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cri 0712 prostate cancer 12/14/07 2:41 PM Page 2 Have you considered Prostate MRI? Prostate MRI is a medical imaging technology that provides a very accurate, detailed view of the prostate. It can provide clarity when you have: increasing PSA levels but more than one negative biopsy uncertainty about treatment after a prostate cancer diagnosis Prostate MRI actually pinpointed exactly where my cancer was in the capsule of the prostate. It allowed my doctor to change my course of treatment. Jim Davis, Sarasota, FL Prostate MRI with ecoil may assist your physician in providing accurate diagnosis and picking the right treatment path for your situation. Ask your doctor about Prostate MRI. www.prostatemr.org

cri 0712 prostate cancer 12/14/07 2:41 PM Page 3 A MESSAGE FROM DR. FRANK A. CRITZ Prostate cancer. This disease affects every man diagnosed and those around him: his wife/significant other, family and friends. Yet, while prostate cancer is the most common cancer in men, other than skin cancers, it can be cured if found early and if properly treated. For these reasons alone, it is worth being knowledgeable about and tested regularly for this disease. Keep in mind: Screening for prostate cancer is easy. A simple blood test called Prostate Specific Antigen (or PSA) can lead to early diagnosis and early diagnosis is a critical part of cure. All men who have reached age 50 should have an annual PSA test. African-Americans should begin testing at age 40, as should men who have a family history of prostate cancer. Prostate cancer is typically slow growing. Men have the time to learn about this disease and the treatment methods available for cure. With few exceptions, men with prostate cancer have only one chance to be cured. I know how overwhelming and confusing a prostate cancer diagnosis can be. My colleagues at Radiotherapy Clinics of Georgia and I have treated more than 10,000 men, which gives us more experience treating early prostate cancer than any other physician group in Georgia. And, using my more than 30 years of experience treating men with prostate cancer, I have pioneered a treatment that provides one of the highest cure rates for prostate cancer in the United States. Based on this experience, my advice to you is simple: if you (or a friend or relative) are diagnosed with an abnormal PSA or prostate cancer, take the time to study, ask questions and make an educated decision about all your treatment options. Why? Because with few exceptions, you will get only one chance to be treated for cure. Sincerely, Frank A. Critz, M.D. Medical Director and Director of Prostate Cancer Research Radiotherapy Clinics of Georgia An Accredited Center of Excellence TAKE CONTROL OF PROSTATE CANCER 3

cri 0712 prostate cancer 12/14/07 2:41 PM Page 4 odds The good news is: THE ODDS Each year approximately 220,000 men in the United States are diagnosed with prostate cancer. That s one in six men will develop prostate cancer in their lifetime. Pretty dramatic odds. Only one in 35 men will die of this disease. In fact, more than two million men in the United States who have been diagnosed with prostate cancer during their lifetime are still alive today. Cure is possible if prostate cancer is detected early and properly treated. THE PROSTATE Prostate cancer starts in the prostate. This walnutsized gland, located behind a man s pelvic bones, is sandwiched between the bladder on top and the rectum underneath. The gland is covered with a capsule similar to the shell on an egg. Running through the prostate is the urethra tube, which drains urine out of the bladder as it exits the body. As men age, the prostate gland typically enlarges and often compresses the urethra, causing the typical urinary symptoms of weak or slow stream. Also as men age, there is an increasing chance that some normal prostate cells can change into cancerous cells. APPROXIMATELY 220,000 MEN IN THE UNITED STATES ARE DIAGNOSED WITH PROSTATE CANCER 1 American Cancer Society 4 TAKE CONTROL OF PROSTATE CANCER

cri 0712 prostate cancer 12/14/07 2:42 PM Page 5 THE TARGET POPULATION What causes prostate cancer? We don t know. Uncontrollable risk factors such as age, race and family history play significant roles. Two thirds of prostate cancers are found in men over the age of 65. African-American men are more likely to get prostate cancer than any other race. Asian-American and Hispanic men are less likely to have prostate cancer than non-hispanic whites. A man whose father or brother has had prostate cancer has twice the odds of getting this disease. The more relatives affected by prostate cancer, the higher the risk. Diet, medication and nationality may influence risks. A diet high in red meat or fatty dairy products and/or low in fruits and vegetables may contribute to a man s chance of getting prostate cancer. North American, European, Australians and residents on Caribbean islands are more apt to be diagnosed with prostate cancer. Men in Asia, Africa, Central America and South America are less likely to have prostate cancer. However, this may be due to frequency of screening and/or diet. TAKE CONTROL OF PROSTATE CANCER 5

cri 0712 prostate cancer 12/14/07 2:42 PM Page 6 THE AMERICAN CANCER SOCIETY RECOMMENDS BOTH PSA AND DRE BE USED TO SCREEN FOR PROSTATE CANCER. THE SCREENING APPROACH PSA Prostate cells produce a Prostate-Specific Antigen (PSA) enzyme within the gland. In a healthy male body, small amounts of this enzyme will leak into the bloodstream. If a prostate cell becomes cancerous, it may produce 10 times the amount of this enzyme, leaking more PSA into the bloodstream. Using a simple blood test called PSA, medical practitioners can check men s blood for increased enzyme levels that signal prostate cancer cells may be present. Given its effectiveness, PSA testing should be conducted annually by: Every man beginning at age 50 African-Americans starting at age 40 Men with a family history of this disease starting at age 40 PSA testing is available through your physician, hospital or community health center. PSA Results For men 60 years old or younger, a normal PSA reading can go up to 2.5 ng/ml. As the prostate enlarges with age, PSA readings in older men can range up to 4.0 ng/ml. While these levels can be affected by other factors, an abnormal reading signals a prostate biopsy should be considered. 6 TAKE CONTROL OF PROSTATE CANCER

cri 0712 prostate cancer 12/14/07 2:42 PM Page 7 As men age, PSA levels usually increase, even when there is no cancer. This elevation is typically due to enlargement of the prostate, a disease called benign prostate hypertrophy. This is also why doctors suggest comparing PSA results with results from other men of the same age. Conversely, a man can have a normal PSA and still have prostate cancer. That is why taking regular PSA screening tests and tracking the results is important. An increasing PSA, even if the increase is within the normal range, can indicate prostate cancer. If you have an elevation in your PSA, talk with your physician about whether or not you should have a prostate biopsy. Q. If my PSA is elevated after an annual PSA test, what do I do next? A. Your urologist should do a digital rectal exam (DRE) and advise whether or not you need to have a biopsy or just wait and see. If a biopsy is recommended and prostate cancer is found, do your homework, do your research, learn as much as you can about this disease and then decide for yourself on a treatment method based upon cure. Your goal from research is to find the best cure for your prostate cancer with the least chance of complications. Why? Because with few exceptions, you will get only one chance to be cured of prostate cancer and you want to make absolutely sure that you are getting the best treatment and the best doctor. DRE (Digital Rectal Exam) Medical practitioners may detect changes in the prostate through digital rectal exams (DRE). A doctor inserting a gloved finger into the rectum can reach and detect bumps or hard areas on the prostate gland. These physical changes can signal the presence of cancer even in men with normal PSA readings. The American Cancer Society recommends both PSA and DRE be used to screen for prostate cancer. Thanks to PSA tests and DRE screenings, most prostate cancers are detected early; or in other words, while the cancer is still confined to the prostate gland. This means it is still very curable. Biopsy A prostate biopsy is an outpatient procedure conducted by a urologist. Using an ultrasound machine as a guide, the urologist inserts thin needles through the rectum into the prostate gland. These needles are used to remove a tiny amount of prostate tissue from the top, middle and bottom of each side of the prostate. Each tissue sample is identified as to location and then a pathologist, using a microscope, looks at the tissue to see if prostate cancer is present. TAKE CONTROL OF PROSTATE CANCER 7

cri 0712 prostate cancer 12/14/07 2:42 PM Page 8 ttreatment There are a number of treatment options for prostate cancer. From surgery to seeds, from radiation to drug therapies, the list seems to be endless. In fact, the treatment suggested to a man newly diagnosed with cancer will vary depending on the medical provider that man is talking with and the treatment his doctor specializes in. That s why it s important for you to do your research, take your time, talk to others and choose the treatment that makes the most sense to you. Q. Why not just let my doctor decide how I should be treated for my prostate cancer? A. Most doctors who treat prostate cancer urologists and radiation oncologists will recommend whatever treatment method they do themselves. For instance, urologists will typically push radical prostatectomy, radiation doctors will push irradiation, cryosurgery doctors will push freezing of the prostate, and so forth. What doctors recommend may not be the best treatment method for you. 8 TAKE CONTROL OF PROSTATE CANCER CURE RATES It is very important to focus on your doctor s skills as well as his cure rates for the treatment method you choose. All doctors do not have the same cure rates, any more than all professional

cri 0712 prostate cancer 12/14/07 2:42 PM Page 9 athletes have the same golf scores or batting averages. In fact, there is no way to distinguish the hall-of-famers from the mediocre players without knowing their statistics. As you consider your treatment options, talk to your doctor about his own cure rates based on the number of patients he has treated and, of those, who have a PSA of 0.2 ng/ml 10 years after treatment. Questions to Ask Your Doctor 1. How many patients have you yourself treated for prostate cancer? 2. Of these patients, how many have a PSA 0.2 ng/ml 10 years after treatment? 3. How long and where were you trained to do your particular treatment method? Q. Will doctors object to my asking them about their cure rates? A. Most doctors do not mind being asked about their cure rates. If a doctor does get mad, you may want to go to another doctor. After speaking to several doctors with different treatment methods, choose the doctor and treatment method that give you your best chance of being cured of prostate cancer. Remember, there is a big difference between treatment of prostate cancer and cure of prostate cancer. TAKE CONTROL OF PROSTATE CANCER 9

cri 0712 prostate cancer 12/14/07 2:42 PM Page 10 TWO TREATMENT OPTIONS WITH THE BEST CURE RATES There are at least 13 treatment methods available, including: Radical Prostatectomy ProstRcision Seeds alone Iodine or palladium seed implants after external beam radiation Radiation alone Chemotherapy Immunotherapy Hormone Therapy Cryosurgery Proton Beam However, only the first two treatment methods (Radical Prostatectomy and ProstRcision) offer the highest cure rates. And that s IF radical prostatectomy surgery is performed by a highly skilled urologist. ProstRcision is the logical integration of two separate methods of irradiation performed only by Radiotherapy Clinics of Georgia (RCOG) located in Atlanta. Radical Prostatectomy Radical prostatectomy is the surgical removal of the prostate gland. This is a major operation performed in a hospital with the patient under general anesthesia. Depending on the skill of the surgeon, patients will be hospitalized two to four days or more after the surgery. These surgeries, when performed by physicians who do these surgeries often and with proven statistical results, have a 10-year cure rate of 80 percent. Peer-reviewed medical journals from Centers of Excellence that specialize in radical prostatectomy cite the main complications from this procedure as urinary incontinence and loss of sexual function of men, depending on age and health prior to surgery. 10 TAKE CONTROL OF PROSTATE CANCER

cri 0712 prostate cancer 12/14/07 2:42 PM Page 11 PROSTRCISION THE UNIQUE SOLUTION ProstRcision ProstRcision is the insertion of radioactive iodine (I-125) prostate seeds followed by irradiation of the cells with intensity modulated radiotherapy technique (IMRT). The tiny capsules emit radiation directly at the prostate cells to cut out the diseased and normal cells. Then using the seeds as a target, additional radiation is delivered to the gland to integrate the two best forms of irradiation. The database of results following more than 10,000 surgeries by Radiotherapy Clinics of Georgia in 30 years substantiates a cure rate comparable to that of radical prostatectomy. The 10-year cure rate with ProstRcision is 86 percent with few complications. Comparing Radical Prostatectomy and ProstRcision These two procedures offer the best 10-year cure rates available today, assuming radical prostatectomy is performed by experienced physicians. There is not a so-called best decision between the two. It comes down to personal choice. Some men are more comfortable with the surgical removal of the prostate from the body, radical prostatectomy, while other men prefer a radiation program that is less invasive and helps preserve urinary and sexual functions. Do your homework. Consider the potential complications. Determine what makes you the most comfortable. Then decide the best treatment method for you. ProstRcision is offered only by Radiotherapy Clinics of Georgia, the oldest and largest prostate seed implant program in the United States. Approximately 1,000 men are treated with ProstRcision each year at RCOG. More than 10,000 men have been treated with ProstRcision in the past 30 years, coming to Atlanta from 42 countries and every state in the United States. RCOG maintains one of the largest prostate cancer computerized databases in the world, which allows RCOG to continually refine its treatments and improve cure rates. ProstRcision cure rates are calculated using PSA cut point 0.2 ng/ml for an apples-toapples comparison with radical prostatectomy using the same cut point calculations. RCOG physicians have written more than 80 articles documenting evidence-based treatment outcomes that have been published in peerreviewed medical journals and have made presentations at major medical meetings around the world. Because of RCOG s unique database, individual treatment outcomes (cure rates) can be calculated for men newly diagnosed with prostate cancer having like symptoms. Radiotherapy Clinics of Georgia is rated as a Center of Excellence for the radiation treatment of prostate cancer. TAKE CONTROL OF PROSTATE CANCER 11

cri 0712 prostate cancer 12/14/07 2:42 PM Page 12 NANCY AND WOODY RAY W Woody Ray had check-ups throughout his Army career. It was only after retirement that his new family doctor found that Woody s PSA was elevated. Even before the Rays got the final diagnosis, the couple began reading everything they could find about prostate cancer. When their urologist confirmed the diagnosis was prostate cancer, he told Woody he should have surgery right away. However, Woody and his wife Nancy took a step back. After all, it was deer season an important time of year to Woody, so the two split up research tasks. On the Internet, Nancy uncovered programs, groups and treatment approaches. Woody would read Nancy s findings and, throughout, their family doctor continued to encourage the couple to explore all their options before making a treatment decision. At first I was looking at cure rate, says Nancy. I wanted my husband to be cured of prostate cancer. But right up there with cure were side effects, because the side effects of so many of these treatments are horrible, extreme and permanent. Then Nancy came across a Mentor s Page on the Internet. She found a man from their area who had undergone prostate cancer treatment 9 1/2 years ago. While it was important to talk with people who were currently going through treatment, for us it was also important to talk to those men who had been treated a long time ago so we could find out how they are doing now, explained Nancy. The man they found was very pleased with the ProstRcision he had undergone at Radiotherapy Clinics of Georgia. Nancy and Woody poured over RCOG s educational brochure, reading the program s Q&As about cure rates and low side effects. Now, that s the quality of life we re talking about, said Nancy. Still they continued researching. We looked for facts, not the air-brushing of materials we kept running into with other options, remembers Nancy. That s what was so excellent about RCOG. They have the facts to back up what they say. I mean, they are even published in Urology! There is science there to support ProstRcision. The bottom line for us? emphasized Nancy. Cure rate and few side effects. That made our decision easy. 12 TAKE CONTROL OF PROSTATE CANCER

cri 0712 prostate cancer 12/14/07 2:42 PM Page 13 CALVIN MCINTYRE A As an employee of the U.S. Government s Business Transformation Agency of Bowie, MD, annual physicals are a regular part of Calvin McIntyre s health care. It was following the blood work taken during one of these physicals that he got a call. His PSA was slightly elevated at 4.2 just high enough for concern. Calvin was referred to a urologist who determined Calvin s DRE (digital rectal exam) showed no lumps or changes on the prostate. It was the biopsy though that told the tale. Calvin had prostate cancer. His urologist suggested an immediate radical prostatectomy. NOT ONLY DID I FEEL GOOD ABOUT MY DECISION, BUT I MET MEN FROM ALL OVER THE WORLD AT EACH APPOINTMENT. - MCINTYRE But, as he acclimated to the news, Calvin decided to learn more about the disease and his options. Cure was his overriding goal. His search took him to numerous sources, including the Q&A section on Radiotherapy Clinics of Georgia s web site. I read that Dr. Critz of RCOG said to ask your doctor three questions, recounts Calvin. How many men have you yourself treated for prostate cancer using radical prostatectomy? How many articles have you published in peer-reviewed medical journals? And what is your 10-year cure rate? When Calvin posed those questions to his urologist, he learned that his doctor had been in practice for only three years. When asked how his patients were doing, the doctor told Calvin that he guessed they were doing fine. As to being published, the doctor replied, I m a surgeon, not a researcher. I don t publish/write papers. Calvin cancelled his surgery and redirected his sites on John Hopkins based on the respect Dr. Critz had expressed on the RCOG web site for those doctors. It was a Johns Hopkins urologist who surprised Calvin with the news that there were other treatment options other than radical prostatectomy. As long as Calvin was exploring those options, he opted to send his records to Georgia. It was a Sunday afternoon when the phone rang in Calvin s Maryland home. Dr. Frank Critz was calling him. Normally all these doctors and places need to know you have insurance, if they ll get paid, and so forth before they ll even talk with you, says Calvin. Dr. Critz didn t ask me any of those things. Calvin made his decision. He flew to Atlanta for a seed implant on December 14, 2006, and remained in Atlanta for six weeks of follow-up irradiation. Not only did I feel good about my decision, but I met men from all over the world at each appointment, he remembers. We d share stories, talk about our families and get treated. It was a great place to be and the right place for me. TAKE CONTROL OF PROSTATE CANCER 13

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