Purging Prostate Cancer

The latest technology at Dattoli Cancer Center & Brachytherapy Research Institute

By: Virginia ‘Ginya’ Carnahan, APR, CPRC

Michael Dattoli, MD, and Richard Sorace, MD, PhD, have shared a challenge for more than two decades. The radiation oncologists have sought a better way to treat prostate cancer – a definitive treatment that will defeat the cancer while not destroying the man’s quality of life after treatment. The reported incidence (and additional whispered stories) of incontinence and impotence in men following radical prostatectomy was just unacceptable to these physicians.

As technology has advanced in the last half of the 20th century to harness and focus the power of radiation, it became a personal challenge for these doctors to develop a treatment protocol using radiation to kill the cancer, while sparing and preserving the function of the delicate tissues and organs surrounding the prostate gland. So strong has been their dedication that they have been accused of living on “Planet Prostate.”

The Start of Something Good

In 2000, Dattoli and Sorace, with business partner (and prostate cancer survivor) Don Kaltenbach, opened the Dattoli Cancer Center & Brachytherapy Research Institute in Sarasota, Fla. Their vision was to create the most technologically advanced center for the non-surgical treatment of prostate cancer in the world. Today, as men travel from all corners of the globe to receive treatment at the center, it is arguably the embodiment of their dream.

The Dattoli Cancer Center would become the site for the partners’ unique “combination therapy,” utilizing beam radiation with subsequent brachytherapy, housed in a warm, supportive environment designed by an actual patient. Beginning back in 1991, Dattoli and Sorace started systematically honing the treatment protocol and evaluating outcomes. Five years into the venture, they began reporting their findings of combination therapy in major medical journals. From the start, their results eclipsed the reported success of radical prostatectomy – the traditional “gold standard.”

To continue their research and report results, and to expand knowledge of the effects of radiation on prostate cancers, the doctors insisted that only the latest and most effective technologies would be housed at the center. An auspicious investment of $3.9 million for technology alone underscored the partners’ serious commitment to “doing it right.” An additional $2.2 million was required to build out the center.

One of the signature exams of the Dattoli Center is the color-flow Doppler ultrasound, used to pinpoint the location of suspect areas of the prostate gland. “Without the addition of color, ultrasound exams are difficult to read, at best,” Dattoli says. “We see many patients here who have endured repeat negative biopsies elsewhere, but whose PSA indicators continued to rise. If more centers owned and knew how to utilize color-flow Doppler, these men could be diagnosed earlier, spared repeat biopsies and, theoretically at least, stand a better chance for complete cures.”

Two specially trained ultrasound techs perform the exams in-house at the Dattoli Center and assist Dattoli in the seed implant process, which is performed at nearby Sarasota Memorial Hospital. Although the hospital is a nationally ranked facility, it does not have color-flow Doppler (CFD) ultrasound technology on-site. The Dattoli Center provides its own CFD equipment for the seed implant procedures performed two days each week.

A high-speed helical CT scanner from Wauskesha, Wis.-based GE Healthcare provides the physicians with quality images of the gland and all the structures in close proximity. These images are used by staff dosimetrists to create individually tailored 4-D image-guided, intensity-modulated radiation therapy (IMRT) plans for each man and individual seed implant maps. Incorporated in the CT scan is a quantitative CT module, which is used to assess bone density.

At this point, Dattoli Cancer Center patients are routinely referred out for MRI and PET scans, and for the occasional ProstaScint and Combidex scans.

Building on the Basics

The original workhorse of the center is a linear accelerator from Palo Alto, Calif.-based Varian Medical Systems. It was the first freestanding installation of this technology anywhere in the world. At Dattoli, patients are treated to daily IMRT, beginning at 7 a.m. Most patients receive both IMRT and brachytherapy – however, individual situations dictate the plan. Some will receive only IMRT and some only brachytherapy. The general course of IMRT is 24 to 25 treatments over five to six weeks. Brachytherapy follows after a brief “cooling-off” period of between two and 10 weeks.

In the summer of 2006, demand was such that a second Varian linear accelerator with SonArray ultrasound was purchased and installed. The new machine enables the center to treat with the most advanced form of external radiation: 4-D image-guided IMRT, with dynamic adaptive radiation therapy (DART).

DART is a coordinated systems approach made possible by the convergence of image-guided tools integrating both the image and data. It enables the center to provide sophisticated treatment planning capabilities, such as autosegmentation and deformable registration, to optimize the IMRT delivery.

“DART achieves the single most important goal achieved in radiation treatment,” says Sorace, “and that is the ability to deliver the exact dose to the exact place at precisely the right time, every time – even when the target moves, shrinks or changes shape.”

Also, the center’s eight registered radiation therapists are cross-trained to work in either the treatment area or the “simulation” (CT) area.

The Art of Perfection

The brachytherapy portion of the treatment protocol is performed by Dattoli, a renowned expert in this procedure. He has performed the procedure thousands of times throughout his career, which began at Memorial Sloan Kettering Cancer Center in New York City. Dattoli is a co-author of the textbook used to teach brachytherapy in medical schools all over the world.

The resurgence of interest in prostate brachytherapy over the past two decades was primarily driven by the technological innovation of transrectal ultrasound, which allows for real-time imaging during treatment planning and for monitoring intraoperative needle placement during the seed implant procedure.

Dattoli has pioneered the implant of seeds outside the gland in the peri-prostatic tissues. By delicately introducing radiation sources to the most obvious and common route for cancer cell escape, he is offering patients a little bit of added insurance against recurrence.

In addition to this aggressive brachytherapy approach, Dattoli patients return to the center 90 days post-seeding for what is called a “boost.” Depending on the patient’s original assessment and post-seeding evaluation, he will receive between five and eight additional IMRT treatments to the abdomen – not the prostate. This is thought to catch any cellular migration into the lymph system and other nearby organs.

The Dattoli Cancer Center also houses a state-of-the-art clinical laboratory to perform a battery of diagnostic lab exams required for each patient. By bringing this service in-house, the patients are saved time and aggravation, and they are assured of having the same controls on each specimen, a quality assurance effort on the part of the center.

With all this high-tech equipment at the center, one might expect it to appear cold and intimidating. However, the opposite is true. Harking back to his own prostate cancer diagnosis and search for an appropriate treatment option, CEO Don Kaltenbach set the tone for how the Dattoli Cancer Center looks and feels.

There is no glass partition separating the reception desk from the patients. And the lobby feels more like a comfortable hotel or men’s club than a medical office. Cool shades of forest green, navy and burgundy form the décor and adorn the comfortable overstuffed chairs and couches, which are placed strategically to encourage conversations between patients.

Also, there is no TV blaring in the corner to distract patients. And like all doctors’ offices, there are magazines – but Dattoli’s are never more than four weeks old and feature titles that attract men, such as Auto Week, Newsweek, New Yorker, etc. Daily local and regional newspapers are supplied, along with a fresh coffee and juice bar.

Kaltenbach aspired to create a patient-friendly environment. Because of this, Dattoli even offers “Internet suites” for patient and family use, each containing a private phone, fax machine and computer with Internet access.

Reaching Out

The center’s outreach to patients is equal to the technology it houses. Each patient receives an award-winning, in-depth patient handbook which outlines his treatment, what to expect, a glossary of terms and even suggested menus and dietary advice during and after radiation treatment.

Once a week, the patients are invited to an evening education session on beam radiation, which is called “Beamers.” The programs feature one aspect of their experience, such as “All About Color-Flow Doppler Ultrasound,” “What to Expect from Seeding,” “What the Heck is “Dosimetry?’” “Osteoporosis – Do I Need to Be Concerned?” and “Cancer and Nutrition.” The first Beamers meeting of each month offers a popular behind-the-scenes tour, which is called “Dattoli After Dark.”

Dattoli patients leave the center having learned an incredible amount about cancer, prostate cancer and their own particular cancer. They march home to their family and friends convinced that they have received the very best treatment available, administered by the most professional, caring staff around.

Each year, the patients return to the center for an annual follow-up. Their de-identified data is added to that which started in 1991, and now forms the largest and longest-standing academic study of combination radiation therapies for prostate cancer.

Author’s note: The 13-year study results of the Dattoli protocol were published in the January 2007 issue of the journal Urology, and the 14-year study results will appear in an issue of Cancer in fall 2007. Further information about the Dattoli Cancer Center & Brachytherapy Research Institute is available at www.dattoli.com.

— Virginia ‘Ginya’ Carnahan, APR, CPRC, is director of marketing at Dattoli Cancer Center & Brachytherapy Research Institute (www.dattoli.com), Sarasota, Fla. Questions and comments can be directed to editorial@rt-image.com.

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