Gov. Jerry Brown: Some information about early prostate cancer

Gov. Jerry Brown is undergoing treatment for localized prostate cancer, according to a statement released by the governor’s office.

In it, Brown’s UC San Francisco oncologist was quoted as saying that “fortunately, this is early stage localized prostate cancer, which is being treated with a short course of conventional radiotherapy. The prognosis is excellent, and there are not expected to be any significant side effects.” The statement also said that Brown’s treatment should end the week of Jan. 7 and that he was “continuing a full work schedule.”

We called three physicians to learn more about this cancer, its treatment and prognosis. (None of them are personally treating Brown.)

An early stage localized prostate cancer is one that is not believed to have spread beyond the prostate gland and is therefore a candidate for a variety of different treatments, said Dr. Mark Litwin, chair of UCLA’s Department of Urology. Options include radiation therapy, surgery and “active surveillance,” in which a tumor is not treated but carefully monitored. “If it ever begins to misbehave, we change course and treat,” Litwin said.

Active surveillance is increasingly favored for older men because prostate cancers tend to be very slow-growing. But doctors and patients look at more than just chronological age when making that call -- they also consider the man’s state of overall health.

In Brown’s case, although he is 74, “he’s vigorous, healthy-appearing and obviously he’s been taking care of himself,” Litwin said. In such a case, treatment is a reasonable choice, he added.

Treatment choice depends also on a patient’s personal preference -- how comfortable a man is with allowing a cancer to remain in his body and the prospect of treatment side effects, said Dr. Cy A. Stein, a medical oncologist at the City of Hope Medical Center in Duarte.

For surgery and radiation therapy, “the data go out very far -- about 15 years -- and find no meaningful difference in survival,” Stein said. “So it becomes very much a matter of individual preference, what patients feel they want to do. Some people say, ‘Listen, I just want this cut out of me.’ Other people say, ‘No, I don’t want an operation, I’d much rather come in daily for a number of weeks to get a dose of radiation.’ ”

Radiation therapy can be performed in a variety of ways, said Dr. Christopher Rose, a radiation oncologist at the Center for Radiation Therapy of Beverly Hills. “Conventional radiotherapy” implies external beam radiation therapy, and is generally offered in a course of treatment lasting anywhere from 5 1/2 to nine weeks. However, accelerated treatments exist in which five treatments are delivered over the course of eight days, Rose added.

A three-dimensional model of the prostate -- as well as organs that the oncologist wants to avoid -- is pieced together using CT scans. The patient lies on his back and a 360-degree radiation source delivers beams of radiation to the patient in a way that targets the prostate but avoids other structures as much as possible. The beams can be delivered at differing degrees of intensity and in a concave shape so that the rectal tissues, lying near the walnut-shaped prostate, are avoided, Rose said.

Other advances allow a CT scan to be taken at each treatment session and lined up with the initial map so that the patient can be precisely positioned and the same tissue volume irradiated each time, Rose explained. With these advances, “the potential for a cure goes up and the potential for injuring adjacent organs goes down,” he said.

With conventional radiation treatment, each session takes a matter of minutes and is performed on an outpatient basis. “My patients all work through their treatments,” Rose said. “Sometimes, 1 in 4 suffer fatigue but that usually occurs at the end of the day. … Gov. Brown seems at the top of his game, and it probably won’t interfere with activities of daily life.”

Be it radiation or surgery, treatments carry the risk of side effects, Stein said: Erectile dysfunction affects about 50% of cases of either radiation therapy or surgery; with surgery to remove the prostate, maybe 5% or fewer of patients experience problems with incontinence, though these improve as time goes on. With radiation, there is a small probability of damage to the rectum because it sits right behind the prostate gland. “Newer modes of radiation therapy have made those numbers very small,” Stein said.

Prognosis is generally good in early, localized cases of prostate cancer, although factors beyond lack of spread come into play, the doctors said. Physicians consider the blood levels of prostate-specific antigen (PSA) and how disordered and cancerous the prostate tissue looks under the microscope. The latter is used to create a measure called a Gleason score. Gleason scores of 8 to 10 are more serious; 6 and 7 are intermediate, with 7 being more serious; 2-5 are low risk. Most newly diagnosed prostate cancers have scores of either 6 or 7.

All three doctors noted that most men diagnosed with early, localized prostate cancer die of something other than the cancer.

For more about prostate cancer, visit this website of the National Institutes of Health.