Dr. Mack Talks Prostate Cancer for Men’s Health Month

Jun 19, 2024 | Southern Arizona

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, usually after age 65. This common cancer often grows slowly and may not cause significant harm in its early stages, but some forms of prostate cancer can be aggressive and spread rapidly to other parts of the body. This Men’s Health Month, Arizona Oncology radiation oncologist Dr. Curtis Mack weighs in on what you need to know about prostate cancer.

Starting the Journey

Have you or a loved one been newly diagnosed with prostate cancer? Prostate cancer management can follow many paths. It can be difficult to know what to do next, but you do have some control. “Start the process with your urologist to determine the stage of the disease,” says Dr. Mack. Next, he recommends setting up a consultation with a radiation oncologist and considering a second opinion from another urologist. “Knowing all your options is crucial before deciding on the best treatment plan,” Dr. Mack says.

Learn more about reading a prostate cancer pathology report and the Gleason score.

To Treat or Not to Treat

For some patients, active surveillance or “watchful waiting” is a viable option, especially if the cancer is in its early stages and not causing symptoms. Active surveillance involves regular monitoring through PSA tests, digital rectal exams, and sometimes biopsies, to keep an eye on the cancer’s progression. This approach allows patients to avoid or delay more aggressive treatments while still keeping the cancer under close observation. However, for more advanced or aggressive cancers, treatments such as surgery, radiation, or hormone therapy may be necessary. Your health care team will help you weigh the benefits and potential side effects of each treatment option to make an informed decision.

The Role of Radiation Therapy

Dr. Mack sees many prostate cancer patients, as radiation therapy is a cornerstone of prostate cancer treatment. “It has an excellent track record,” Dr. Mack says of radiation therapy for prostate cancer. Treatment is delivered externally on a daily basis or internally (called brachytherapy) using permanent or temporary radioactive seeds. Sometimes the two are combined depending on the stage of the disease and the health status of the patient. “Some of our best results are with a combination of both,” Dr. Mack adds.

Patients are often worried about side effects from prostate cancer treatment. Common short-term side effects include urinary frequency, urgency, and irritation, along with less-common gastrointestinal issues. Long-term side effects can include changes in erectile function and a small risk of urinary incontinence or leakage.

As a cancer survivor himself, Dr. Mack understands the emotions that come with undergoing cancer treatment. “I think it has made me a bit more empathetic for patients when they are going through treatment and having acute side effects, wondering if they will ever get better. I like to say that yes, they will. You just have to get through the treatment.”

Reducing Side Effects with Hydrogel Spacers

At Arizona Oncology, our use of innovations like SpaceOAR and Barrigel hydrogels have significantly reduced the side effects associated with radiation therapy for prostate cancer. These FDA-approved substances provide protection to the rectum and other nearby structures during treatment. The hydrogel is injected into the space between the rectum and prostate where the soft, gel-like material expands to create a protective space. This reduces the radiation dose delivered to the rectum.

Dr. Mack has seen the impact of these cutting-edge advancements firsthand with his patients. “SpaceOAR and Barrigel have been effective in lowering both acute and long-term radiation side effects in the rectum,” says Dr. Mack.

Women, What Does Prostate Cancer Have to Do With You?

While the emphasis may be on men’s health this month, women have a big role to play. Dr. Mack recommends that women encourage the men in their lives to keep up with prostate cancer screenings, including the PSA test. This blood test, which is often done along with a digital rectal exam, is able to detect prostate cancer at an early stage. “Screening is important,” Dr. Mack urges. “Many prostate cancers can be followed because they are early enough to undergo active surveillance but for others, the sooner we know about them, the better our treatment options and outcomes.”

If your significant other or family member has already received a diagnosis of prostate cancer, your support will be paramount. “Encourage the patient to drink plenty of fluids and remain active,” Dr. Mack recommends. “Physical activity helps with both physical and mental wellbeing.”

During Men’s Health Month, encourage your loved ones to keep up with their regular screenings, including prostate cancer screenings. Dr. Mack’s expertise reminds us that while a prostate cancer diagnosis can be daunting, understanding and exploring all options can help patients and their loved ones navigate the complex journey of prostate cancer treatment with greater confidence, clarity, and hope.

What to Eat After Cancer Treatment

May 20, 2024 | Southern Arizona

After completing cancer treatment, you may want to take steps to help prevent a recurrence. While you cannot control every risk factor, one thing you can control is what you eat.

Nutrition plays a role in about one third of all cancers. After smoking, obesity is the most significant controllable risk factor. By maintaining a healthy weight and eating a balanced diet full of healthy, non-processed foods, you can do your part to reduce your risk.

In addition to helping prevent recurrence, a healthy, nutritious diet can also help your body recover from cancer treatment. Eating well can build strength, boost your energy levels, rebuild tissue, and help you feel better overall. Some foods can also help with treatment-related side effects. Other foods should be limited or avoided altogether.

Both the American Cancer Society and the American Institute for Cancer Research (AICR) offer recommendations for maintaining a healthy diet after cancer treatment.

Yes! Eat These Foods

• Protein is important because it provides amino acids, the essential building blocks of all living things. Protein helps build and repair tissue and make hormones and enzymes. Fill your diet with plant-based proteins like beans, lentils, soy, nuts, and quinoa. Healthy animal-based proteins include chicken, turkey, eggs, fish, and seafood. Good sources of dairy-based proteins include milk, cheese, and Greek yogurt.
• Fruits and Vegetables. These are your source of important vitamins, minerals, phytochemicals, and antioxidants, all of which work together to keep you healthy and prevent cancer. You can ensure you are getting a variety of what your body needs by choosing a mix of different colored fruits and vegetables. If your diet includes reds, greens, purples, yellows, and oranges, you’re on the right track!
• Whole grains. Whole grains are much better for you than processed grain products. Whole grains are rich in fiber, B vitamins, antioxidants, and trace minerals like zinc, iron, copper, and magnesium. Look for oats, quinoa, barley, and brown rice. Check the label for “100% whole grain” when buying bread, pasta, crackers, and cereal.
• Healthy fats are good for you! These unsaturated fats mostly come from plant sources like nuts, seeds, and avocados. Cooking oils such as canola, peanut, soybean, and olive oils are good fats, too. Fatty fish, such as salmon and sardines, are also rich in healthy fats.
• Foods rich in vitamin D and calcium. These promote bone growth and combat osteoporosis. Foods rich in vitamin D include salmon, tuna, fortified dairy products, cheese, and egg yolks. Foods rich in calcium include spinach, kale, okra, collards, soybeans, white beans, salmon, sardines, and rainbow trout.

No! Limit or Avoid These Foods

• Added sugar. There is no definitive research that sugar causes cancer, but it is well known that too much sugar isn’t good for you and is linked to obesity, which is a risk factor for cancer. Some healthy foods, like bananas, are naturally sweet. But you want to limit foods with added sugar, such as sodas, sugary cereals, granola bars, sweetened yogurts, candy, and desserts. Consume them as a once-in-awhile treat, not a daily indulgence.
• Refined carbohydrates. These are the so-called “white” foods: white bread, white rice, white flour—even regular pasta. They have been stripped of almost all fiber, vitamins, and minerals through processing, and thus are considered “empty” calories. Because they are digested quickly, they also raise your blood sugar.
• Red meat/processed meat. Red meat is associated with a higher risk of colorectal cancer, as well as other cancers. Processed meats can increase your risk of stomach and colorectal cancer. It’s best to limit or avoid these meats, which include beef, pork, lamb, lunchmeat, sausage, pepperoni, ham, and bacon.
• Trans fats. Trans fats such as partially hydrogenated vegetable oils are often found as an ingredient in commercially prepared pastries, peanut butter, fried foods, cake mix, shortening, and margarine. Eating these foods raises your levels of “bad” cholesterol and puts you at greater risk for heart disease.
• Alcohol. Studies show that alcohol is a risk factor for certain cancers. It can also make cancer treatment side effects like nausea, dehydration, and mouth sores worse. When it comes to alcohol consumption, risk increases with greater intake, but there is no drink that is “better” than another. Beer, wine, and spirits all contain ethanol, which is linked to increased cancer risk.

Build Your Healthy Plate!

The AICR recommends following as much of a plant-based diet as possible. A good start is to follow the New American Plate for cancer prevention.

The New American Plate states:

• At least 2/3 of your plate should be covered with plant-based foods like vegetables, whole grains, fruit, and beans.
• Up to 1/3 of your plate can contain animal-based protein-rich foods like seafood, poultry, dairy, and the occasional lean red meat.

Other AICR recommendations include:

• Eat at least 30g of fiber per day
• Eat at least 3.5 to 5 cups of fruits and vegetables each day
• Be a healthy weight
• Be physically active
• Limit processed, “fast” foods that are high in starches, sugars or fat
• Eat no more than 12-18 ounces per week of red meat
• Avoid processed meat
• Drink mostly water; avoid sweetened beverages
• Limit or avoid alcohol altogether
• Focus on getting your nutrition from food, not supplements
• Mothers should breastfeed their babies if possible; it reduces breast cancer risk
• Cancer survivors should talk to their doctors about nutritional recommendations

Last, but not least, it bears repeating that avoiding tobacco is the number one thing you can do to reduce your cancer risk. Resources to help you quit can be found here.

How Does Your Family’s History of Melanoma Affect You?

May 12, 2024 | Southern Arizona

Is Melanoma Genetic?

Melanoma is the most dangerous type of skin cancer. It forms in the cells that produce melanin, which is the substance responsible for your skin’s color. Exposure to ultraviolet radiation (UV rays) from the sun or tanning beds increases the risk of developing any skin cancer. In the case of melanoma, experts say there’s also a strong link between genetics (your family history) and your risk of developing melanoma.

Family History and Genetic Factors

If one or more of your parents, siblings or children develop melanoma, you have a higher risk of developing melanoma than a person with no family history of the disease. Experts aren’t sure whether the increased risk is because close relatives tend to have similar lifestyles (such as spending lots of time outside in the sun together) or if a genetic mutation is responsible. Regardless of why a family history of melanoma raises the risk of developing the disease, knowing that there’s a link means you should take precautions. That can include reducing the skin cancer risk factors you can control and paying close attention to changes in your skin.

Am I at Risk for Melanoma?

Everyone is at risk for melanoma, regardless of family history. Some people with a family history of the disease never get it. Some people with no family history will get it.

Fortunately, there are concrete steps you can take to reduce your melanoma risks, including:

Did you know sunscreen can expire? Check the date and do not use if it’s expired!

• Avoiding tanning beds.
• Limiting your time outdoors when the sun’s rays are strongest (between 10 am and 4 pm).
• Applying sunscreen of SPF 30 or higher liberally 15-30 minutes before any sun exposure and reapplying every 2 hours throughout the day, after toweling, becoming sweaty or getting wet.
• Checking the expiration date of your sunscreen – do not use if it’s expired.
• Following directions for sunscreen application on babies less than 6 months old.
• Wearing protective clothing, hats and sunglasses so sunlight can’t reach your skin.

Early Detection Increases Survival Rates for Melanoma

Melanoma is responsible for 75% of all skin cancer deaths. A person’s risk of dying from melanoma increases the deeper the cancer grows. Melanomas that aren’t detected early and are allowed to grow can spread to other parts of the body, and because melanoma is an aggressive cancer, it spreads quickly – usually within three to 18 months from the time it becomes noticeable.

Frequent skin exams are especially important for people with a family history of melanoma. Once a melanoma has spread (doctors use the term “metastasized”), the cancer is much more difficult to treat. That’s why it’s so important for everyone to examine their skin and have their skin examined regularly by a doctor. These exams give you and your doctor an opportunity to spot suspicious growths on the skin early. A melanoma that is found early can be removed from the skin before it is able to spread.

Skin Self Exams: What to Look For

Examining your skin monthly allows you to become familiar with the location and appearance of your freckles, moles and other pigmented areas. Whenever you detect changes to existing marks on your body, or new growths or pigmented areas that look unusual or are growing quickly, you should have them checked out by a dermatologist.

Doctors recommend remembering the ABCDEs of melanomas when you’re checking your skin:

• Asymmetry. If you draw an imaginary line through the middle of a melanoma, the two halves would not match.
• Border. The edges of a melanoma are usually uneven, fuzzy or jagged.
• Color. Melanomas change colors and are often a combination of black, brown and tan.
• Diameter. Melanomas may grow larger than the size of a pencil eraser.
• Elevation. Once a mark on your skin becomes raised or thicker, it is a serious red flag indicating a melanoma may be spreading and should be evaluated by a doctor immediately.

Melanoma can be deadly. Whether you have a family history of the disease or not, you’re at risk. Get to know your skin so you’ll know when something simply doesn’t seem right, and if you notice any changes of your skin, it is best to visit your doctor or dermatologist. Arizona Oncology has locations throughout the state if your provider determines a referral is needed.

Originally posted in 2017, updated in 2024.

Developments in Prostate Cancer Research

May 11, 2024 | Southern Arizona

Prostate cancer research has been an ongoing process of looking into causes, prevention, detection, and treatment of prostate cancer. But with hundreds upon hundreds of published studies out there, how can patients keep up with what’s new? Here are some recent developments to watch in prostate cancer treatment: 

1. Genetic & Genomic Testing Related to Prostate Cancer

Genes can play a role in both the development and behavior of prostate cancer. Two types of tests that can be helpful in acquiring information are genetic testing and genomic testing. While they sound similar, they collect different information.

• Genetic testing is used more frequently to define high-risk populations who have yet to get cancer. People who have a known family history of cancer may want to investigate further with genetic testing to see if they carry a gene mutation that puts them at risk. New research on gene changes linked to prostate cancer is helping scientists better understand how prostate cancer develops.
• Genomic testing, on the other hand, is done for patients who have been diagnosed with prostate cancer in hopes of determining how the cancer might behave. This information can be beneficial in deciding the course of care for your cancer. Some of the genomic tests available now include Decipher, Oncotype DX, ProstaVysion, and the Prolaris Test.

Depending on a patient’s circumstance, a doctor may recommend either test if it could be beneficial to the detection of an inherited risk for or the treatment of prostate cancer.

2. Immunotherapy

The goal of immunotherapy is to boost the body’s immune system to help fight off or destroy cancer cells. Prostate cancer has seen much promise and potential in changing the way this disease is treated and cured in the field of immunotherapy.

Prostate cancer immunotherapy studies are being conducted in the following seven categories:

1. Therapeutic vaccines: intended to treat or cure a disease by stimulating the immune system
2. Oncolytic virus therapies: intended to kill cancer cells and stimulate an immune response against tumors
3. Checkpoint inhibitors: drugs that block normal proteins on cancer cells, or the proteins on the T-cells that respond to them
4. Adoptive cell therapies: the collection of T-cells from the blood, which are then modified, and injected back into the patient so they can better recognize cancer cells in the body
5. Adjuvant immunotherapies: substances used to boost the immune system so the patient’s response to therapeutic vaccines can be improved
6. Cytokines: the injection of laboratory-produced cytokines (proteins that boost the immune system) to increase the number of ones the body would normally produce
7. Monoclonal antibodies: antibodies designed in a lab that specifically target a certain antigen, such as one found on cancer cells

According to the American Cancer Society, one promising approach for the future might be to combine a checkpoint inhibitor with a prostate cancer vaccine. This combination could strengthen the immune response and help a cancer vaccine work better.

3. Earlier Detection

Researchers are trying to develop a better prostate-specific antigen (PSA) test, which could lead to earlier prostate cancer detection (PSA is a protein that is produced exclusively by prostate cells. An overabundance of this protein may indicate that cancer is present).

Additionally, cancer researchers are developing a urine test to find a gene called prostate cancer gene 3 (PCA3), which could also help detect prostate cancer more quickly.  When a man has prostate cancer, PCA3 is made in larger amounts when a man has prostate cancer. More accurate testing could help prostate cancer doctors decide if a man needs a prostate biopsy. With a better testing method, more healthy men could be screened for prostate cancer, resulting in prostate cancers being found and treated early.

Thirdly, imaging with PSMA PET is far more sensitive than combinations of bone scan and CT imaging to detect prostate cancer spread, to assist staging, and to dictate treatment alterations.

4.  Stereotactic Body Radiation Therapy (SBRT)

Stereotactic Body Radiation Therapy (SBRT) is a highly targeted form of radiation treatment that delivers precise, high doses to tumors while minimizing damage to surrounding healthy tissue. Radiation therapy using SBRT can be used to treat patients whose cancer has spread to five or fewer sites. This treatment can help keep the cancer from recurring and may also delay the need for hormone therapy.

5. The Approval of Pluvicto

Pluvicto is a targeted radioligand therapy for advanced prostate cancer that binds to cancer cells and delivers radiation directly to them, helping to slow disease progression and manage symptoms. It is an option for patients with castrate-resistant prostate cancer with spread who have not had success with other treatments.

Most new research is developed through prostate cancer clinical trials. Prostate cancer research trials are designed to test new ways to prevent, find, diagnose, treat, and manage the disease more effectively.

Arizona Oncology has recently participated in a variety of prostate cancer clinical trials and has another exciting one on the horizon. Don’t hesitate to speak with your prostate cancer specialist today about the possibility of joining a prostate cancer clinical trial.

Originally posted in 2018. Updated in 2024.

Saying ‘I Do’ Could Reduce Your Risk of Dying from Melanoma

May 10, 2024 | Southern Arizona

It turns out there’s another bonus to marriage: early skin cancer detection and management. According to a study published in JAMA Dermatology, melanomas are more likely to be detected early in married people than people who are single, divorced or widowed.

How can being married help reduce my risks?

Data suggests that spouses or partners may help identify melanoma that may have otherwise gone unnoticed.

The analysis, which included 52,063 people of various marital statuses, found that skin lesions were detected sooner among married people than they were among those who were never married, divorced, or widowed. The study also showed that married people were most likely to have skin lesions looked at by a primary care physician or a skin cancer specialist, such as a dermatologist.

In other words, spouses can help in several ways by applying sunscreen in those hard to reach places, noticing new and suspicious moles on their partners, and urging their partner to get those moles checked out.

If you aren’t married, however, consider teaming up with a partner or having a physician regularly do a spot check on your skin.

Skin self-examinations are also very important. When detected early, skin cancer is almost always curable. This is why getting to know your skin though regular self-exams is so important; so that any new or changing marks or lesions can be caught quickly. It is also a good idea to be aware of the other factors that could put you at risk for melanoma so you can take the necessary steps toward prevention.

If an area on your skin looks suspicious or concerns you, speak with your doctor immediately. The sooner you have it checked out, the easier it can be to cure. Our team of cancer experts are available if you need to see a skin cancer specialist after diagnosis.

Originally posted in 2018, updated in 2024.

Dispelling a Cancer Myth

May 9, 2024 | Southern Arizona

Throughout my practice as a radiation oncologist, I have noticed a recurring question that patients ask; “If the surgeon sticks a needle into the tumor or if they expose the tumor to air, will the tumor spread?”  The answer to the question is that realistically, the possibility is very low. In 2015, the Mayo Clinic analyzed 250 patients that had biopsies and found no risk of tumors spreading associated with the procedure. They went further and analyzed 2,000 Medicare patients with pancreatic cancer and found no significant difference in cancer spread between those that had a biopsy versus those that did not.

I was not able to find any scientific surgical data that indicates exposing a tumor to air will cause it to spread.  Unfortunately, there are old case reports where tumors were ruptured, directly transected, and contamination of surgical instruments increased the risk of spread or contamination. However, today’s modern surgical techniques minimize these risks. Imaging studies such as CT scans, ultrasounds, PET scans, and MRI imaging allow better visualization of the tumor size, shape, blood supply, etc.  These technologies have allowed surgeons to plan ahead on their surgery. Common examples include giving preoperative chemotherapy and radiation for locally advanced rectal cancers. Studies show this results in improved sphincter-sparing (not having a permanent colostomy) as well as improving the chances cancer doesn’t come back locally after surgery. In breast cancers, imaging studies such as MRI have allowed some patients to be treated with chemotherapy before surgery, to shrink a tumor’s size to improve surgical outcomes and increase the possibility that breast conservation therapy can be done.

Related reading: 12 Common Myths About Cancer

The importance of a biopsy or surgery is critical for a patient’s cancer treatment. A biopsy documents the presence of cancer. For most cancer treatments, more than one type of treatment is used; this includes surgery, chemotherapy, and radiation. Thus, it is important to ensure the risks involved with treatment is applied to cancer and not a benign tumor.

Biopsies are also necessary not only to justify risks of therapy but to also establish proper treatments. For most malignancies, surgery plays a primary role by removing the tumor and allowing chemotherapy and radiation to target what may have escaped or microscopic cells that may have been left behind after surgery.

A good example where surgery is not required for a cure would be anal cancer.  These tumors can be cured entirely with chemotherapy and radiation. However, these tumors can sometimes be hard to distinguish between a deficient lying rectal cancer.  For rectal cancer, treatment would require not only chemotherapy and radiation but also a radical surgery that sometimes leads to a permanent colostomy. The only way to distinguish these vastly different tumors and treatments is with a biopsy.

Unfortunately, many cancers are invasive or infiltrating. This means at the microscopic level; the cancer cells are breaking through protective membranes and entering lymphatic and vascular spaces. This allows cancer to spread towards lymph nodes or into the blood system. Many times cancer may have already spread before surgery. Current medical imaging may not have been able to pick up small lesions, and by the time the patient has surgery or shortly after, these lesions may have grown larger.  Therefore, leading to the belief that surgery or the exposure to air caused the tumors to spread.

Since I began practicing radiation oncology over 25 years ago, there has been an explosion in cancer biology as well as drug therapy.  We are now able to determine the molecular profile of a tumor. By knowing its genetic makeup, we can determine if a cancer has a high likelihood to spread and thereby benefit from chemotherapy. Additionally, the presence of specific genes also allows oncologists to be able to select particular drug therapies. When certain types of genes are found, they can increase the aggressiveness, as well as evasiveness of a tumor from the immune system. There are now specific drugs that are designed to shut this gene down causing the tumor to die or be more recognizable to the body’s immune system.

In conclusion, there is no definitive evidence that a biopsy or surgery has led to a spread of cancer. A biopsy or surgery is necessary for a cancer diagnosis, proper treatment, and in some cases, a cure.

Robert Gin, MD is a radiation oncologist at Arizona Oncology. He earned his medical degree at the University of Arizona Medical School. Dr. Gin is board certified in radiation oncology and is a member of the American Society for Radiation Oncology.