Monday, July 19, 1999

Jack Canute , 73-year-old Kauai resident:"They
promised me I'd be the first patient, and I was."

Kauai cancer patient
a man of steel

An implant procedure to treat
prostate disease is performed for the
first time in Hawaii at Queen's

By Helen Altonn


Whether Jack Canute is golfing, walking or traveling, 95 tiny radiating seeds in stainless steel shells are fighting cancer in his prostate.

The 73-year-old Kauai resident was the first patient to undergo radioactive implant therapy in Hawaii for prostate cancer last December.

After seven months, he says, "I'm feeling great." He and his wife, Marge, recently celebrated 51 years of marriage in Las Vegas.

Canute was back to golfing within weeks after the radioactive seed treatment. Now he golfs three times a week and walks with his wife two miles a day at least five days a week, he said.

Hawaii patients with prostate cancer had to go to the mainland for the radioactive implant procedure -- called brachytherapy -- until the Queen's Medical Center began offering it last fall.

Dr. John Lederer, medical director of the Queen's Nae'a Radiation Oncology Department, had done similar implants for 15 years and introduced brachytherapy to Hawaii.

He went to the Northwest Prostate Institute in Seattle three times for training and held a training program at Queen's for other Hawaii doctors.

Two Seattle doctors who pioneered the procedure were at St. Francis Medical Center recently for a teaching session.

"It went very well," said Dr. Herbert Chinn, St. Francis Medical Center urologist. "It has its place."

His sons, urologists Herbert K.W. Chinn of Queen's and Stephen K.B. Chinn of Straub Clinic & Hospital, also have done prostate seed implants.

Preparing for one recently at Queen's, Stephen Chinn said, "John (Lederer) brought a program to Hawaii that was sorely needed. It brought us basically up to speed. ... Patients are really happy with it."

Prostate surgery poses a high risk of impotency and also a risk of incontinence, although it's fairly low, Chinn said. Both are "basically negligible" with seed implants, he said.

As with breast cancer or any other form of cancer, Lederer stresses that the best hope of treating prostate cancer is to catch it early.

One in 10 men is expected to develop prostate cancer in his lifetime. About 300,000 cases are predicted nationally this year, he said.

By Ken Ige, Star-Bulletin
Jack Canute's prostate appears in a three-dimensional CAT scan.

However, he said he expects an increasing cure rate because prostate tumors are being caught sooner with prostate specific antigen blood tests.

PSA is above the normal level 80 percent of the time if there's a prostate tumor, Lederer said. It drops with treatment and "it's a good indicator that we cured them," he said, "but that doesn't mean the PSA won't start to rise."

Lederer said 10 years of data by the Seattle group show "excellent survival." But he and the other doctors point out that radioactive seed implants aren't the answer for every man with prostate cancer.

"There's not one good option to treat everybody," said Herbert K.W. Chinn. "In a select patient, this is a very good treatment."

The doctors use a team approach, with the radiation therapist, surgeon, urologist and patient deciding the best treatment in each case.

Depending on the patient's age, lifestyle, state of the tumor and other medical problems, Lederer said, options range "from watchful waiting to radical surgery and various forms of radiation." Some new male hormones also are available to control or block testosterone production, he said.

Combined treatment is effective for some patients, Lederer said.

The walnut-size prostate sits beneath the bladder and is primarily responsible for producing semen.

Canute, former resident manager for Sandia National Labs at the Pacific Missile Range Facility at Barking Sands, said the only sign he had of prostate cancer was frequent urination, mostly at night.

"Cancer is like a hidden thing," he said. "You don't really know until it manifests itself, but you should get the exam and find out if your PSA is normal."

His doctor on Kauai had literature on brachytherapy and Canute said he discussed it by telephone with Lederer, who was planning to initiate the procedure at Queen's.

"They promised me I'd be the first patient, and I was," he said.

After the implant, Canute said he commuted to Honolulu from his Kekaha home Monday through Friday for five weeks for direct radiation.

Seed prostate therapy initially was a "fad," said Dr. Herbert K.W. Chinn. "Seed implants were the most miserable and least effective way to treat prostate cancer back in the 1970s. The belief is it had to do with inaccurate placement of seeds by finger guidance."

Now, however, "You can put the seeds pretty much where you want them to be," he said.

Special software installed about a month ago at Queen's allows doctors to map the prostate precisely. They can determine the size and shape of the target area for the seeds, and how strong they have to be, Lederer said.

He said 90 to 110 seeds are used for a normal prostate. They're inserted with hollow needles and positioned using ultrasound technology.

Lederer said the seeds were 99 percent on target in Canute's case and 100 percent in their second patient. Seattle averages 91 percent, he said. "Obviously, we're in the ballpark."

Patients go home the same day, usually with just a sore tailbone, Lederer said.

One of his patients, 62 or 63 years old, went skiing in Switzerland a week after the implant, he said. "Acceptance is great. Side effects are very, very low."

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