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Options for treating prostate cancer

Leaving a legacy Life-saving procedures at the new Endoscopy Center The laboratory at LMH Spring 2011

Options for

treating

prostate cancer Prostate cancer is the second most common cancer among American men.

Approximately one in six men will be diagnosed with prostate cancer during their lifetime. Though many men suffer from prostate cancer, many of us remain unaware of this type of cancer and the options for treatment.

The prostate is a walnut-sized gland located in the male reproductive system.

It surrounds the urethra (the tube that empties urine from the bladder) and produces the milky white fluid that makes up part of semen.

A prostate cancer screening tracks the level of prostate-specific antigen (PSA) in a man’s blood. It is normal for men to have PSA in their blood. That is why it is important for them to get the recommended screenings.

Prostate cancer screening guidelines Jon Heeb, MD, urologist with Lawrence Urology, recommends following these screening guidelines: • Men with a family history of prostate cancer should undergo a DRE (digital rectal examination) and PSA screening every year beginning at age 40.

• Those who have no family history of prostate cancer should get a baseline PSA screening at 40 and 45 and then begin yearly DREs and PSA screenings at 50.

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• Screening is not beneficial for men who are over the age of 75 to 80 or in those whose life expectancy based on overall health is less than 10 years.

Based on the results from the PSA and DRE, physicians can make the determination if it is necessary for a man to undergo an ultrasound and a biopsy to test for prostate cancer.

Treatment options If cancer is diagnosed, patients and their family members and physicians have various treatment options to choose from. There are four primary options for men who have been diagnosed with prostate cancer.

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“Wait and watch” When men opt to wait and watch they are monitored by their physicians on a regular basis to ensure the cancer isn’t growing rapidly or interfering with normal activities.

Because prostate cancer can be slow growing it is possible for older men to live the remainder of their lives with prostate cancer.

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Surgical removal of the prostate (open prostatectomy) is a treatment option men frequently choose. During an open prostatectomy, the prostate is removed through a small incision in the pelvis.

Once it is removed, the bladder and the urethra are reattached. There is some risk of bleeding, impotence or incontinence associated with this surgery; however, newer surgical techniques have helped minimize these risks.

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“The surgical option has been around for many years, but the advanced techniques developed in the past 15 years have minimized the complications associated with surgery,” says Dr. Heeb.

Men who undergo this surgery are required to use a catheter for seven to 10 days. In two to three weeks, generally they are able to return to work and normal activities can resume in about six weeks.

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Radiation therapy technology During treatment, radiation kills the prostate cancer cells and keeps them from growing and spreading to other parts of the body. The drawback for this treatment option is the length of treatment. Patients who choose this treatment option undergo radiation therapy treatments five days a week for eight weeks and each treatment takes about 15-20 minutes.

Radiation therapy is noninvasive and there is no risk of bleeding or infection and a very minimal risk of incontinence or impotence, but nearby organs such as the bladder and rectum can be affected by radiation. As a result, men often experience increased urinary frequency and urgency during treatment, a side effect that tends to resolve in less than two months. The most likely chronic side effect of radiation is small amounts of rectal bleeding with bowel movements.

This occurs in approximately 10 percent of men.

Those who choose this option can keep working, have no lifting restrictions,

Annually, 186,000 men are diagnosed with prostate cancer in the U.S. Learn about the screening and treatment choices for this disease. have no restrictions on sexual activity and can continue normal activities during treatment. The cure rate for this option is equal to that of the surgical procedure.

Darren Klish, MD, a radiation oncologist at Lawrence Cancer Center, recommends that all men diagnosed with prostate cancer do their research and explore all treatment options. “They should weigh their options before making a decision. Men should always talk with an urologist, a radiation oncologist and a medical oncologist prior to making a treatment decision,” notes Dr. Klish.

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Medical oncology treatments Depending on whether the patient has advanced, metastatic or recurrent prostate cancer, a variety of medical oncology treatments can be used.

“Therapies available at the LMH Oncology Center include hormone therapy, chemotherapy and immunotherapy,” says Ron Stephens, MD, medical director of the Oncology Center at LMH. • Chemotherapy consists of drugs that destroy cancer cells by interfering with the cells’ ability to grow and divide. Chemotherapy is administered in a variety of ways including orally, into a vein or artery, or by injection into muscle or under the skin.

• Immunotherapy consists of treatment designed to stimulate a patient’s own immune system to fight disease. Such therapy consists of antibodies, growth factors and other immune factors that are typically administered intravenously or under the skin. Certain types of cancer appear to be more responsive to immunotherapy.

• Hormonal therapy is used to block the effects of hormones on a tumor.

Side effects can very upon the type of treatment. Immediate side effects can include nausea, vomiting, hair loss, diarrhea and constipation. Typically these side effects occur only during treatment.

Fatigue can last beyond treatment but not indefinitely. The average medical oncology treatments last from one to two months.

Prostate cancer support group Men who are diagnosed with prostate cancer also may benefit from the Man to Man Prostate Cancer Support Group. Meetings are held on the first Tuesdays of the month at 5:30 p.m. at Lawrence Memorial Hospital. The meetings allow men and their spouses to learn from each other. Those who are newly diagnosed ask questions of those who have been through the disease.

Survivors share information about treatments, medications and outcomes.

For more information, contact Deb Parsons at the American Cancer Society, 800-359-1025, Deb.Parsons@cancer.org.

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LAWRENCE UROLOGY The physicians at Lawrence Urology diagnose and perform the surgical treatment of prostate cancer. These physicians include: • Jon Heeb, MD • Douglas Klingler, MD • Michael Well, MD 330 Arkansas Street, Suite 205 lawrenceurology.com 785-749-0639 LMH ONCOLOGY CENTER The Oncology Center at Lawrence Memorial Hospital provides exceptional quality cancer care in a safe, caring environment close to home. The physicians at the Oncology Center include: • Michelle Affield, MD • Sharon Soule, MD • Matthew Stein, MD • Ronald Stephens, MD 325 Maine St., Lawrence www.lmh.org/oncology 785-505-2800 LAWRENCE CANCER CENTER The physicians at the Lawrence Cancer Center provide radiation therapy for those diagnosed with prostate cancer. These physicians include: • Darren Klish, MD • Harold Johnson, MD 330 Arkansas Street, Suite 120, Lawrence 1402 S. Main St., Ottawa lawrencecancercenter.com 785-749-3600

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Prostate cancer: Three men’s stories Ron Lang, a retired Lawrence High School teacher, never had reason to think he would put his life in the hands of one of his former students.

But that is just what happened.

After Ron’s primary care physician began noticing elevated PSA levels, he was referred to a urologist. Ron turned to Lawrence Urology’s Jon Heeb, MD, one of his former students, and underwent a biopsy to determine if he had cancer. He had a family history of prostate cancer, but the diagnosis still came as a surprise.

Ron says he experienced a variety of emotions when faced with the cancer diagnosis. In the beginning he was in denial. Denial then turned to anxiety and the string of emotions finally culminated in determination. Though he was determined to beat the disease, he found it almost overwhelming to choose a treatment option.

In addition to doing research on his own, Ron talked to Dr. Heeb and family and friends who had also experienced prostate cancer. He ultimately came to the conclusion that a prostatectomy was the right answer for him. He stressed appreciation that prostate cancer patients don’t have to travel out of town to receive outstanding care, no matter which treatment option they choose.

Ron is now cancer free and credits Dr. Heeb with being very supportive. “He is a wonderful physician. He is very professional and has a wonderful calming effect,” Ron says.

Ron maintains a positive outlook. He continues to work part time and advocates passionately for men’s health. He always reminds his friends and family members to make the PSA test part of their regular exam.

George Paley has called Lawrence home for almost 40 years. As a successful businessman, he is vocal and passionate about Lawrence and various community issues. In the late ’90s he was a vocal proponent for keeping LMH a non-profit community hospital. So, when he was a cancer patient at LMH, it was not a surprise that he was just as vocal about the care he received and the staff he encountered.

When his PSA levels first went up and Dr. Heeb suggested George have a biopsy, he sought out a second opinion at KU Medical Center.

The physician he saw told him, “Dr. Heeb was one of my students. You are in the best hands possible. Go back to LMH.” So he did. He had surgery and radiation treatment as well as medical oncology treatments at the Oncology Center at LMH. “The entire Oncology Center is pretty amazing from the time you walk through the door,” George says. “The people at the front desk are nice, organized and sympathetic. They know you and why you are there. The nurses are really intelligent, sharp and on top of things. And the people in the imaging department are great. They are funny and you need that kind of attitude every step of the way.”

George adds, “Dr. Matt Stein (oncologist at the Oncology Center) is an amazing, kind and humble person. He would call me personally with lab results. When I emailed him at night, I always got a response first thing in the morning. I did not have any experience (at LMH) that was not positive.”

Charles Cowdin, a married father of four and retired from his job as a painter, was diagnosed with prostate cancer in 2006 after his physician noticed elevated PSA scores. At that time he discussed his options with his physician and family and opted for the “wait and watch” approach.

After monitoring the cancer for two years, they noticed a progression and at that time they chose to actively treat the cancer.

After 42 years of driving daily from Ottawa to Topeka for work, he chose to stay close to home and met with Darren Klish, MD at Lawrence Cancer Center. Charles decided radiation therapy was the right treatment option for him.

Charles underwent 42 treatments in Lawrence and drove himself to each one. He can’t say enough about Dr. Klish, the staff at the center, the treatment he received and the great results. Since he was cured of prostate cancer, 81-year-old Charles has gone to work every day. He credits Lawrence Cancer Center with making him “feel brand new, like a young man in an old man’s body.”

Mark your calendars!

Ribbon Cutting/Open House at LMH Eudora Medical Park Monday, May 16, 4:30 - 6:30 p.m.

600 East 20th St. (K-10 & Church Street)

small town BIG CAUSE 5k Run/Walks benefiting Lawrence Memorial Hospital Endowment Association Tonganoxie: Saturday, July 23 Eudora: Saturday, July 30 Baldwin City: Saturday, August 27 Register online today at lmhendowment.org. If you have any questions, please call 785-505-3317

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Become a member of the LMH community. Gifts of time and resources are welcome.

Life-saving procedures performed at the new Endoscopy Center To improve efficiency of patient care, the LMH Endoscopy Center has recently relocated from the LMH South location to the main hospital campus. The move is beneficial for staff and physicians because it has consolidated the departmental operations. Now inpatient procedures and outpatient procedures take place in the same location. Prior to the move inpatient procedures took place at the hospital and outpatient procedures took place at the LMH South location.

The move was made possible, in part, by a $100,000 grant from The Sunderland Foundation. “We are so grateful for the support The Sunderland Foundation has given to this project,” says Kathy Clausing Willis, vice president and chief development officer at LMH. “Their commitment to the hospital over the years is proof of their commitment to quality health care.”

The new location boasts time-saving features and an updated layout. There are five procedure rooms in the new center and each will be fitted with new scopes, monitors and video processors. One important aspect of the new layout is that the preparation area and the procedure areas are in the same location. This allows for better staffing and easier patient flow. There are several important procedures that take place in the Endoscopy Center.

Colonoscopy Colonoscopy, the most frequent procedure performed in the center, tests for colon cancer. During colonoscopy, a scope is used to view the entire colon and screen for possible polyps, tumors or cancerous growths. If a physician locates an abnormality during a colonoscopy, he or she is generally able to remove it during the procedure.

According to the American Cancer Society, colorectal cancer is the third leading cause of cancer-related deaths in the U.S. when men and women are considered separately, and the second leading cause Kenneth Kimmel, MD when both sexes are combined. But colorectal cancer is often avoidable.

Gastroenterologist Kenneth Kimmel, MD, Lawrence Internal Medicine Associates, stresses the importance of colonoscopies.

“Colorectal cancer is very preventable. Most colorectal cancer begins as a polyp and if polyps are removed during a colonoscopy, the patient’s risk of developing colorectal cancer becomes very low,” he notes.

Dr. Kimmel recommends colonoscopies beginning at age 50 for men and women who are at average risk for developing colorectal cancer. This screening should take place every 10 years and if a polyp or tumor is discovered during a colonoscopy, more frequent colonoscopies may be recommended. To schedule your colonoscopy speak with your primary care physician. www.lmh.org

EGD Other vital procedures are performed in the center, such as the esophagogastroduodenoscopy (EGD). With an EGD, physicians can examine the lining of the esophagus, stomach and upper duodenum (first section of the small intestine). Doctors are able to Endoscopy Center staff review the day’s schedule at the new centralized nurses station view these areas by inserting a small camera (flexible endoscope) down the throat and viewing the images on a TV monitor.

This procedure is usually performed to evaluate or locate possible problems causing abdominal pain, Crohn’s disease, heartburn, swallowing difficulties or a variety of other medical conditions.

Bronchoscopies Bronchoscopies are also performed in the center. The technology used in bronchoscopies is similar to that used in an EGD. But, unlike EGDs, bronchoscopies are employed to visualize the inside of the airways. This test is generally used to diagnose problems with the airway or lungs, or to remove or treat growths or objects in the airway.

ERCP Like other procedures performed in the center, an endoscopic retrograde cholangiopancreatography (ERCP) utilizes a scope.

But this procedure pairs scope technology with X-ray imaging to diagnose and treat conditions of the bile ducts including gallstones, strictures, tumors or leaks from trauma.

During this procedure the physician utilizes a scope to visualize the inside of the stomach and duodenum. Once the scope is in the correct place the physician can inject contrast material into the ducts in the biliary tree (the path by which bile is secreted by the liver) and pancreas so they can be seen on X-rays.

Physicians The physicians on staff in the Endoscopy Center have received specialized training to perform these procedures.

The physicians on staff at the center include: • Charles Brooks, MD • Ervin Eaker, MD • William Freund, MD • Philip Hoffman, MD • Kenneth Kimmel, MD • Teresa King, MD • Thomas Marcellino, MD • Lida Osbern, MD • Charles Yockey, MD Patient assistance and services are provided only with a physician’s order. Please speak with your physician about scheduling an appointment.

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The laboratory at LMH

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The interior of the laboratory at Lawrence Memorial Hospital is not something that patients generally see, and yet every other clinical department in the hospital depends on its services.

The lab is the physical hub of pathology, the study and diagnosis of disease, where samples of tissue, blood and other bodily fluids are tested and analyzed. Machines of all sizes — from the size of a paper cutter to that of a washer and dryer set — whir and spin in a steady hum. Coded vials parade neatly in square blocks waiting to be processed. And people — from pathologists to technologists to administrative staff — all work in tandem to provide this critical service to patients and their doctors.

At the core of the lab are the skill and work of LMH’s pathologists. Pathologists are specialized medical doctors who analyze cells for the existence and extent of disease.

Accredited in clinical and surgical pathology, they work in close collaboration with surgeons and clinical doctors to diagnose and determine a treatment path for each patient.

“The treating physician gives us the patient’s symptoms, and then we advise the best way to proceed with lab tests, biopsies and special procedures to determine a diagnosis,” explains Michael Thompson, MD, pathologist. “We work with clinicians to help them rule in or rule out different diseases.”

Pathologists analyze a myriad of different specimens taken from patients in varying ways, from blood samples to bone marrow needle aspirations to surgically removed biopsies.

Highly specialized machines are used to prepare the material, but the crucial part of a pathologist’s work is done with a microscope and their own experienced eyes.

Some tests are carried out over a length of days or weeks, but others are done with time ticking by the minute. A surgeon may remove a biopsy, send it to the lab for immediate analysis, and determine his course of action during that surgery by what is reported back by the lab. This may save the patient from having to undergo a possible second surgery or having a more invasive surgery than necessary.

Pathologists rely heavily on a team of medical technologists, cytotechnologists and histotechnologists. These specially trained staff prepare and analyze samples for different subspecialties within pathology such as chemistry, microbiology (the study of microorganisms), histology (the study of tissue), cytology (the study of cells), and hematology (the study of blood).

The lab also employs phlebotomists who draw blood from patients, a courier who transports specimens to and from the

Pathologists Mike Thompson, MD, and Richard Galbraith, MD, in the new LMH lab

hospital, and clerical and billing personnel. It is also home to the blood bank and transfusion medicine.

“Every individual in the laboratory is important in making the whole process work,” says Connie Broers, administrative lab director at LMH. “Work at the lab is a very collaborative effort.”

In the 10 last years, the volume of tests done at the lab has doubled. As well, more than 50 tests that formerly were sent away for analysis are now being done in house. All that has led to the need for a more updated lab facility.

In May 2010, remodeling began on the lab at LMH to give it an expanded and redesigned space. The first of three phases has been completed, and the entire new lab will be finished in May 2011. Even with 575,000 relocated offices, construction detours and a few other inconveniences, there tests were has been no interruption in the work that goes on in the lab, which continues performed in 24 hours a day, seven days a week.

Meanwhile, patients continue to the LMH Lab use the lab at LMH, whether they realize it or not. They rely on the techin 2010. nologically advanced equipment. They trust the accuracy and timeliness of the tests and reports that come out of the lab. They are dependent on the skilled expertise of the pathologists and technologists. All this is true even though most patients have never met the lab staff, whose work interfaces with patient care in every discipline of medicine.

“That is one thing that appealed to me about being a pathologist,” says Richard Galbraith, MD, pathologist. “I didn’t feel like I was being funneled into one specific facet of medicine. I get to remain in contact with everybody and everything.”

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Physician shadowing Studies have shown that role models in medical education are important not only to enhance learning but also to affect the student’s choice of specialty. A mentoring relationship can result in personal growth and development, as well as influencing the choice of clinical field for residency training.

In late 2007, a formalized physician program was created in order to place students who wanted to shadow a physician. These changes were enacted so Lawrence Memorial Hospital could identify students interested in a medical career. “This program allows students to shadow physicians, getting a unique view of the career they are interested in pursuing,” explains Becki Carl Stutz, volunteer services coordinator and administrator of the physician shadowing program.

“We also hope it creates a lasting impression on the student and will assist us in recruiting them back to LMH once they have completed medical school.”

In the three years LMH has been offering this program, nearly 130 students have been placed through the volunteer services office with physicians in the community.

David Goering, MD, LMH hospitalist, has had numerous students shadow him through this program. “The students get to be exposed to the real world,” he says. “I try to be honest with them. It (being a doctor) is not a glamorous profession. It’s a lot of hard work.”

Dr. Goering usually spends half a day with the college students. He lets them observe his interactions with the patients, as well as all of the documentation that he does.

Alex Rippberger, a pre-med sophomore at the University of Kansas and volunteer at the LMH Oncology Center, has shadowed with Mike

Thompson, MD, LMH pathologist.

“He let me see everything that he does. I got to scrub up and go into an operating room,” Alex says. “I also got to look in microscopes and observe slide preparations.” Alex has signed up to shadow one of the LMH hospitalists.

“There are a million health care jobs out there and I want to see what they are all like.”

It’s not just the students that benefit from this program. Dr. Goering admits that the students keep him on his toes.

“I encourage them to ask questions about what they are seeing. And they can be very inquisitive. It serves almost as a refresher for me.”

We also hope it creates a lasting impression on the student and will assist us in recruiting them back to LMH once they have completed medical school.

New requests come in every week by students who are interested in being placed with a physician. Currently 27 students are waiting to be matched with a physician. If you have questions about what it takes to be involved in this program, please contact Becki Carl Stutz in the volunteer services office at 785-505-3146 or by e-mail at becki.carlstutz@lmh.org.

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325 Maine Street Lawrence, KS 66044

Leaving a legacy

Una S. and Karl M. Kreider

Karl M. & Una S. Kreider

What legacy do you want to leave? Karl M. and Una S. Kreider knew they wanted to take care of their children and granddaughter but they also wanted to take care of the community where they built their family.

Before their deaths in 1983 and 1994, respectively, Karl and Una established matching charitable remainder trusts that benefited their daughter, Margaret Larsen. Upon her passing at age 88 this past winter, the remaining part of the trusts, totaling nearly $1.3 million, was donated to Lawrence Memorial Hospital Endowment Association.

“Una and Karl met as children in Lawrence. They fell in love, got married and raised their two children in Lawrence,” says Kathy Clausing Willis, VP/chief development officer. “They were dedicated to this community and they knew they wanted to leave behind a legacy of kindness to a community they held dear to their hearts.”

When Lawrence Memorial Hospital was first notified of the existence of the Kreider Trust in 1995, the hospital named its new rehabilitation center “The Kreider Rehabilitation Center” in their honor. In the 15 years since the Kreider Rehabilitation Center opened, the number of therapy service hours provided has increased by 37 percent.

During their time in Lawrence, they did their part to make Lawrence a worthwhile place to reside. Karl established the Securities Investment Co. in Lawrence and both Una and Karl were active in the community. In 1996, his daughter described him as a man of few words but above all honest and fair. “He loaned money for people to buy cars,” Margaret said. “When the depression hit and everyone was going through hard times, he allowed people to pay their debts with eggs or catfish.”

“This gift is a reminder of the true community nature of our hospital,” says Gene Meyer, President and CEO. “LMH began with a philanthropic gift from Elizabeth Watkins, and the Kreiders and many others have continued that tradition by donating to LMH and ensuring that our region has access to quality health care.”

A Charitable Remainder Trust is an irrevocable trust that distributes a fixed percentage of the value of its asset(s) to a non-charitable beneficiary, such as the donor, donor’s children, or others. Once the beneficiary of the trust has passed away, the assets of the trust are liquidated and transferred to the charitable beneficiary. To find out more about how you can establish a charitable remainder trust, please contact the LMH Endowment Association at 785-505-6134.

connect is published by Lawrence Memorial Hospital. The information in this newsletter is intended to educate readers about subjects pertinent to their health and is not a substitute for consultation with a personal physician. To have your name added to or removed from this mailing list, please call 785-505-3315.

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Gene Meyer | President and CEO, Lawrence Memorial Hospital Editorial Board | Kathy Clausing Willis, Sherri Vaughn, MD, Janice Early, Heather Ackerly

Lawrence Memorial Hospital • 325 Maine Street • Lawrence, KS 66044 • 785-505-5000 • www.lmh.org