcher said he was lucky to have caught the cancer early. “I had a sister who died of cancer and part of it was because she didn’t go in and get a physical exam and follow up on her health like she should have,” he said. “I think it’s very important that people check up on their health even when they feel healthy.”
Mack and his team are enrolling patients for a clinical trial that would again serve to reduce the number of radiation treatments and increase the dosage per treatment. Instead of 28 treatments, patients would receive a higher dose of radiation over just five treatments.
“There has been a lot of research done on prostate cancer patients and we have made progress over the years due to the large number of patients that we are able to study,” Mack said.
Another important advancement in the treatment of prostate cancer has been the introduction of a technology called SpaceOAR in 2015, which injects a hyrdrogel behind the prostate to help reduce potential damage to surrounding organs. Mack said the technology has been shown to decrease complications for patients undergoing radiation.
Prostate cancer screening guidelines are being reevaluated by the U.S. Preventative Services Task Force, which will help physicians catch these cancers as early as possible.