Cancer hits Berkshire Beacon editor and publisher

Editor’s Note: Prostate cancer hits men of all ages and at various degrees.

The questions are: Do you have a doctor examine you or do you let it go until such time as it become painful?

Do you have surgery for removal or does one try the new robotic process with limited invasion? Chemotherapy? And/or radiation therapy?

In this pull out section with pictures and text, we’ll attempt to show how one – namely the editor/publisher of The Berkshire Beacon – proceeded almost a year ago.

The Berkshire Beacon Editor and Publisher George C. Jordan III first realized there was a problem when he received a message from his bladder.

It was a Thursday afternoon in May 2012, and George was driving westbound on the Massachusetts Turnpike coming back from Attleboro, where he had picked up the latest edition of The Berkshire Beacon.

Mr. Jordan had stopped on Route 146 that goes between Millbury and the Rhode Island border for a 20-ounce Polar Lemon soda.

He had passed the Charlton rest stop, confined in his 2002 Toyota Highlander for the next 30 miles.

Then, it happened. Without warning, he had wet his pants.

When he arrived back home in The Berkshires, Mr. Jordan wasted no time contacting the urology department at Berkshire Medical Center (BMC).

He went in for an appointment with Dr. David Noyes. The doctor felt George’s prostate and also did a biopsy. Mr. Jordan brought in a urine sample for testing.

It didn’t take long to figure out what was wrong.

“We went in, and they said he had cancer,” said his wife, Christine Jordan.

The urology department did a prostate specific antigen (PSA) test. It came back with score of 23, which is considered very high.

They also did a Gleason test that revealed cancerous cells in the prostate tissue.

In a follow-up appointment, the doctor performed a CT scan on the abdomen and the pelvis.

The scan found a large right renal cyst, an enlarged prostate and mild bladder wall thickening. The diagnosis became clear – prostate cancer.

“I think I took it internally,” Mr. Jordan said of learning that he had cancer.

“I was more inclined to learn what my options were at that point.”

Prostate cancer is the most commonly diagnosed type of cancer, according to the National Cancer Institute.

It occurs when tissues in a man’s prostate gland generate abnormal cells that form a tumor.

As men age, their risk for developing prostate cancer increases. It is generally recommended that men 50 and older go for a prostate screening, regardless of symptoms, as careful screening can help detect early stages of a developing tumor.

Doctors who screen men for prostate cancer commonly use the PSA test.

High levels of PSA, a protein produced by the prostate gland, may be indicative of cancer in the prostate.

PSA screening has led to earlier detection, but according to Dr. Mary-Ellen Taplin, associate professor of medicine at Dana-Farber Cancer Institute, “screening is very controversial.”

An elevated blood-level PSA does not necessarily mean a man has prostate cancer, and conversely, a low PSA level can give false hope that no cancer is present when it actually is.

“It’s hard to show how good you’re doing [with this screening],” said Dr. Taplin. “You have to screen a lot of men and health care dollars are limited.”

Still, she acknowledged, “screening does lead to earlier diagnosis.”

There are now around 275,000 new prostate cancer cases each year, according to Dr. Taplin.

It is even more common than breast cancer, which has around 230,000 new cases a year.

About one out of every five or six men develop prostate cancer at some point in their lives. Not every case needs to be treated, however.

It depends on how aggressive the cancer is.

With a higher-grade tumor (a more aggressive form), doctors generally recommend some form of intervention.

Which type of intervention is best, however, is not always as clearly apparent as the diagnosis.

Deciding on the treatment

During his next visit to Berkshire Medical Center, Mr. Jordan met with Dr. Wade J. Gebara in the radiation oncology department.

Dr. Gebara reviewed the diagnosis and presented Mr. Jordan with an overview of the options for treatment, including robotic surgery, seed implanting, external beam radiation and hormone therapy.

Initially, George was of the mindset that he would have his prostate surgically removed, because, as he put it, he “just wanted to be rid of it.”

However, given his medical history of co-morbidities, or multiple health issues such as heart disease, gout and diabetes, Dr. Gebara recommended radiation therapy as opposed to a more risky surgical operation.

“Dr. Gebara from the beginning did not think he was a good candidate for surgery, and was advocating radiation,” said Mrs. Jordan.

After meeting with Dr. Gebara, Dr. Noyes and Dr. Jonah S. Marshall, who has been extensively trained in the use of the da Vinci Robotic-Assisted Surgical System for Urologic surgical procedures involving the prostate and kidneys, it was decided that a second opinion was necessary.

Second opinion

George and Chris then made a trip to Boston’s Dana Farber Hospital for a consultation with Dr. Taplin at the Dana-Farber Cancer Institute.

According to Mrs. Jordan, Dr. Taplin also recommended radiation, due in part to Mr. Jordan’s age and the fact he had previously undergone open-heart surgery.

Because of his co-morbidities, Dr. Taplin further suggested a shortened six-month hormone therapy window rather than the standard two years of hormone treatment.

“With his underlying CAD [cardiovascular disease] and obesity, longer ADT [androgen deprivation therapy] could put him at risk for cardiovascular side effects,” Dr. Taplin explained via email.

“For the same reasons stated above,” she continued, “XBRT [external beam radiation treatment] would be favored over surgery. He’s at increased risk of side effects due to his medical issues and he’s a bit old for prostatectomy.”

Mr. Jordan returned home to The Berkshires with a clearer understanding of what his treatment options were and which one would be best suited for his particular case.

The month or two of time he took to talk to different doctors and review his options is a critical step to take following any diagnosis of cancer.

“Patients need to stop, pause, look at their options and talk to different doctors,” said Dr. Gebara.

Getting different perspectives and opinions from different physicians is important, he explained, since physicians may be biased in recommending their own specialty treatment.

“You have to get what’s best for you,” said Dr. Gebara.

For Mr. Jordan, that meant going with a course of external beam radiation with a side of hormonal therapy.

About 50 percent of patients diagnosed with cancer will receive radiation at some point in their treatment course.

The Cancer Institute of the Berkshires at Berkshire Medical Center offers state-of-the-art cancer radiation therapy.

For cases of prostate cancer, one method used is internal radiation through prostate seeding.

This treatment involves placing small, irradiated “seeds” inside the prostate. The seeds supply a small, concentrated dose of radiation to the cancerous area without affecting the surrounding tissue.

Alternatively, there is the option of external beam radiation, a treatment wherein the patient receives radiation externally from a machine.

An advantage of doing external beam radiation is that it treats cancer in the whole prostate, as opposed to localized seeding which risks missing a small bit of tumor.

“The external beam therapy we have now is better than the external beam therapy we had when I started working here,” remarked BMC’s Dr. Michael J. Sheridan, one of the doctors involved in Mr. Jordan’s case.

“We had a choice of doing seeds,” Dr. Sheridan said in reference to Mr. Jordan’s treatment options. “But seeds are not quite suitable for him, so we’re doing external beam radiation.”

TomoTherapy

The Berkshires are a unique place, Dr. Sheridan, longtime lead physician in the radiation oncology department of Berkshire Medical Center, will tell you.

A native of Ireland, Dr. Sheridan came to The Berkshires in 1986 after spending over 15 years in Youngstown, Ohio, where he helped start up the radiation oncology department at a local hospital.

He brought this experience with him to BMC when they were looking to build their own radiation oncology department.

“They wanted somebody who had started a department, and I had done that,” he explained.

Dr. Sheridan has since retired from his post as lead radiation oncologist at BMC, but before he stepped down he wanted to make sure he was leaving the department in capable hands.

He interviewed many candidates, but something stood out about Dr. Gebara.

“I pretty much decided then and there,” said Dr. Sheridan about meeting Dr. Gebara for the first time.

A native of Georgia, Dr. Gebara now lives in Williamstown with his wife and two children.

As head of the radiation oncology department, it is his job to bring the highest level of care to his patients using the best, state-of-the-art technology, such as an external beam radiation machine.

Known as TomoTherapy, this machine has built-in imaging technology to locate cancerous tissue, and it delivers a precise, concentrated dose of radiation through an external beam, similar to an x-ray.

External beam radiation allows you to give a high dose to the cancerous area, and then the dose drops off quickly to avoid affecting the nearby bladder and rectum.

“It is seed-like in its action,” said Dr. Sheridan, referring to the precision inherent in both seed and external beam treatment.

The difference, and main advantage, of doing external beam radiation is that it treats cancer in the whole prostate, as opposed to localized seeding which risks missing a small bit of tumor.

Prior to the radiation treatment, the doctor uses advanced imaging technology through a built-in CT scanner to get a clear picture of the tumor.

Next, the doctor prescribes an appropriate dose of radiation for the tumor and determines acceptable levels for surrounding tissue.

The machine then calculates the right angles and intensity of radiation beams based on the doctor’s prescription.

Once the machine calculates the dosage and the doctor approves, the doctor applies the dosage on a “dummy” (fake subject) to test it out. If all goes well, the machine is then ready to take in a live cancer patient.

The patient receiving treatment lies on his/her back on the machine bed. The procedure takes about 20 minutes and is completely painless. It is similar to the experience of having an x-ray or MRI.

“It’s a quick, easy in, reposition, in, out and done,” explained Dr. Gebara.

The Cancer Institute at BMC was only the second cancer center in the state of Massachusetts to acquire the new TomoTherapy machine. (Good Samaritan Medical Center in Brockton, Mass., was the first.)

The TomoTherapy machine retails at a price of about $4.5 million. BMC was able to get the machine for less than that, at $3.3 million, due to the trade-in value for the hospital’s older machine, a spokesman told The Berkshire Beacon.

According to Dr. Gebara, it was cheaper for them to buy the more expensive TomoTherapy machine that fitted into a pre-built vault than to buy the standard radiation machine and have to build a whole new storage space.

“We were both able to save money and bring better technology into our center,” said Dr. Gebara. “It was a win-win.”

Dealing with cancer

Mr. Jordan finally began radiation treatment for prostate cancer last November, after being diagnosed late last spring.

He spent the summer months consulting with different doctors and trying to decide which course of treatment was right for him.

Fortunately, his cancer had not spread during that time.

“Our main concern after finding out the diagnosis was having the CT scan to find out if the cancer had spread.,” explained Mrs. Jordan.

Still, Mr. Jordan had a history of other medical issues, including gout, diabetes and heart disease.

He took a brief vacation to Nantucket last September, and days later, he was admitted to BMC with pneumonia and congestive heart failure.

He was hospitalized for a week. This further delayed him from going in to start his external beam radiation treatment for prostate cancer.

He began his treatments in late November right after Thanksgiving.

Mr. Jordan was scheduled to have 42 treatments in total, each consisting of a concentrated dose of radiation designed to destroy cancerous cells without affecting the surrounding tissue.

“George didn’t exhibit too many outward fears,” said Mrs. Jordan.

“He had a couple scares where he was urinating blood,” she explained.

That is one of the side effects, and doctors were able to confirm that Mr. Jordan did not have bladder cancer.

Mr. Jordan also experienced pain in his kidneys and observed a dark color in his urine. Doctors scanned his kidneys and fortunately did not find anything troubling.

“We dodged a bullet there,” said Mrs. Jordan.

“George was always a trooper,” she explained. “He didn’t complain too much.”

“It was good, but I didn’t have anything to compare it to,” Mr. Jordan said of the overall treatment experience. “The personnel were very helpful, friendly and kind.”

He even got to request a hot blanket (steamer) to have draped over him as he went on the slab into the machine, which is located in a relatively chilly vaulted space.

“It’s all about comfort,” said Mr. Jordan.

Another experience

Joseph McGinniss had a quite different experience compared to Mr. Jordan.

Mr. McGinniss, a writer based in Pelham, formerly of Williamstown, was diagnosed with prostate cancer last year, after doctors at the Dana-Farber Cancer Institute did a biopsy.

They found an “advanced, aggressive” form of the disease, and a follow-up MRI revealed the cancer had spread beyond the point where it could be surgically removed.

According to Mr. McGinniss, his initial reaction to his diagnosis was, “Holy shit!”

He was given hormone injections – 30 days of Casodex and then Lupron for 12 weeks – and he started to eat healthier.

“Starting last July, I shifted totally to a Mediterranean diet, giving up sugar, red meat, potatoes, bread, dairy products, etc., and forcing down kale, broccoli, other greens and grains such as quinoa and freekeh and red lentils that would never previously found their way to any plate of mine,” he explained.

Now, he said he feels great and has experienced almost no side effects.

“I haven’t felt better since I used to run the New York City Marathon 35 years ago,” Mr. McGinniss said. “The ‘roto-rooter’ surgical procedure done by a Dana Farber urologist resolved my urinary difficulties and I’ve really not suffered from either symptoms of the metasteses, or side effects from the Lupron.”

For the author of best-selling books such as Fatal Vision, The Selling of the President and The Rogue, which he wrote about Sarah Palin after moving into the house next door to her in Wasilla, Alaska, the cancer was so advanced that it was determined to be incurable.

“My cancer has been declared ‘terminal,’ so it’s likely that intensity of the treatments will only increase over time,” he explained.

“My main focus at this point is providing as much love and support as I can to my wife and children and grandchildren, before the tide turns and they will have to support me,” Mr. McGinniss added. “Secondarily, it is getting as much quality writing as possible done, before the disease starts to interfere with my work.”

BMC plans new cancer

As Berkshire County experiences up to 700 new cancer cases each year, Berkshire Health Systems has teamed up with Berkshire Hematology/Oncology to help deliver comprehensive care and treatment to patients in one centralized location.

Last summer, announcement came that a new, state-of-the-art cancer center operated by Berkshire Medical Center is being built at the Hillcrest Campus.

The $30 million center will include classrooms and conference rooms, exam rooms, a meditation room, exercise rehabilitation, library, on-site pharmacy, clinical laboratory, infusion service and counseling services.

A wide array of treatment options will be available, including external radiation provided by the new TomoTherapy machine.

According to Michael Leary, Director of Media Relations for BMC, the new cancer center will allow patients to receive a more integrated treatment than they currently receive.

“It will be a lot easier and convenient for patients to receive care in one location,” he said.

According to a press release posted on the Berkshire Health Systems website, “The new BMC Cancer Center will provide a wide range of patient care services under one roof, including Hematology/Oncology, Radiation Oncology, Surgical Oncology consultation and numerous support services designed to help make the cancer patient’s care easily accessible and seamless among multiple disciplines.”

“We want to make it as convenient and comfortable a process for the patient as possible,” said Mr. Leary.

The focus for the new center will be bringing multiple physicians and perspectives together under one roof.

“We’re going to have multiple disciplines working together,” said Dr. Gebara, head of radiation oncology at Berkshire Medical Center.

Dr. Gebara’s predecessor in radiation oncology, Dr. Sheridan, thinks it is useful to have more integration of the different disciplines.

“I think that’s a very good idea to have them all in the one building,” he said.

As part of this integrating process, doctors Michael DeLeo, Harvey Zimbler and Paul Rosenthal, physicians with Berkshire Hematology/Oncology, will be added to BMC’s Physician Practice organization.

Their offices will be based at the Hillcrest campus, and they will be joined this year by Dr. Trevor Bayliss, a fellowship trained hematologic oncologist.

The new cancer center building is currently under construction, with crews working on building a new entryway, new waiting and lobby space.

The final phase of construction, to be completed by early 2014, includes building and renovating space for the radiation oncology department. The project will open in 2014 in the first half of the year.

For now, new cancer patients are still in great hands with Berkshire Medical Center’s cancer facility and its team of physicians.

The treatment is state-of-the-art and the doctors are personable and compassionate.

Just ask Mr. Jordan. He was diagnosed last year with prostate cancer and has now completed a course of 42 radiation treatments at BMC.

Upon completion of his treatments he received a yellow rose, which admittedly made him smile.

His support group along the way included his pharmacist and friend G. Bruce Rumph, a former lawyer and current pharmacist at BMC; Steve Giroux, a former nurse and current accountant; and Donna Thomas, a former nurse and current business manager of The Beacon.

They kept him informed and knowledgeable at each stage. He also received tremendous support from his wife.

Going through treatment for prostate cancer, or any kind of cancer for that matter, is an ordeal, but the cancer team at BMC is there to help patients every step of the way.

Posted by Dana Drugmand on July 25, 2013. Filed under Community News,Featured,News. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry