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Urdu“He told me he needed to get an EKG to check for possible heart issues so I thought if he has to get checked out at this point, then I probably should too,” said McCarrick.
The news was just the nudge McCarrick, a busy partner in a construction business, needed to make an appointment with his internist in Oakland. He did a whole range of tests, including a blood test to check his prostate-specific antigen (PSA) levels.
While there is no specific normal or abnormal level of PSA in the blood, a PSA score greater than 4 is often considered abnormal for men in their 60s. A PSA score may also be considered abnormal if it rises a certain amount in a single year. If PSA levels are elevated, it can indicate the presence of cancer.
McCarrick’s test results showed that his PSA levels had more than doubled since the last time he got his bloodwork done.
While this alarmed his doctor, McCarrick wasn’t too worried since he figured the change in the PSA levels had to do with a medication he recently stopped taking.
“My PSA was less than six and I had no symptoms of prostate cancer so I argued a bit with my doctor about needing to get this checked out,” said McCarrick.
However, McCarrick ended up agreeing to visit a urologist just to be safe.
Diagnosis and treatment plan
After another round of tests with the urologist, McCarrick was told the results came back “aggressively positive” for prostate cancer – and that he needed to schedule surgery for the following week.
But McCarrick wasn’t ready to make that sort of life-altering decision without getting a second opinion.
McCarrick started doing his own research and reached out to colleagues who had gone through prostate cancer treatment and some who were still in the process of getting treated. It was through one of his colleagues that he heard about Amar Kishan, MD, and UCLA Health.
“My colleague told me about how UCLA had a world-renowned reputation for treating this disease and it was the only place I should go,” McCarrick said. “So I spoke with Dr. Kishan and felt very confident with him and his approach.”
Dr. Kishan, vice chair of clinical and translational research and chief of the genitourinary oncology service in Radiation Oncology at the UCLA Health Jonsson Comprehensive Cancer Center, specializes in using radiation to treat prostate cancers. He has led several clinical trials specifically looking at the benefits of MRI-guided stereotactic body radiotherapy (SBRT).
This type of radiation combines imaging of the cancer within the body with the delivery of five precisely targeted doses of radiation. Dr. Kishan and team are developing techniques to reduce SBRT side effects—such as urinary, bowel and sexual dysfunction—through more precise targeting of the prostate.
“One of the major concerns for patients with a new diagnosis of prostate cancer are the post-treatment side effects and how it may impact their quality of life,” said Dr. Kishan. “As treating physicians, we want to make sure we are giving patients a treatment with the least amount of toxicities possible.”
One phase III clinical trial led by Dr. Kishan, called the MIRAGE trial, compared CT-guided SBRT and MRI-guided SBRT to help determine whether the use of MRI guidance to reduce the volume of tissue receiving radiation leads to a reduction in side effects. SBRT, a five treatment approach for prostate cancer, had been used at UCLA since 2010 and was traditionally delivered with CT guidance. Dr. Kishan launched the MIRAGE trial in May 2020, shortly after a novel MRI-guided linear accelerator was installed at the Westwood campus.
In June 2021, McCarrick and his wife Stacey headed out to Los Angeles to enroll in the MIRAGE trial and start radiation therapy.
“I hate hospitals. I hate everything about them,” said McCarrick. “But I never felt as welcomed in a hospital than I did at UCLA Health. The whole staff, including the radiation technicians, nurses and everyone behind the scenes, were just amazing. They all just had an amazing level of talent, skill and care.”
Other than a little irritation around his bladder that lasted a couple weeks, McCarrick found the treatment to be unobtrusive and it had no negative impacts on his and his wife’s lives.
Results from the trial are showing that there’s a significant advantage to MRI-guided radiotherapy. The team found the precise targeting capabilities of MRI guidance resulted in fewer toxicities and better quality of life for patients. Continued follow-up to evaluate long-term outcomes is ongoing.
“We found that leveraging the precision of the MRI-guided linear accelerator to reduce treatment volumes led to fewer short-term side effects, giving patients a better quality of life,” said Dr. Kishan. “We will conduct an analysis looking at longer-term outcomes this fall, and have already planned the successor trial to MIRAGE, which will evaluate additional technologic innovations as well as precision medicine concepts.”
Staying proactive
Now just a little more than two years since treatment, McCarrick has no evidence of cancer. He’ll continue to have to watch his PSA levels, but has had no issues going back to his everyday life. He keeps busy running his business, traveling with his wife and now helps others going through treatments for prostate cancer.
He often hears from others that are sent his way through colleagues or mutual friends at least once a month who may have just gotten diagnosed and while he may not know all the answers, he is more than willing to share his experience and help people figure out what questions they should ask their health care providers to help them understand their best options.
“One thing I’ve become a big advocate for when I talk to people is to be as proactive and preventive as you can. You can get this treatment done without disrupting your life, but doing nothing is definitely going to disrupt your life.”
