Thomas Takes Charge of His Health and Chooses Adaptive Radiation Therapy

Thomas Sulfaro has always taken an active role in his healthcare. So when routine bloodwork in 1998 showed an elevated level of prostate-specific antigen (PSA), Thomas began educating himself about prostate cancer. “I'm the only one that's responsible for my health. The doctors give me advice, but I'm responsible,” he says.

He recalls sitting in the waiting room alone after a biopsy showed he had prostate cancer and thinking about the future. “I told myself that if I need surgery, I'm not going to mess around. I'm going to do what I need to do for my health.”

Thomas’ doctors at another health system said surgery was possible, but they offered another option. Rather than surgery to remove the cancer, Thomas chose “active surveillance” — which means periodic PSA testing, digital rectal exams and biopsies as needed. While Thomas carried on with his life and his cherished hobbies like fishing, gardening and golfing, the cancer wasn’t far from his thoughts.

Active surveillance of prostate cancer at Henry Ford Health

About 15 years ago, Thomas began seeing urologist James Peabody, M.D. at Henry Ford Health, who continued active surveillance of the prostate cancer. Over time, Thomas’ PSA increased and MRI-targeted biopsies detected three areas of slow-growing cancer on his prostate.

“Dr. Peabody said in the old days they would have treated it at that point with surgery or radiation,” Thomas recalls. “But researchers are learning more about prostate cancer, and treatment is not necessary in a lot of cases early on. He told me I'm probably one of the people who are going to die with prostate cancer, not from it.”

Still, Thomas’ care team increased the frequency of testing. Eventually — more than 25 years after Thomas’ diagnosis — Dr. Peabody detected a change that made him suggest treatment. “The doctor said I was ready. It was getting worse,” Thomas says.

He was concerned about potential long-term side effects of treatment, including urinary incontinence, bowel issues and erectile dysfunction. Determined to empower himself with knowledge about the latest advances in prostate cancer care, he researched treatments ranging from surgery and radiation to chemotherapy, cryotherapy and hormone therapy.

Adaptive radiation therapy

In June 2023, Thomas met with radiation oncologist Aharon Feldman, MD, who told him about a new type of radiation therapy offered at Henry Ford West Bloomfield Hospital. Known as adaptive radiation therapy, it combines fast CT imaging with artificial intelligence to target tumors with more precision than traditional radiation treatment.

Thomas found the new treatment very appealing. “It targets the cancer without damaging other parts of the body,” he says. He also liked that it could be done over a few days instead of weeks, with fewer side effects.

In December 2023, Dr. Feldman used Henry Ford’s new Halcyon™ CT-guided linear accelerator with Ethos™ technology to plan five highly specific, targeted radiation treatments based on daily imaging. Each day before the treatment, Tom’s care team used the fresh imaging set to replan and remap where the radiation was targeted.

Thomas was pleased by how smoothly the treatment went. He had five radiation appointments over 10 days, each about 30 minutes long. “I laid on my back in the CT machine. My head was out of the tube and my pelvis was inside. It made some minor noises, but not much. They were playing music, and it was actually quite pleasant,” he says. “It was totally non-invasive. I felt nothing.” After each appointment, he went about his day like normal. “I had some side effects, but they were extremely minimal,” he adds.

Lowering Thomas’ PSA score

In the nine months after adaptive radiation therapy, his PSA score dropped from 16.8 ng/mL to 3.3 ng/mL, considered an acceptable range. “It’s a great improvement without surgically removing the cancer,” Thomas says. “I have been extremely pleased with the treatment and I have recommended it to many people.”

With the cancer under control, Thomas can focus on the things he enjoys … fishing, gardening and golfing.