Prostate Cancer Survivor
|Tabb Morgan, Tacoma, Washington|
Dutifully dedicated to getting annual exams since turning 40, Tabb Morgan was alarmed when his PSA results rose to 5.6.
“My PSA went from 1.2 to 5.6 in four years,” Tabb says. “My primary care physician immediately scheduled me for a biopsy. The results were positive, 1/3 of the biopsy samples collected had a Gleason score of 7. The urologist informed me that those results indicated an aggressive form of cancer.”
The prognosis given by the diagnosing urologist wasn’t very positive, Tabb recalls. “He recommended a prostatectomy with immediate radiation therapy to follow. He estimated the chances that the nerves would be preserved was between 20 to 40 percent.”
Tabb’s wife Cindy, who works as a flight attendant for a major airline, shared Tabb’s dilemma with her co-workers. They provided a remarkable number of suggestions from their personnel experiences and those of their spouses. “Seattle Cancer Care Alliance was mentioned by many of those offering advice,” Tabb says. Armed with these recommendations and the support of his family and friends, he began an extensive Internet study of his options.
One of the most significant factors in Tabb’s decision was family history. His father was diagnosed with prostate cancer and died five years later at the age of 62. Both of his grandfathers had cancer, one of them prostate. Tabb’s PSA escalated to 7.8 three months after his initial diagnosis.
Determined not to let history repeat itself, Tabb got a second opinion at Seattle Cancer Care Alliance and eventually decided on treatment based on a clinical trial focused on the basic level of cancer – how it grows.
SCCA and UW Medicine medical oncologist, Dr. Elahe Mostaghel, suggested hormone therapy for three months before Tabb had a radical prostatectomy at UW Medical Center in June 2007.
“Dr. Lange, Dr. Mostaghel, and everyone at SCCA and UW Medical Center were incredibly helpful,” Tabb says. “They provided remarkable professional insight and sincere interest in my well being as I wrestled with the most difficult decision I have faced in my life.”
Testosterone is the male hormone; it’s also a growth factor for prostate cancer.
“Another name for this class of growth factor hormones is androgens,” says Dr. Mostaghel. “‘Hormonal therapy’ generally refers to treatments designed to suppress levels of this growth factor hormone,” she says.
Standard hormone therapy decreases blood levels of the growth factor reasonably well. “However, if we evaluate prostate tissue samples from patients on hormone therapy it turns out that the levels of testosterone inside the tissue are still high enough to potentially stimulate growth of the tumor,” she says.
It is unknown exactly what is causing the residual growth factor levels to persist in prostate tissue in patients who are receiving standard hormone therapy.
“However, we do know that the adrenal glands produce growth factors that are related to testosterone (called adrenal androgens), and that these adrenal hormones circulate in the blood and can be picked up by the prostate tissue,” Mostaghel says.
What Dr. Mostaghel’s group has done in patients with much more advanced prostate cancer suggests that their cancer may be able to manufacture some of the testosterone itself, according to Dr. Bruce Montgomery, who heads up the prostate team at SCCA.
“Many studies have indicated that prostate tissue can convert adrenal hormones to the growth factors that stimulate prostate tumors,” Mostaghel explains. “Moreover, standard hormone therapy does not suppress the ability of the adrenal gland to produce these growth factors, or the ability of the prostate tissue to take up and convert them to its own growth factors.”
Essentially, the goal of the clinical trial that Tabb Morgan was enrolled in is to see if something better than standard hormone therapy can be done.
The clinical trial Tabb participated in was designed to combine the drugs used in standard hormone therapy with drugs that can either inhibit the ability of the adrenal gland to produce the adrenal hormones, or inhibit the ability of the prostate to convert these adrenal hormones to its own growth factor.
“An important component of the study is that patients undergo the treatment before their prostate surgery,” Dr. Mostaghel says. “Any prostate tissue that is leftover after surgery can be used to specifically measure how well the treatment has worked inside the prostate tissue. This provides much more detailed information about how well the treatment has worked than what we can learn from blood levels alone.”
Ultimately, the information learned from this clinical trial will help Dr. Mostaghel and her group understand how prostate cancers are affected by hormone therapy, and whether treatment combinations such as the ones they are testing could be beneficial for other patients with prostate cancer.
“I studied for many hours before deciding on my course of action,” Tabb recalls, “and talked to several doctors and many prostate cancer patients.”
Since there aren’t any good tracers for prostate cancer outside of the prostate, Tabb decided on a radical prostatectomy, to insure that the doctors could identify if the cancer had spread beyond the prostate.
“I was initially confused about all the options available,” Tabb says. “But researching it showed that it was manageable. I’d heard about proton therapy and radiation therapy. They are certainly less intrusive compared to surgery, but my top priority was knowing if the cancer had progressed outside of the prostate.”
Tabb’s surgery was an absolute success.
Tabb had a PSA of 0.003 in November 2007. “It’s very good, so I won’t need follow-up treatment,” he says.
Concerned about his older brother and his sons who are only in their 20s, Tabb is hopeful that by participating in this clinical research study he’s helping his sons avoid a future diagnosis, or at least an easy cure. “Who knows, maybe there will be a vaccine in less than 10 years!”
Tabb wishes that awareness of prostate cancer was better when his father was alive. “He might have been as fortunate as I have been to get such great care and it could have saved his life.”