Proton Therapy, One Man's Assault on Cancer

By La Rue Novick | Inland Valley Daily Bulletin | 07.31.2005

No Fear: One Man's Assault on Cancer Leads to Father-Daughter Bonding, a New Book, and a Renewed Life

Bill Vancil is not the kind of guy to run from big dogs. At age 9, he marched straight up to a stout Great Dane and hugged it. His mother snapped the photo that to this day hangs in Vancil's office with the words "Don't Fear the Big Dogs" written on the frame.

Little did he know at that young age he would follow this creed his whole life.

Vancil takes pride in never backing down in the face of adversity. That's why when he was diagnosed in March 2004 with an aggressive form of prostate cancer, he didn't ask "why me?" Instead, he educated himself about the cancer and its various forms of treatments. After careful consideration, he chose to pursue proton beam radiation therapy at Loma Linda University Medical Center and not the surgery his physician had recommended.

"I didn't want to do surgery because I was worried about the side effects (impotence and incontinence)," said Vancil, 64, who lives in Madison, Wis. "I didn't want to take the chance."

But, a major roadblock popped up. His insurance company refused to pay for such an "experimental" procedure. (Medicare does cover 80 percent of proton therapy, according to Gerry Troy, coordinator of patient services and education for LLUMC. Vancil did not have Medicare.)

Proton therapy is hardly experimental, said Troy, who also heads LLUMC's prostate cancer support group of more than 150 members. Proton radiation was discovered in the early 1900s, a prominent doctor wrote about it in the '40s and in 1954, Caltech first tested it on humans.

But, LLUMC is the first hospital in the world to actually have a proton radiation treatment facility, thanks to Dr. James Slater, a physicist, doctor and diesel mechanic who had all the right tools to bring the technology to the hospital in 1990, Troy explained.

LLUMC's proton therapy facility remained the only one for a little more than 10 years. Now there are two other operating proton therapy facilities (at Harvard and Indiana universities) in the U.S. with two more (Houston and Jacksonville) to open within the year. More have begun to open worldwide, including Munich, Germany last month.

"We were the guinea pigs and we proved it works," Troy commented. "And now they're going (up) like crazy."

Vancil, a former executive vice president and general manager of a group of five radio stations in Madison, said he chose LLUMC because its staff had the most experience treating patients with proton therapy. More than 70 percent of the proton therapy patients seen at LLUMC come from out of the area, Troy said.

In terms of eliminating cancer, proton therapy (which uses positively charged particles) and conventional radiation (which uses light rays) are about equal. But conventional radiation often damages surrounding tissues as it burns on the way in and keeps going through the body, Troy said. Proton therapy is more exact. About 80 percent of the dose stops exactly where it's supposed to, exploding the energy into the tumor.

"There's no damage on the way in and no damage on the way out and we've doubled or tripled the dose on the target," Troy explained. "We've taken the bad parts away from conventional and made them good."

Vancil hired the help of an attorney friend who happened to be a prostate cancer survivor, for the fight with the insurance company. They submitted documents about the effectiveness of proton therapy, but the decision-makers weren't budging.

In May 2004, Vancil packed his convertible Mitsubishi Spyder and headed for the West Coast, confidant that he had made the right treatment choice, but a little fearful of what would happen next. He traveled nearly 2,000 miles to Loma Linda, not knowing if his health insurance would cover the procedure or not. (Without coverage, Vancil would be responsible for a bill in the tens of thousands of dollars.)

Soon after arriving in California, he got a call from his attorney friend, Jerry McAdow, who said the insurance company requested Vancil undergo laparoscopic surgery to make sure the cancer had not spread from his prostate. Surgery was the very thing Vancil was trying to avoid. But he agreed to do it, if it meant the insurance would cover the proton therapy.

The results showed the cancer had not spread, which was a huge relief -- not only because the insurance company would have to pay for the treatments, but Vancil and his radiation oncologist, Dr. Carl Rossi, knew exactly what they were dealing with.

Vancil, who rented a fully-furnished apartment next to the hospital, began his treatments June 1, 2004. Forty-four treatments later, he was given a clean bill of health. He said he experienced zero side effects during and after the procedures. Rather, he felt fine. And he stayed active.

"These guys play golf or tennis each day. They have to exercise every day because that helps the immune system," Troy said of the prostate cancer patients treated with proton therapy at LLUMC.

Vancil's daughter, Victoria Louise (Tori Lou) Vancil, 14, came to visit her dad for his last month of treatments. They spent lots of time at the beaches where Tori Lou learned how to surf and at skate parks where Tori Lou showed up the boys with her skateboarding skills. (Tori Lou is an avid skateboarder and recently took second in a competition against all boys.)

Father and daughter bonded like never before.

"We were always close," Tori Lou said. "But this made us even closer."

Vancil and his daughter returned to California in June and July to visit all the friends they'd made (including a St. Bernard named Sebastian). Vancil was also here to promote "Don't Fear the Big Dogs" (Tate Publishing $16.95), a book he wrote about his experience with prostate cancer, LLUMC and his many adventures with his wise-beyond-her-years daughter, who often offered support and advice to her dad during his bout with cancer.

Sharon Hoyle, Vancil's case manager and a registered nurse, said she read the book cover to cover.

"I thought it was a cute read. It had a whole different slant on it. Most of our prostate cancer patients don't have teenage daughters," she said.

Vancil's radiation oncologist said he wasn't surprised Vancil wrote the book.

"I expected him to," Rossi said. "He took down a lot of notes while he was here."

Vancil said he hopes the book will encourage men to get screened for prostate cancer (age 50 if they don't have family history; age 40 if they do), especially since men don't typically like to talk about such things.

"We need to get the awareness up even more," Troy said. "(Vancil's) book will help."

Vancil said his book does not advocate proton therapy as the ONLY treatment for prostate cancer. The book is supposed to encourage men to explore ALL treatment options, including radiation seed implants, conventional radiation and surgery and decide what's best for them.

"It's important to believe in your choice," Vancil said --as he did in his.

HOW IT WORKS

Here's how proton beam radiation therapy works (as explained by Gerry Troy, coordinator of patient services and education for Loma Linda University Medical Center):

Proton therapy does not use light rays like conventional radiation. It uses positively charged particles taken from hydrogen gas.

"You take hydrogen gas and push a little bit into an injector. Then it gets hit with the equivalent of a lightning bolt of electricity. That splits the atoms," Troy said.

A hydrogen atom is simple in that it has a proton in the middle and one electron floating around the outside. The electric charge splits the negatively charged electron from the positively charged proton.

"We get rid of the electrons, keep the protons and we do this every two seconds," Troy said. "We get about 20 billion protons at a time."

The protons are pushed into a big aluminum pipe (called a synchotron) so they can start circling around super fast.

"We get them up to 60 percent of the speed of light --that's several times around the earth in a second," Troy said.

And then a specialist manipulates and shapes the positively charged proton beam so it is the exact same shape as the target (tumor) it's designed to hit. The invisible beam penetrates the skin, leaving no mark (sometimes the skin will appear a bit darker at the entry point -- almost like a tan), and explodes right inside the target.

"One guy said it very well: ‘I didn't know I was sick. I didn't know if I was being treated. And I don't know if I'm well, but what the heck,' " Troy said.

Proton therapy treats almost all kinds of cancer. It is not used for bone cancer or cancer that has spread into the bones. It has not been used on cervical cancer yet.

WHEN TO GET TESTED

According to the American Cancer Society, more men will be diagnosed with prostate cancer than women (and men) with breast cancer. More than 230,000 cases of prostate cancer will occur this year, while more than 210,000 men and women will be diagnosed with breast cancer.

Ironically, the annual budget for breast cancer awareness was $250 million last year, but for prostate cancer, it was $25 million, according to Gerry Troy, who heads the prostate cancer support group at Loma Linda University Medical Center.

Men should begin annual prostate screenings by age 50 if they have no family history of prostate cancer. If they do have a history, men should begin screening at 40.

The test is a prostate specific antigen (PSA) blood test, which measures the level of the antigen in the blood.

The exact cause of prostate cancer is not known, but a diet rich in animal fat and red meat increases the risk dramatically. The American Cancer Society recommends a diet low in fat and high in vegetables, fruits and whole grains.

Early prostate cancer does not have any symptoms. Progressed prostate cancer might show signs of slowing or weakening of the urinary stream or the need to urinate more often. Advanced prostate cancer may have the following symptoms: blood in the urine, swollen lymph nodes in the groin area, impotence and pain in the pelvis, spine, hips or ribs.

Treatment options and support groups for prostate cancer at a handful of local hospitals.

The Robert and Beverly Lewis Family Cancer Care Center at Pomona Valley Hospital Medical Center in Pomona has a prostate support group that meets on the third Tuesday of each month. For information, call (909) 865-9517.

Treatment options for prostate cancer at PVHMC include radiation seed implantation (where radioactive seeds are implanted directly into the prostate), surgery, conventional radiation and the latest, IMRT (intensity modulated radiation therapy).

Arrowhead Regional Medical Center in Colton doesn't have a cancer support group specifically for prostate cancer patients, but the Medical Center does have a general cancer support group. This group meets every second and fourth Wednesday of the month, from 3 to 4:30 p.m. in south conference room on the fifth floor. For information, call (909) 580-6204.

ARMC offers three treatment options for prostate cancer: hormone therapy, surgery and conventional radiation therapy.

Loma Linda University Medical Center in Loma Linda offers a prostate cancer support group every Wednesday from 5:30 to 8:30 p.m. For more information, call (800) 776-8667.

Treatment options at LLUMC include surgery, conventional radiation and proton beam radiation therapy.

San Antonio Community Hospital in Upland does not have a prostate cancer support group, but has plans to start an I Can Hope support group for cancer survivors. It starts on Sept. 7 from 10 a.m. to noon at SACH. For information

There will be a free prostate cancer screening available from 5:30 to 8:30 p.m. on Sept. 27 at the Montclair Community Clinic. Call (909) 944-WELL (9355).

Treatments options at SACH: traditional and laparascopic surgery, radiation seed implant, cryotherapy (freeze the prostate down to -20 degrees Centigrade), conformal external beam radiation (conventional radiation with a more narrowly focused beam).

Kaiser Permanente Medical Center in Fontana has Prostate Pals which meets the fourth Wednesday of every month. For information, call (909) 427-6340. Erectile dysfunction clinics for patients.

Treatment options at Kaiser: surgery including laser prostatectomy (a less invasive form of surgery), radiation and/or chemotherapy, seed implantation (in San Diego and Los Angeles only).

- La Rue Novick may be reached by phone at (909) 483-9328 or by e-mail at larue.novick@dailybulletin.com.