Until three years ago, Randy Drymiller lived a relatively worry-free life. By age 45, he had risen in the ranks of the Federal Aviation Administration to become a high-level agent specializing in hazardous materials. When work was done, he left the hazards behind. Drymiller shared a home with his wife, Hsiou-Fang, and their then-15-year-old daughter, Michelle, in Bartlett, Ill., a pleasant, family-friendly suburb of Chicago. Why worry? His family loved him; his health was good. Drymiller ate right, worked out regularly and was in good shape. Or so he thought.

In March of 2005, Drymillert went in for his annual physical. After performing a digital rectal exam (DRE), his doctor suspected an enlarged prostate gland. Drymiller knew something about prostrate problems. His father had been diagnosed with prostate cancer and had undergone a radical prostatectomy (prostate gland removal) in 1999.

Drymiller himself had prostatitis, a chronic inflammation of the prostate, and had seen an urologist for the past 10 years. As a result, he had yearly PSA screenings—but they’d always clocked in below the danger zone of 2 ng/mL. (PSA tests indicate the level of a prostate-specific antigen. Men normally have low PSA levels in their blood; elevated levels can indicate prostate cancer or other prostate conditions.) Until recently, PSA values below 4.0 were considered normal. But new research has shown that a percentage of men diagnosed with prostate cancer have PSA levels below 4.0. The bar had been raised.

Aside from prostatitis, Drymiller had no symptoms and felt perfectly healthy. Just to be safe, though, he took his doctor’s advice and made an appointment with his urologist for further testing. Then he put it out of his mind.

A few weeks later, the urologist performed a DRE and also felt something. A subsequent test revealed that Drymiller’s PSA level had risen to 3.83—up from less than two the year before. The urologist was suspicious. He advised Drymiller to have a biopsy and scheduled it for mid-May. In the weeks before the test, Drymiller researched prostate cancer on the internet. “I believed the odds were against cancer,” he says. “I was convinced I was too young and the lump would turn out to be benign.”

The biopsy shattered his optimism; five of the 12 samples were cancerous. Worse, the doctor calculated his Gleason score at nine. The Gleason system uses a score of two to 10 to analyze a tumor; a score between eight and 10 suggests an aggressive, fast-growing tumor that’s probably spread beyond the prostate gland.

Drymiller and his wife were shattered. “I’d done enough research to know what a Gleason score of nine meant,” he says. “I thought the worst-case scenario was a score of five or six. I was prepared for that. I figured I’d wait and watch for a few years. But a score of nine? I was at the top of how bad the cancer could be.”

Drymiller’s urologist ordered a bone scan to see if the cancer had spread to his bones. The results were negative. Still, the doctor’s prognosis was grim: He advised Drymiller to have a radical prostatectomy, just as his father had before him.

Drymiller sought a second opinion with a surgeon, but that physician was reluctant to take on a patient with such a high Gleason score. As Drymiller explains it, “The docs didn’t want to touch me. Statistically, I was probably a negative outcome. Even after removing the prostate, my odds of surviving the cancer were slim. It had probably metastasized outside the gland itself.”

What were his remaining options? Drymiller plunged into more research. The choices he discovered weren’t good. At his level of cancer risk, most doctors recommended hormonal therapy to reduce testosterone levels (which aid the cancer’s growth)—and nothing else. If he opted for surgery, complications could include erection difficulties, urinary incontinence and damage to the urethra or rectum.

Drymiller remembers, “I thought, what the heck are my options? Just let myself die? That wasn’t going to happen.” He was determined to find the best specialists in the field.

In June, he saw a third specialist, who suggested a robotic prostatectomy. This procedure removes the cancer and usually spares the two nerves on either side of the prostate gland; this can preserve sexual function and urinary control. Drymiller signed up for it, but spent the next few weeks in a depression.

On one particularly dark day, he wound up at a meeting of Us TOO, a grassroots support group started by prostate cancer survivors. It proved to be his salvation.

“Things changed very quickly after that,” says Drymiller. The group’s leader, Russ Gould, provided him with some of the latest research on prostate cancer treatments, including videos from the National Conference on Prostate Cancer held just two weeks earlier.

“It opened my eyes,” he says. “There were choices I hadn’t even imagined.”

Drymiller studied the conference video. Dr. Michael J. Dattoli was one of the most inspiring speakers, a radiation oncologist who treated high-risk Gleason patients with a radical combination of hormonal, radiation and seed implant therapies. As a former chief fellow in brachytherapy and radiation oncology at Memorial Sloan-Kettering Cancer, Dattoli had two decades of brachytherapy experience and had performed thousands of prostate implant procedures. (Brachytherapy is a procedure that implants “seeds”—tiny pellets of radioactive material—directly into the tumor.)

Dattoli was also the founder of the Dattoli Cancer Center & Brachytherapy Research Institute here in Sarasota.

Drymiller was intrigued. He checked out Dattoli’s background. He spoke to other Us TOO members who’d had successful outcomes at the Dattoli Institute. After he talked to Dattoli on the phone for more than hour, he and his wife decided against surgery. They would try it the Dattoli way. “We believed this was my best choice of treatment,” says Drymiller.

Dattoli started Drymiller on aggressive hormonal therapy and kept him on it for a year. This treatment reduces the level of androgens, or male hormones, in the body. Androgens stimulate prostate cancer cells; lowering androgen levels can shrink or slow the growth of prostate cancers. But the side effects can be unpleasant. Drymiller experienced “mild hot flashes” and a loss of sexual drive. “It knocks the testosterone down to zero,” he says. “But I knew the score going into it.”

Dattoli also ordered a ProstaScint scan. It confirmed that Drymiller’s cancer had spread beyond the prostate, outside of the prostrate membrance, but without reaching organs or bone.

Dattoli’s next plan of action combined brachytherapy with another treatment: four-dimensional image-guided intensity-modulated radiation therapy (IG-IMRT). This cutting-edge procedure targets the highest possible levels of radiation at the tumor itself, while sparing surrounding tissue, which significantly reduces the long-term side effects of surgical treatments, such as incontinence and impotence. (Since Drymiller’s treatment, the center has developed a more advanced technology called dynamic adaptive radiotherapy, or DART, which uses four-dimensional up-to-the-moment captured image data to adapt a patient’s treatment to constantly evolving information that occurs during the IG-IMRT treatment course.)

In August of 2005, Drymiller came to Sarasota for five weeks to undergo 23 IG-IMRT treatments. Hsiou-Fang and Michelle came and stayed for the first week. “Obviously, this had a big impact on our lives,” says Drymiller. “But we had all decided I had only one life. We’d do everything we could to save it.”

The treatments were relatively painless and lasted 30 minutes each. Afterwards, Drymiller spent time with other men who’d been through the same thing. “The center is a place where men and their spouses compare notes and make friendships,” he says. “It’s a home away from home.”

In October of that year, Drymiller returned to Sarasota for two weeks of brachytherapy treatment. He was in and out of the hospital within a matter of hours and flew home that same day.

In January 2006, Drymiller returned for eight additional IMRT treatments. Since then, he’s been cancer-free, with PSA readings below .75. He’s remained fully continent and his sexual potency has returned as his testosterone level jumped up after hormone treatment. 

“Randy is a real success story,” says Dattoli. “He and his family were totally committed to his recovery. He wanted to beat this, and he did.  He’s enjoying a high-quality life now. Everything’s working and functioning; he’s cured of cancer.”

Good news, but Drymiller doesn’t take his good fortune for granted. At work, he specializes in screening out hazards. He’s learned to do the same thing for the hazards in his own life.

“The cancer was a wake-up call,” he says. “Now, I have a new lease on life. Diet, exercise, regular exams—I want to stay healthy by any means necessary.”

To stay healthy, Drymiller has radically changed his lifestyle. Apart from eating fish for its omega-3 content, Drymiller now sticks to a vegan diet. He walks a few “fast miles” a day and practices yoga whenever he can. He’s also an active member of his local Me Too group. His advice for anyone with a prostate cancer diagnosis?

“Don't rush to make a decision. Get second and third opinions on treatments. Look at options from surgeons, radiation oncologists and medical oncologists. Visit Web sites such as Us TOO, PCRI and the Prostate Cancer Foundation,” he says. “When you decide on a treatment, seek out the best doctor in the field. The best doctors have the best results. Above all, get involved in a local prostate cancer support group. You don’t have to go through this alone.”

Resources:

·        Us TOO International Prostate Cancer Education and Support (630) 795-1002; (800) 808-7866; www.ustoo.com.

·        The Prostate Cancer Research Institute (PCRI); (800) 641-PCRI; (310) 743-2110; www.prostate-cancer.org

·        Prostate Cancer Foundation; (800) 757-2873; (310) 570-4700; www.prostatecancerfoundation.org

·        Dattoli Cancer Center; (1) 877-328-8654; (941) 957-1221; www.dattoli.com

Who is at risk for prostate cancer?

An important risk factor is age; more than 70 percent of men diagnosed with this disease are over the age of 65. African-American men have a substantially higher risk of prostate cancer than white or Hispanic men. Dramatic differences in the incidence of prostate cancer are also seen in different populations around the world. There is some evidence that dietary factors, such as vitamin E and selenium, may have a protective effect. Genetic factors also appear to play a role, particularly for families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.

What are the symptoms of prostate cancer?

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:

• Not being able to urinate.

• Having a hard time starting or stopping the urine flow.

• Needing to urinate often, especially at night.

• Weak flow of urine.

• Urine flow that starts and stops.

• Pain or burning during urination.

• Difficulty having an erection.

• Blood in the urine or semen.

• Frequent pain in the lower back, hips or upper thighs.

Source: National Cancer Institute

What are the long-term results for brachytherapy?

The long-term survival rates for patients who have completed brachytherapy or combination therapy including brachytherapy under the care of a skilled radiation oncologist are as good as or better (typically greater than 90 percent, depending on the PSA, stage and grade) than those who have had surgical removal of the prostate. The biggest difference is in the quality of life after treatment, with far fewer incidents of erectile dysfunction, while incontinence is virtually unheard of following brachytherapy.

What are the possible side effects from brachytherapy?

The two major side effects of any aggressive prostate cancer treatment are the risk of erectile dysfunction and incontinence. With Palladium-103 seed implants, erectile dysfunction occurs in about 15-20 percent of cases; incontinence is virtually unheard of following Palladium implants. Meanwhile, 85-90 percent of the 15-20 percent of patients regain their erectile function when using erectile aids (Viagra, Levitra, Cialis, etc.). With brachytherapy there is typically a diminished ejaculate. After surgery, there is no ejaculate. Complete or partial erectile dysfunction is experienced in most cases of surgical removal of the prostate gland. Up to 40 percent of surgical cases also result in some degree of incontinence.

Source: Dattoli Institute

FACTS:

• Prostate cancer is the most common cancer, other than skin cancers, in American men.

• The American Cancer Society estimates that during 2008 about 186,320 new cases of prostate cancer will be diagnosed in the United States.

• About 1 man in 6 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 35 will die of it.

• More than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

• Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer.

• The American Cancer Society estimates that 28,660 men in the United States will die of prostate cancer in 2008. Prostate cancer accounts for about 9 percent of cancer-related deaths in men.

• More than 9 out of 10 prostate cancers are found in the local and regional stages (local means it is still confined to the prostate; regional means it has spread from the prostate to nearby areas, but not to distant sites, such as bone). When compared to men the same age and race who do not have cancer (called relative survival), the five-year relative survival rate for these men is nearly 100 percent.

• The five-year relative survival rate for men whose prostate cancers have already spread to distant parts of the body at the time of diagnosis is about 32 percent.

• African-American men are more than twice as likely to have prostate cancer as Caucasian men, and have nearly a two-fold higher mortality rate than Caucasian men.

Source: American Cancer Society

GLOSSARY

• Brachytherapy:  A form of radiation therapy in which radioactive seeds or pellets which emit radiation are implanted within the prostate.

• Radical prostatectomy (RP): An operation to remove the entire prostate gland and seminal vesicles.

• Robotic prostatectomy: A new minimally invasive type of surgery that features telemanipulation devices allowing the performance of complex surgical tasks with dexterity and minimal fatigue due to their ergonomic design. They also provide expanded degree of movements, tremor filtering and 3D stereoscopic visualization.

• IMRT (intensity modulated radiation therapy): An approach to radiation therapy allowing the treatment team to specify the tumor target dose and the amount of radiation allowable to the nearby tissues and using sophisticated computer planning to arrive at acceptable equations.

• Hormone Therapy (HT): Because prostate cancer is usually dependent on male hormones (i.e., testosterone) to grow, hormone blockade or deprivation (also called androgen deprivation therapy) can be an effective means of alleviating symptoms and retarding the development of the disease.

• Dynamic adaptive radiotherapy (DART): Technology that involves using up-to-the-moment "captured" image data to adapt a patient's treatment to constantly evolving information that occurs during a 4D IG-IMRT treatment course. It is becoming increasingly well known that changes such as tumor position, size and shape occur not only during a several week treatment regimen, but also on a daily basis. DART delivers the exact dose to the exact place at exactly the precise time, every time, even when the target (tumor) moves, shrinks or changes shape.

Source: Prostate Cancer Research Institute and Dattoli Institute