Prostate cancer patients can choose watchful waiting or active surveillance if they wish to forgo immediate treatment

Prostate Cancer: Watchful Waiting vs. Active Surveillance

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About one out of every nine men will be diagnosed with prostate cancer during his lifetime, making it the second most common cancer in American men, behind only skin cancer.1 However, due to advances in cancer screening awareness and early detection, most men will not die from prostate cancer. In fact, many men who are diagnosed with an early-stage, low-grade cancer may need little to no immediate medical treatment. Instead, they can choose from two different methods of monitoring their prostate cancer: watchful waiting or active surveillance.

For men with prostate cancer, the goal of cancer management methods like watchful waiting and active surveillance is to avoid the side effects caused by cancer treatments like surgery or radiation therapy.

Both watchful waiting and active surveillance are ways of monitoring the cancer for changes, but the reasons for choosing one method over the other are different:

  • Watchful waiting is better for men who can’t undergo curative treatment. It is meant to manage symptoms by controlling the cancer, but is not intended to cure it.
  • Active surveillance is better for men who would benefit from curative treatment should the cancer become more aggressive.

Prostate cancer patients may wish to forgo immediate treatment, and instead use watchful waiting or active surveillance when:

  • There are no symptoms present
  • Gleason score indicates a slow-growing cancer
  • PSA level is relatively low (less than 10ng/mL)
  • Tumor size is small
  • Cancer has not spread beyond the prostate

In this article, we’ll explain the differences between watchful waiting and active surveillance, and which patients might be better suited for each. We’ll also look at the advantages and disadvantages of both methods and discuss your next steps if you’d like to discuss your diagnosis with a physician.

ABOUT WATCHFUL WAITING

Watchful waiting is used when there are no symptoms present. It involves closely monitoring a patient’s condition, but not treating the prostate cancer unless symptoms appear or change. During watchful waiting, men may undergo occasional prostate-specific antigen (PSA) tests or digital rectal exams (DRE), but this method mainly relies on watching for symptoms of prostate cancer.

You may also hear watchful waiting referred to as observation, watch and wait, or wait and see.

Men with other chronic, potentially life-threatening illnesses are best suited for watchful waiting because the risk of possible side effects from other treatments, like surgery or radiation therapy, could outweigh the benefits. Older men may also benefit from watchful waiting because other treatments may not help them live any longer, and the cancer isn’t likely to impact their quality of life.

If symptoms appear or change during watchful waiting, a patient may choose to discuss other treatment options, such as hormone therapy. Symptoms to look for during watchful waiting include frequent urination (especially at night), difficulty stopping/starting urination, blood in the urine, painful or burning sensation during urination, dull pain in the lower pelvis, and widespread pain in the lower back, hips or thighs.

Typically, treatment during watchful waiting is not meant to cure the cancer, but rather control it to help manage the patient’s symptoms.

Advantages of Watchful Waiting

  • Passive approach with fewer tests
  • Avoids side effects of surgery or radiation therapy
  • Cancer may never need to be treated

Disadvantages of Watchful Waiting

  • Cancer could grow or spread between follow-ups, making treatment harder
  • Patient must live with anxiety of having cancer, worry about it growing
  • Family members may worry and not understand why you aren’t treating the cancer

ABOUT ACTIVE SURVEILLANCE

Active surveillance is a more aggressive form of monitoring prostate cancer than watchful waiting. It involves a regular testing schedule, including a PSA test every six months and a DRE at least once a year. Imaging tests and prostate biopsies are also usually performed every one to three years.

You may also hear active surveillance referred to as active monitoring or deferred therapy.

The goal of active surveillance is to avoid or delay the need for other treatments like surgery or radiation therapy. This helps the patient avoid possible side effects like erectile dysfunction and incontinence for as long as possible.

If test results show that the prostate cancer is getting worse, a patient may choose to stop active surveillance and start a treatment plan designed to cure the cancer. Since treatment may ultimately be necessary, patients who are best suited for active surveillance include:

  • Men with slow-growing cancer that has not spread beyond prostate
  • Men whose benefit from surgery or radiation outweighs the risk

Advantages of Active Surveillance

  • Avoid sexual, urinary or bowel side effects for as long as possible
  • Regular testing means cancer is more closely monitored
  • Cancer may never need treatment

Disadvantages of Active Surveillance

  • Aggressive approach, more rigorous testing schedule
  • Regular biopsies are necessary
  • Patient must live with anxiety of having cancer, worry about it growing

NEXT STEPS FOR PROSTATE CANCER PATIENTS INTERESTED IN WATCHFUL WAITING OR ACTIVE SURVEILLANCE

If you have been diagnosed with prostate cancer, it’s important to understand all of your treatment options, and the possible side effects of each. This includes the options of watchful waiting or active surveillance. Your physician will consider many factors when helping you choose a treatment plan including: PSA level, tumor size, Gleason score (grade), cancer stage, age, overall health, family history, race, ethnicity and personal preference.

The board-certified radiation oncologists at Provision CARES Proton Therapy are experts in prostate cancer treatment. When you schedule a consultation with one of our physicians, they will be able to discuss the specifics of your prostate cancer diagnosis, and help determine whether watchful waiting or active surveillance may be beneficial for you.

They can also discuss your next steps and treatment options, including proton therapy, which is an advanced form of radiation therapy that reduces treatment-related complications and side effects compared to traditional x-ray radiation.

As a first step in moving forward with your cancer care, we recommend calling the Provision location nearest you. Our Cancer Care Experts can speak with you about your diagnosis, answer any questions you may have and, if desired, schedule you for an in-person or telehealth consultation with one of our physicians.

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As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a Provision treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy is right for you.

1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/prost.html

Delaying cancer screening tests during COVID puts patients at risk

Delayed Cancer Screenings in COVID-19 Era Put Patients at Risk

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When the COVID-19 pandemic began, life as we knew it came to an abrupt halt. That included routine healthcare visits, as many providers postponed appointments and cancer screening tests that were deemed “non-essential.”

In the United States alone, an estimated 22 million cancer screening tests were disrupted by COVID-19 from April to June 2020. As a result, about 80,000 patients could be at risk for delayed or missed diagnoses.

The IQVIA Institute for Human Data Science recently published these estimates as part of its report on shifts in healthcare demand, delivery and care during the COVID-19 era. In this article, we’ll look at how diagnostic procedures for some of the most common cancers are impacted. We’ll also share some tips to help you move forward with your cancer-related care in a timely and safe manner.

DRAMATIC DROP IN DIAGNOSTIC TESTS

The IQVIA report looked at insurance claims for five of the most common cancer screening tests – breast, cervical, colorectal, lung, and prostate – and found a significant reduction across the board as a result of COVID-19.

“Claim codes for diagnostics commonly used to screen and monitor for cancer were generally stable from March 2019 through February 2020,” noted the report’s authors. “However, as the country prepared for COVID by canceling/postponing non-essential visits, procedure codes throughout March declined dramatically, coming to a near stand-still for some tests by the first week in April.”

The number of cancer screenings during COVID dropped by up to 90%

As you can see in the chart above, colorectal cancer screenings took the biggest hit. In the week ending April 10, 2020, claims filed for colonoscopies dropped by 90%. Mammograms for breast cancer screening saw a similar decline (87%), as did pap smears for cervical cancer screening (83%).

The number of CT scans related to lung cancer and PSA tests for prostate cancer was also lower, but the reductions weren’t quite as dramatic.

While PSA tests did drop by 60%, some physicians may have opted to continue with scheduled screenings in order to adhere to the patient’s testing plan. This is because the severity of a potential prostate tumor is often measured by how much time it takes for the PSA level to double.

The report’s authors also reasoned that the lower rate of disruption for CT scans (a 39% reduction) could be due to the generally more serious nature of lung cancer. Physicians may have also been trying to rule out COVID-related issues in the lungs for some patients.

RISK OF MISSED CANCER SCREENINGS DURING COVID ERA

Using the screening data from early April, the IQVIA report went on to project how many patients could miss a diagnostic procedure between April and June 2020, and the risk that would create for potentially delayed or missed diagnoses.

More than 80,000 patients may have delayed or missed diagnoses because of delayed cancer screenings during COVID

In the chart above, you can see the estimated reduction in the number of tests ranges from 30 to 72 percent, depending on the cancer type. As a result, COVID-19 potentially disrupted more than 22 million cancer screening tests overall. That included an astonishing 13.2 million fewer pap smears and 7.2 million fewer mammograms over the three-month period.

It’s important to note that not all abnormal test results lead to a cancer diagnosis. With the rate of positive cancer diagnosis per test in mind, the report’s authors determined the reduction in screenings could put more than 80,000 patients at risk for a delayed or missed diagnosis. Breast cancer is estimated to be the most impacted (36,000 patients), followed by prostate cancer (22,600) and colorectal cancer (18,800).

A delayed diagnosis could ultimately lead to a more advanced cancer when it is diagnosed. Not only will that have negative impacts on a patient’s prognosis, but it could also have long-term effects on our healthcare system.

“Current excess healthcare capacity to catch-up on missed tests and associated cancer treatments would require providers to shift priorities to make time and space in schedules and facilities,” said the IQVIA report authors. “An immediate return to previous volumes of testing and care will require substantial reallocation of resources and likely last months after social distancing rules are relaxed.”

WHAT YOU CAN DO TO MOVE FORWARD WITH YOUR CARE

Provision CARES Proton Therapy is a strong advocate for timely cancer screening and treatment. As such, we have developed a list of guidelines to help you move forward with your care and avoid putting yourself at higher risk.

First and foremost, we encourage you to call your primary care physician and discuss any regularly scheduled procedures like a mammogram, pap smear, colonoscopy or PSA test. Based on your medical history, your provider can help you determine whether it’s appropriate to continue with your cancer screening during the COVID-19 pandemic or delay it.

If you do receive a cancer diagnosis, we can help you move forward with your cancer care in a timely and safe manner. Depending on your diagnosis, it may be appropriate to delay treatment until the COVID risk is lowered. However, some patients may be better off beginning their cancer treatment immediately. As a first step after your diagnosis, we recommend calling the Provision treatment location nearest you to speak with one of our Cancer Care Experts. They can discuss your specific diagnosis and, if necessary, schedule you for a consultation with one of our physicians.

During your consultation, you’ll be able to meet with one of our board-certified Radiation Oncologists. They will be able to answer any questions you may have about your diagnosis and review all of your treatment options, as well as the possible side effects of each.

Provision offers both telehealth and in-person consultations. Telehealth consultations allow you to speak directly with a physician from the comfort and safety of your own home.

Some patients may benefit more from an in-person consultation. We encourage you to follow the CDC’s guidelines for leaving your house for doctor visits during the COVID-19 pandemic. When you arrive at our facility, rest assured we have established our own standards of excellence to keep our patients, visitors and employees safe. All Provision cancer centers are stand-alone medical facilities, which helps limit your exposure to others compared to a busier hospital setting.

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As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a Provision treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy is right for you.

 

Proton therapy cancer treatment significantly lowers the risk of second cancer compared to IMRT and 3DCRT

Proton Therapy significantly lowers your risk of second cancer

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X-ray (also called photon) therapy has long been known to cause the development of potentially deadly new cancers in patients who undergo radiation therapy to treat their cancer. However, research shows that patients who choose proton therapy for cancer treatment have a significantly lower risk of developing a second cancer later in life. In a  comprehensive study published last month in Cancer, the prestigious, peer-reviewed journal of the American Cancer Society, researchers at Stanford University found that patients who were treated with x-ray therapy developed more than three times as many new cancers as patients treated with proton therapy.1

ABOUT THE STUDY

The study was conducted by Stanford University physicians Michael Xiang, MD, PhD; Daniel T. Chang, MD; and Erqi L. Pollom, MD, MS. Their research team conducted a retrospective cohort study using the National Cancer Database (NDCB), the most comprehensive cancer registry in the United States.

The study included over 450,000 patients of all ages with a variety of cancers, such as:

  • Prostate
  • Head and neck
  • Breast
  • Gastrointestinal
  • Gynecologic
  • Lymphoma
  • Lung (non-small cell)
  • Bone/soft tissue
  • Brain/central nervous system

Patients included in the study were treated with intensity-modulated radiation therapy (IMRT), 3-dimensional conformal radiation therapy (3DCRT), or proton therapy between 2004 and 2015. They were followed for a minimum of 2 years and an average of 5 years after receiving radiation therapy.

RESULTS HEAVILY FAVOR PROTON THERAPY

Compared to proton therapy, the incidence of second cancers was 3.5 times higher after IMRT and 3.6 times higher after 3DCRT, the two most common forms of x-ray radiation therapy. These differences were found to be highly significant. Proton therapy decreased the overall risk of developing a second cancer by over two-thirds (69%) compared to IMRT. In fact, proton therapy reduced the occurrence of second cancer for eight of the nine types of cancer most commonly treated with radiation therapy.

Compared to IMRT, proton therapy substantially reduced the risk of developing a second cancer for most disease sites, including:

  • 82% reduction among prostate cancer patients
  • 58% reduction among head and neck cancer patients
  • 38% reduction among breast cancer patients with at least five years of follow-up
  • 69% reduction among all cancer patients

“These findings show the extraordinary benefits of proton therapy when it comes to reducing the risk of second cancers, confirming the results of prior modeling studies,” says Mike Sommi, President of Provision CARES Proton Therapy Knoxville. “The data powerfully bears out the theories regarding the benefits of proton therapy in terms of reducing the risk of second cancers.”

The dramatic reduction in risk of second cancers is likely due to to the fact that protons concentrate their radiation delivery within the cancer much better than x-rays. Patients treated with x-rays absorb 2-3 times more radiation in their bodies than patients treated with protons.4-6 The excess radiation from x-rays can severely damage and mutate healthy cells, resulting in serious toxicities, including causing a new cancer.

Proton therapy cancer treatment reduces your risk of developing a second cancer, compared to x-ray/IMRT.

STUDY CONFIRMS PRIOR RESEARCH

The Stanford study confirms the findings of a previously published study from Harvard using the other main American cancer registry, the Surveillance, Epidemiology, and End Results (SEER) Program. The Harvard study found the second cancer rate to be 48% lower after proton therapy, compared to x-ray treatment. The average follow-up period in the Harvard study was 6 years after radiation therapy. 18

The Harvard study noted that while proton therapy reduced second cancers in all age groups, protons may be particularly beneficial for young patients, who have decades to accumulate radiation-induced cancers. In children, for example, x-ray therapy is estimated to increase second cancers by 600-1,000%.19-21

“As time passes and the follow-up period for these patients lengthens, the benefits of proton therapy will become even more pronounced,” Sommi agrees. “This is especially important for patients who expect to survive 10 years or more.”

OTHER BENEFITS OF PROTON THERAPY FOR CANCER TREATMENT

The results of this study highlight yet another clinically-proven benefit of proton therapy for cancer treatment. Because proton therapy precisely targets the tumor and avoids unnecessary radiation to nearby healthy tissue and organs, patients have a lower risk of short-term and long-term side effects.

Depending on cancer type, other benefits of proton therapy include:

Prostate Cancer

  • 25% lower risk of erectile dysfunction7
  • 35% less radiation to bladder8
  • 59% less radiation to rectum8

Head, Neck and Oral Cancer

  • 27% reduction in overall risk of needing a feeding tube for oropharyngeal cancer9
  • 45% reduction in overall risk of needing a feeding tube for nasopharyngeal cancer10
  • Dramatic reduction of negative impact on taste, nausea and painful changes to the mouth in salivary gland treatment11

Breast Cancer

  • 88% less radiation to the heart for left-sided breast cancer9,10
  • 44% reduction in clinically significant radiation doses to the lung10
  • 90% of partial breast irradiation cases result in good to excellent cosmetic outcomes at 5 years11

Brain and Spine Cancer

  • 31% increase in disease control for aggressive tumors at base of skull (chordomas) at 5 years12
  • 50% less likely to have secondary brain tumor from treatment13
  • 55% reduction in average dose to the hippocampi (memory function) in treatment of meningioma14

Esophageal

  • 26% reduction in lung toxicity compared with IMRT15
  • 21% reduction in the risk of severe, treatment-related lymphopenia, particularly in lower esophagus16
  • 3-4 day reduction in average hospital stay after surgery17

To learn about other cancers that can be treated with proton therapy, and to read about the benefits of proton therapy for those cancers, visit our Cancers We Treat page.


Sources & Studies

  1. Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer. 2020;0:1-9.
  2. Journy NM, Morton LM< Kleinerman RA, Bekelman JE, Berrington de Gonzalez A. Second primary cancers after intensity-modulated vs 3-dimensional conformal radiation therapy for prostate cancer. JAMA Oncol. 2016;2:1368-1370.
  3. Diallo I, Haddy N, Adjadj E, et al. Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer. Int J Radiat Oncol Biol Phys. 2009;74:876-883.
  4. Eaton BR, MacDonald SM, Yock TI, Tarbell NJ. Secondary malignancy risk following proton radiation therapy. Front Oncol. 2015;5:261.
  5. Chargari C, Goodman KA, Diallo I, et al. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models? Cancer Metastasis Rev. 2016;35:277-288.
  6. Hoppe BS, Flampouri S, Su Z, et al. Consolidative involved-node proton therapy for stage IA-IIIB mediastinal Hodgkin lymphoma: preliminary dosimetric outcomes from a phase II study. Int J Radiat Oncol Biol Phys. 2012;83:260-267.
  7. Comparative toxicity and cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer. Read More
  8. Dose–Volume Comparison of Proton Therapy and Intensity-Modulated Radiotherapy for Prostate Cancer. Read More
  9. Gastrostomy Tubes Decrease by Over 50% With Intensity Modulated Proton Therapy (IMPT) During the Treatment of Oropharyngeal Cancer Patients. Read More
  10. Proton therapy reduces treatment-related toxicities for patients with nasopharyngeal cancer: a case-match control study of IMPT and IMRT. Read More
  11. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Read More
  12. Effectiveness and Safety of Spot Scanning Proton Radiation Therapy for Chordomas and Chondrosarcomas of the Skull Base: First Long-Term Report. Read More
  13. A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy. Read More
  14. Projected second tumor risk and dose to neurocognitive structures after proton versus photon radiotherapy for benign meningioma. Read More
  15. A Multi-Institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients. Read More
  16. Lymphocyte-sparing Effect of proton therapy in patients with esophageal cancer treated with definitive chemoradiation. Read More
  17. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Read More
  18. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):46-52. doin: 10.1016/j.ijrobp.2013.04.030. Pub 2013 Jun 15.
  19. Curtis RE, Freedman DM, Roe E, et al. eds. New malignancies among cancer survivors: SEER Cancer Registries, 1973-2000. NIH Publ. No. 05-5302. National Cancer Institute; 2006.
  20. Yock TI, Caruso PA. Risk of second cancers after photon and proton radiotherapy: a review of the data. Health Phys. 2012;103:577.
  21. Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35:1641-1649.

 

Provision doctor diagnosed with cancer, chooses proton therapy for his own treatment

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This story starts the way a lot of cancer stories start. A visit to the doctor for an unrelated issue. A few tests. And then, while trying to solve one problem, the doctor discovers another – a red flag.

That discovery sparks a journey down a road far too many have traveled. First, more trips to the doctor. Then more tests. And then the waiting. Waiting with fear and uncertainty – hoping for the best, but preparing for the worst. Until eventually, the wait is over and the news is in…

It’s cancer.

And from there, this story continues down a common path. Mulling over questions like “How bad is it?” and “How do I deal with this?” Determining the options and choosing a treatment. And of course, fighting the cancer.

There’s something uncommon about this story, though – the person making the journey. Because he’s literally been down this road hundreds of times before. He knows the roadmap better than most, because he’s guided people through it for decades.

The only difference this time? He’s no longer the guide. This is his journey.

FROM DOCTOR TO PATIENT

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleDr. James Gray is a board-certified Radiation Oncologist and the Medical Director at Provision CARES Proton Therapy Nashville. His career includes work with the National Naval Medical Center and the National Cancer Institute. He began practicing radiation oncology in Nashville in the mid-1990s, including membership in Tennessee Oncology, one of the largest privately-held physician groups in the country. He has established his reputation as a pioneer in the industry, performing many advanced procedures never-before-seen in the region.

Accomplishments and accolades, aside, it’s Dr. Gray’s passion and commitment to his patients that define him. He’s spent 30 years studying cancer and helping patients navigate the difficult path of fighting it.

“I get to work with patients in a time of dire need for them. They undergo a diagnosis of cancer, and this is terribly frightening for most people to accept and move forward,” says Dr. Gray. “Helping someone move through that. Counseling them. Making them understand their disease. That’s what brings joy to me – the actual effort of bringing this understanding to those patients and then bringing the best possible care to them. That drives me every day.”

Then, in 2019, he visited a physician to check out a minor health issue. During that visit, Dr. Gray underwent a PSA level screening. Much to his surprise, the levels came back slightly elevated – a possible indication of prostate cancer.

“I realized with that PSA level, I needed to pursue this, and I went to see another physician – an outstanding urologist – and he proceeded with a diagnostic work up. That led to some other lab tests, an examination and then a biopsy.”

Dr. Gray recalled the anxiety he felt during the days following the biopsy. “You’ve got to wait maybe 3 or 4 days to get the pathology results back. I got to live firsthand that trepidation – that worry of, ‘Oh gosh. I hope it’s not cancer.’”

Unfortunately, though, it was cancer. Prostate cancer.

“It put me in a unique position where I’ve actually counseled patients who’ve just gotten this news. I’ve counseled probably more patients in this setting than anybody else in the area. All of a sudden, I’m counseling myself. Now, I’m the patient.”

WEIGHING THE OPTIONS

After receiving the news of his cancer diagnosis, Dr. Gray says he had a 30-year head start on the typical patient. As an established Nashville oncologist, he already had a strong grasp on the answers to questions like, “What does this mean for my life?” and “Am I going to die from this?” However, it was still important for him to remain objective, gather information about the severity of his cancer, then step back and make a clear treatment decision.

The initial decision for most prostate cancer patients is to determine whether the cancer is actually worthy of treatment, or if it would be more appropriate to observe it through active surveillance. In Dr. Gray’s case, he felt the cancer was threatening enough to treat immediately.

The next big divide – the “fork in the road,” as Dr. Gray calls it – is to decide whether to remove the prostate surgically or treat the tumor with radiation therapy.

“For me, that was not a difficult decision,” he says. “Knowing what I know about the likelihood of getting rid of the disease and the likelihood of having any kind of consequences from the treatment itself, I knew pretty quickly that I wanted to have radiation.”

That led to his next decision – choosing a radiation therapy method. There are many options for prostate cancer patients, including traditional x-ray radiation, radioactive seed implants (brachytherapy) and proton therapy.

For Dr. Gray, this was another easy decision. “One of the key advantages of proton therapy is that we’re putting (radiation) into the tumor with as little unnecessary dose to other tissues as possible. That inherently reduces the possibility of side effects – fatigue, difficulty with urination or bowels in my circumstance. So statistically, I am convinced. I’ve seen the data. I know what I consider to be the best treatment for prostate cancer, in my particular setting, was a proton therapy treatment system.”

“And fortunately, I happen to work at a proton system.”

WORK-LIFE BALANCE

They say it’s important to have a good work-life balance in your career. In Dr. Gray’s case, those two worlds collided as soon as the radiation oncologist began his proton therapy treatment in Nashville.

“I could actually go to work every day and receive a treatment – close to six weeks of treatment – but I was just going to work. And for 20 or 30 minutes, I stepped into the patient role, had my treatment, then went back into the doctor role.”

Dr. Gray remembers the transition from doctor to patient being fairly easy, mainly because of the trust he had in the treatment itself, as well as the Provision CARES team performing the treatment.

“For a lot of patients, they have to slowly gain the trust in me as their physician. They have to gain the trust in the people that are going to do their treatment. They have to gain the trust in the technology,” notes Dr. Gray. “I didn’t have those misgivings. I knew that when I was being treated, very bright people were watching over the treatment and making sure it was done right. I know how competent, outstanding and professional those people are, so I didn’t have any qualms about that.”

In fact, Dr. Gray’s positive attitude during his treatment actually helped the other staff members deal with a situation in which their colleague, friend and mentor was battling cancer – and they happened to be the ones treating it.

“I’ve never been in that situation before where you’re treating someone that you know so closely,” remembers Justin Pigg, Radiation Therapy Manager at Provision Nashville. “But to Dr. Gray, he just wanted to be treated like any other patient. He wanted the patient experience.”

“He was really calm and really strong through it, and I think that helped everybody else be calm, as well,” says Valerie Bohannon, the proton center’s Patient Concierge.

That sense of calm among the team was critical, as just about everyone at Provision Nashville had some role in Dr. Gray’s treatment.

“It’s all the way from the top to the bottom,” Dr. Gray says. “Every member of this staff had something to do with making sure my treatment went well. They all wished me well. They all asked me how I was doing. They were genuinely concerned about this.”

And that concern – that culture of care – is what Provision is all about. Dr. Gray hears it from his patients all the time.

“They will tell me how impressed they are from the moment they walk in the door to the time they’re leaving the center. They felt like they’ve been enveloped in care. And I felt the exact same way. It was obvious to me that I was brought into that care – that love – that people wanted me to do well.”

WALKING IN THE PATIENT’S SHOES

Dr. Gray, a Nashville oncologist, completing his proton therapy treatment at Provision CARES NashvilleDr. Gray successfully completed proton therapy in January 2020, placing him in a rare category of radiation oncologists who’ve actually been through the very cancer treatment in which they specialize. He says the entire experience impacted the way he’ll approach his role as a doctor going forward.

“It was enlightening. Going through the treatment myself gave me quite a bit of a different perspective. It’s important for me to understand that my personal experience can be translated only some degree to my patients, but at least having a taste of it allowed me to understand a bit more how they see it – how they experience the whole treatment process.”

That “taste” of proton therapy, as he calls it, will now be another tool for a Nashville oncologist who is passionate about making this effective and successful treatment available to as many people as possible.

“Some people suggested I had to choose proton therapy because I work at a proton therapy center. No, not necessarily. I’m not going to compromise my own good health just to make a point in my professional career. I wanted to have the best outcome, and I genuinely believe my best outcome would be achieved through the use of proton therapy.”

And with 36 operating proton centers across the country, why did he choose to be treated at Provision CARES Proton Therapy Nashville? He says that was another easy decision.

“Why would I leave here when I know I’ve got great people here to treat me. I can get world class treatment by world class people just downstairs from my office. Why wouldn’t I take advantage of that?”

Upcoming Event: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

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Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, September 20th from  930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Free PSA level screenings offered throughout East Tennessee

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Eddie Check® and the Provision CARES Foundation Team Up for Blood Drive and Free PSA Screenings

Available at 16 different East Tennessee locations across 10 counties on September 12th & 13th.

Unbelievably, One in nine men will be diagnosed with prostate cancer during his lifetime – and one in 41 will die from it. Prostate cancer is second only to skin cancer as the most common cancer in American men and second only to lung cancer as the leading cancer-based cause of death in American men. The American Cancer Society estimates that in the U.S. during 2019, about 174,650 new cases of prostate cancer will be diagnosed and 31,620 men will die from it.

But there’s still good news. If prostate cancer is caught early, the 5-year survival rate is nearly 100%. The numbers say it all: Get tested!  Prostate cancer is rare before age 40, so if you are 40 or older, the first step is a free, simple PSA screening that only requires a blood sample. “PSA” stands for prostate-specific antigen, a protein produced by prostate cells. The PSA test is done to help diagnose and follow prostate cancer in men.  No certain PSA level is called normal or abnormal, and an elevated level does not mean you have prostate cancer – only a biopsy can diagnose cancer. Always discuss PSA test results with your doctor and be sure to have a digital rectal exam (DRE), as about 6% of men with prostate cancer continue to have normal PSA.

In 2004, Rockford-based Nisus Corporation, a manufacturer of green products for the pest control and wood preservation industries, teamed up with area hospitals and MEDIC Regional Blood Center to create Eddie Check, an annual event that adds free PSA screening for prostate cancer to blood drives. It was a simple strategy using MEDIC’s already existing resources to make it fast and easy for men to get a blood sample drawn for the screening. Nisus has a personal stake in the fight; marketing vice president Jim Gorman is a prostate cancer survivor, while company president Kevin L. Kirkland lost his father, Eddie Kirkland, to the disease. In fact, “Eddie Check” is named for Eddie Kirkland.

Once again, Nisus, MEDIC, Provision CARES Proton Therapy, and Provision CARES Foundation join with sponsors WIVK FM 107.7, Sports Radio WNML 99.1 FM & 990 AM, NewsTalk 98.7 FM, WVLT, and Abacus Arts, Inc.

Sites and Locations

Thursday, September 12

Friday, September 13

Am I at Risk for Prostate Cancer

Am I at Risk for Prostate Cancer?

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September is Prostate Cancer Awareness Month.  It is important to know if you are at risk of prostate cancer and whether you should get an annual Prostate-Specific Antigen (PSA) level test.

In Tennessee, as well as the United States, prostate cancer has the second highest new cancer rate overall and is the number one cancer for new cancer types among men.(1)    According to the Center for Disease Control (CDC), there are an estimated 3,110,403 men living with prostate cancer in the US.  Based on their 2014-2016 data, approximately 11.6% of men will be diagnosed with prostate cancer at some point in their lifetime.  According to SEER, there will be an estimated 174,650 new cases of prostate cancer in 2019 with an estimated 31,620 deaths from prostate cancer.  The five year survival rate for prostate

Prostate cancer is most frequently diagnosed among men aged 65-74 with a median age of 66.  However, 9.2% of new prostate cancer cases are among men under the age of 55.(2)

In addition to age, other factors can increase the risk of being diagnosed, including family history, genetic factors, race, lifestyle and dietary habits.

If an immediate family member such as your father or brother have been diagnosed with prostate cancer, then your risk of developing prostate cancer is 2 to 3 times higher than normal.  Your risk increases with each relative that has been diagnosed with prostate cancer.  Your risk will also increase if two or more close relatives on the same side of the family have been diagnosed with prostate cancer before the age of 55.(3)

African American men have a higher risk and are more likely to be diagnosed at a younger age and have been found to have a more aggressive tumor.

There have not been any studies to prove that diet and nutrition has any direct correlation with developing prostate cancer.  However, if a male who is overweight is diagnosed with prostate cancer, they are at a greater risk for developing a more aggressive cancer.

While there can be lifestyle and dietary habits that can increase your risk of prostate cancer, there are a few myths that have been rumored to increase your risk of prostate cancer.   Sexual activity level is a non-factor as well as having a vasectomy.  Alcohol is another non-risk factor for prostate cancer.

If you do have any of these risk factors, it is important to have your PSA level checked annually.  If you do have an elevated PSA level, your doctor can provide information on additional testing to confirm your diagnosis.

Source:

(1) Center for Disease Control.  Prostate Cancer Statistics.  https://www.cdc.gov/cancer/prostate/statistics/index.htm

(2) National Cancer Institute.  Surveillance, Epidemiology, and End Results Program.  Cancer Stat Facts:  Prostate Cancer. https://seer.cancer.gov/statfacts/html/prost.html

(3) Cancer.Net.  Prostate Cancer Statistics.  https://www.cancer.net/cancer-types/prostate-cancer/statistics

Upcoming Events: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

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Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, July 26th from 930-11a and Friday August 23rd from 930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Thursday, May 9th at 6:30pm or Friday, May 17th at 9:30am

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com