Prostate Cancer Treatment at NYPC: Meet Dr. Shaakir Hasan

How did you come to practice radiation oncology and, ultimately, proton therapy?

Good question. In medical school, what really drew me to radiation oncology is that it’s a unique branch of medicine. Cancer itself is very diverse and intricate and requires you to understand every organ system in the body. The technology and equipment are just incredibly innovative, with lots of physics and math, which is pretty unique to medicine. Plus, unlike some disciplines you really get to see the patient a lot. So the job is never boring because every patient is unique, and you really get to build these individual relationships because of how often we see our patients.

And then protons take it to the next level. There’s this incredible precision, a unique and most technologically advanced process of delivering and distributing the radiation compared to conventional linear accelerators.

What landed you at the New York Proton Center?

Coincidentally, NYPC opened the year I was applying for a position. So I was at the ASTRO convention, where typically only about five percent of people who interview actually end up getting a job. But the stars aligned. I met with Dr. Simone, who liked what I had to say and brought me aboard.

Let’s talk about prostate cancer. Who is most at risk and are there genetic or lifestyle factors men should be aware of?

I would say that every male is basically at risk for prostate cancer, every single one.

Overall, though, age is definitely the biggest factor. About 1 in 8 men will be diagnosed with prostate cancer in their lifetime, and over half of those cases are in men over 65 years old.

The problem is that because prostate cancer is so common in general, it’s hard to find particular risk factors—since a lot of people can have it without those risk factors.

As for genetic risk, there are two BRCA genes, BRCA1 and BRCA2. While both are common breast cancer risks for women, the BRCA2 gene can also predispose men to prostate cancer.

Beyond that, investigators have assessed a correlation with prostate cancer and lifestyle, and there’s probably something there. But we don’t really have hard evidence. Obesity can lead to inflammation in the body and, therefore, malignancies in general, and there has been a link between colorectal/endometrial cancer and obesity. But there’s no definitive link to prostate cancer.There are also biological aspects of proton therapy that make protons more effective at actually killing the tumor and engaging the immune system to attack cancer cells.

Given that high degree of risk, when and how often do you recommend screening?

Again, every single male is at risk. I think the most important thing is to raise awareness of that risk.

Guidelines of the National Comprehensive Cancer Network recommend that anyone over 45 get a PSA and digital rectal exam—though it’s 40 if you’re African-American, have a germline mutation such as BRCA, or a suspicious family history of prostate cancer.

But really, any male over 40 can and should request a PSA from their primary care provider.For patients who already received high doses of radiation with their first course of treatment, we can safely deliver targeted proton therapy and provide patients with a new chance of cure.

Let’s talk about why proton therapy is so effective. Is it just the lack of side effects, or is it actually better at eradicating the tumor?

Overall, protons “pack a stronger punch” by creating more complicated DNA damage. The idea is that you could kill more cancer cells and ultimately might have a higher cure rate.

As to side effects, the big advantage is how the protons are delivered. Instead of building up radiation from multiple different angles and then having it dissipate beyond the target, you generally just need two angles—from the left and the right hip. You can deliver a curative ultra-high dose directly to the prostate without an exit dose hitting other body parts like the bladder, rectum or bowel as much as you would with conventional radiation. This should theoretically lead to less long-term side effects such as erectile and bladder dysfunction, and rectal bleeding.

Proton therapy has the potential to reduce the risk of secondary cancers around the treatment site compared to conventional radiation, given the lower total radiation dose to the body. Additionally, if prostate cancer were to come back after being irradiated, protons can re-irradiate the cancer very effectively and offer a new chance of cure, again because the amount of total radiation to the surrounding healthy tissues is reduced compared to conventional radiation.

Is there any evidence to show that proton therapy reduces side effects?

There is really good data with over 1,400 patients treated at the University of Florida that showed patients who had proton therapy reported having fewer side effects, particularly gastrointestinal ones like rectal urgency and frequent bowel movements. We are still collecting more prospective and randomized data to produce more evidence.

Does that mean you always recommend proton therapy for prostate cancer?

Well first off, I think it’s important to point out that many prostate cancer patients just hear about a particular treatment option—usually surgery. But they need to know that many radiation treatments can achieve similar tumor control with few side effects.  Radiation options include IMRT, brachytherapy, SBRT/CyberKnife—and of course proton therapy. So they need to explore and understand their options, and ultimately choose the therapy that they feel most comfortable with.

Sometimes surgery is preferred over radiation, like when the patient presents with obstructive uropathy. In other words, parts of the prostate gland are enlarged and obstruct the urinary pathway, and this obstruction will not improve with radiation and thus needs to be surgically removed. That said, there’s no situation in prostate cancer I can think of where protons could or should not be utilized relative to the other radiation modalities.  Given the dosimetric advantage (less total dose to healthy tissues), it makes sense to go with protons if opting for radiation.

Watch Dr. Shaakir Hasan present at the ZERO Prostate Cancer Summit 2022

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One More Way NYPC is Addressing Non-Clinical Patient Needs

Cancer patients tackle a range of challenges beyond the immediate physical and medical aspects of their condition. A myriad of non-clinical needs can significantly impact well-being – in particular, financial burdens related to necessities such as housing, transportation, and groceries due to loss of income and increased out-of-pocket expenses.

Recognizing the importance of addressing these non-clinical needs, the New York Proton Center and the WiTT Group, Inc. recently joined forces to provide holistic support and revolutionize the way cancer patients handle various non-clinical challenges associated with their treatment.

WiTT has created a unique online Support Registry™ platform that allows patients to get the support they need by making it easy to ask for and receive help. The strategic partnership aims to leverage WiTT’s innovative solution to support our patients and help relieve financial burdens that accompany cancer treatment, while gathering data on the differences in non-clinical needs across patient populations.

NYPC aims to help relieve the financial burdens of patients. Costs related to non-clinical needs can cause stress and make the treatment process more difficult. WiTT’s platform allows patients to voice these challenges and express specific needs, such as money for groceries, gas, or transportation to treatment.

WiTT can also facilitate non-financial assistance: patients using the platform can ask for support such as a walk with a friend, picking up a child from school, dog walking, or accompaniment to an appointment.

It can be difficult to ask people individually for support – particularly when it comes to financial support – and bringing patients access to WiTT’s platform allows patients and caregivers to express their individual needs comfortably, while giving family and friends guidance on which types of contributions might be most helpful.

Since the adoption of the WiTT platform last year, NYPC has made remarkable strides in supporting our patients. Over $35,000 has been distributed to nearly 70 patients thus far, with housing, transportation, and groceries emerging as some of the top areas for support.

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New York Proton Center’s 2023 Year in Review

As we begin a new year, we want to take a moment to reflect on some of the highlights from an incredibly successful 2023 for NYPC. From leadership achievements to groundbreaking medical advancements and so much more, 2023 was a year of immense growth and impact.

NYPC celebrated some major institutional milestones last year. Not only did our Center mark its fourth anniversary since opening in the summer of 2019, but we also celebrated the treatment of our 4,000th patient in under four years – making us the fastest proton center in the world ever to reach that milestone. We are honored to have played a role in the health and well-being of so many lives and look forward to continuing our rapid growth and evolution as the only provider of proton therapy in New York State.

Leading the Way in Proton Therapy

We also celebrated some significant developments and achievements within our leadership team. It was an honor to welcome James Loos, CPA, as NYPC’s new Chief Financial Officer in July. James is a wonderful addition to the team – bringing over 25 years of experience in the healthcare and life sciences industry. His expertise has already proven invaluable to our Center.

Our leadership team also set some incredible new benchmarks in their respective fields. Dr. Isabelle Choi, NYPC’s Director of Research and Clinical Director, was elected a Fellow of the American College of Radiation Oncology (FACRO) – a highly prestigious recognition awarded to those who meet rigorous criteria of outstanding service to the College, the field of radiation oncology, and the patients they treat. Dr. Choi was one of just three radiation oncologists of the more than 5,300 practicing radiation oncologists in the United States who was elected for this distinction this year! Dr. Choi was also selected by Crain’s New York Business as one of this year’s 40 Under 40 honorees – a hugely well-deserved recognition that acknowledges her vast contributions to the field and her excellent patient care.

Meanwhile, Chief Medical Officer Dr. Charles B. Simone, II was named a Fellow of the American Society for Radiation Oncology (FASTRO) for his exceptional efforts in developing clinical trial strategies, leading innovative research and providing gold-standard patient care. Dr. Simone is one of the youngest in ASTRO’s history to be awarded this prestigious honor and one of only a handful of radiation oncologists in the world to have both FASTRO and FACRO distinctions. Congratulations to Dr. Choi and Dr. Simone on these tremendous achievements – we’re so proud to boast such an amazing team of leaders.

In June, we were thrilled to welcome New York State Health Commissioner James McDonald, who toured NYPC to learn more about our innovative research and the patient care we offer. It was an honor to be recognized for our efforts as an industry leader in the field of proton therapy.

Making Advances in Oncology Research

Our commitment to driving innovative treatments has continued to foster significant clinical progress. NYPC has remained a leader in providing 5-fraction proton SBRT, an extremely effective treatment modality that utilizes highly focused radiation beams to deliver a higher dose per treatment session over just five days. Five-fraction SBRT has been shown to achieve hugely promising results – particularly for prostate cancer patients, as the treatment’s ultra-specificity spares vital organs in close proximity to the prostate like the bladder, bowel, and rectum. We are proud to offer such a cutting-edge option to our patients and are committed to bringing increased awareness to this important treatment.

During 2023, NYPC also launched three new FLASH radiation therapy (FLASH RT) mouse model studies that will examine the use of FLASH RT to improve treatment of lung, pelvic and abdominal tumors. The studies are conducted with our partners at Memorial Sloan Kettering Cancer Center, Montefiore Medical Center and Mount Sinai Health System, in collaboration with NYPC’s Dr. Simone, who is the co-author of the first ever clinical trial on FLASH radiotherapy. FLASH enables ultra-high dose-rates with targeted precision, reducing treatment time and side effects – it is one of the most promising game-changers in oncology, and we’re proud to be leading the charge on advancing this crucial treatment option.

NYPC’s doctors also led major research efforts supporting the broader use of proton therapy treatment. Several NYPC physicians are leading large national clinical trials using proton therapy. NYPC has also been awarded research grant funding from the National Institutes of Health, as well as industry partners.

Committed to Proton Therapy Education

Our team also contributed to ASTRO revising its guidelines for proton beam therapy for the first time in more than half a decade – including the expansion of recommended uses for proton therapy. With the updated proton policy model, proton therapy has now emerged as a recommended standard of care for the adolescent/young adult (AYA) population, as well as a wider range of conditions, including head and neck, thoracic, abdominal, and pelvic tumors. This pivotal update signifies a major advancement in the effort to broaden access to proton therapy, ultimately improving the quality of care for a more extensive demographic of cancer patients.

Additionally, our team remained active participants giving invited educational lectures or presenting impactful research at numerous prominent conferences, including the 2023 Annual Meetings for ASTRO, ACRO, the Particle Therapy Co-Operative Group (PTCOG), the American Radium Society (ARS), the National Association for Proton Therapy (NAPT), and many more. Our physicians, physicists, and dosimetrists have presented research talks, lectures, panel discussions, and educational sessions on a wide variety of topics, demonstrating our continued dedication to sharing knowledge and working with our colleagues in the proton therapy field to advance the understanding and awareness of this advanced treatment.

Our commitment to education persisted as we continued to train radiation oncologists, physicists, and dosimetrists from around the world. In 2023, we proudly extended our expertise to the faculty and staff for multiple sites of new proton centers in North America, Europe, and Asia, contributing to the growth and development of the field.

We also demonstrated our commitment to being an active and caring member of our neighborhood through close engagement with the East Harlem community through activities such as a toiletry and spa product drive with WIN NYC– an organization which provides safe housing and critical services to homeless women and children in New York City–as well as our participation in local events like the Boriken Neighborhood Health Fair and Uptown Grand Central’s Party On Park. In addition, several NYPC leaders are actively involved with a Downtown Revitalization Initiative (DRI) grant that will support transformation of East Harlem into a transit hub and gateway to the historic El Barrio. It will also provide resources needed to create more green and functional public spaces, and support business and job growth in the neighborhood. As an anchor of the 125th Street Development project, NYPC was one of eight Applicant Partners supporting the grant application for the DRI initiative.

As we look back on 2023, we express our deepest gratitude to our patients, staff, and the community for their unwavering support. Together, we have achieved remarkable milestones, and we eagerly anticipate the triumphs that 2024 will bring. Here’s to another year of excellence, innovation, and compassionate care!

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