Treatment And Analysis Of Data
The value of the PSA at the time of failure was kept as the last PSA record for that patient, discarding subsequent PSA values, because they would be influenced by androgen deprivation.
The cases confirmed as loss in the follow-up were censored on the date referring to the last follow-up recorded in the medical record. Patients who died due to causes unrelated to prostate cancer or its treatment were censored at the date of death.
The cases were stratified according to risk classification proposed by D’Amico,2121 D’Amico AV. Combined-modality staging for localized adenocarcinoma of the prostate. Oncology . 2001 15:1049-59 discussion 1060-2,1064-5,1069-70,1073-5.considering: low risk as patients with PSA 10ng/mL, a Gleason score 6 and staging T2a intermediate risk as patients with staging of T2b or PSA between 10 and 20ng/mL, or Gleason score of 7 and high risk as patients with PSA > 20ng/mL or Gleason score 8 or staging T2c.1414 Comploj E, Pycha A. Experience with radical perineal prostatectomy in the treatment of localized prostate cancer. Ther Adv Urol. 2012 4:125-31.,2121 D’Amico AV. Combined-modality staging for localized adenocarcinoma of the prostate. Oncology . 2001 15:1049-59 discussion 1060-2,1064-5,1069-70,1073-5.
We used the Epi Info 2000 program for input and descriptive analysis of the data and Stata version 9.0, for survival analysis and prognostic factors.
The study was authorized by the ethics committee of the Federal University of Juiz de Fora .
Brachytherapy For Prostate Cancer
Brachytherapy is a form of internal radiation therapy. With this type of therapy, radiation is delivered to the prostate tumor inside the body via a catheter or another implantable device.
High-dose rate brachytherapy uses radioactive Iridium-192 to deliver high doses of radiation to the prostate tumor. Treatments are short, sometimes requiring as few as five sessions. Brachytherapy radiation more tightly surrounds the tissues were targeting, which may help spare normal tissues.
A Brief History Of Prostate Treatment From Surgery To Radiation
Surgery has been the standard of care for prostate cancer for the past 150 years. Although effective, radical prostatectomies are invasive and not without complications. But then, shortly after the discovery of X-rays and radium at the turn of the last century, physicians began to explore how these modalities might improve survival and decrease potential side effects from the radical surgery. In 1917, Dr. Benjamin Barringer, chief of urology at what is now known as Memorial Sloan Kettering Hospital, espoused the use of radium needles for prostate cancer.
Initially, radioactive seed implantation was performed via free-hand technique, using direct visualization of the prostate to guide the radiation oncologist with seed placement. However, the results of this preliminary approach were hampered by suspect dose distribution in the prostate.
In 1987, Dr. John Blasko from Seattle described a reproducible system to implant radioactive iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patients perineum . The template guides the placement of the needles that are loaded with radioactive seeds. This technique allows a reproducible, uniform dose distribution to the prostate.
At Princeton Radiation Oncology, our radiation oncologists have been performing the prostate seed procedure since 1997. We use the Seattle groups criteria for implant selection.
Whos Eligible For This Procedure
Permanent implants are relatively low-energy sources, and therefore have limited tissue penetration. A well-done implant treats the prostate and the surrounding few millimeters of adjacent tissue.
The best candidates for this procedure are patients with a cancer within or near the prostate. Patients with prostate cancer thats invading nearby structures like the bladder or rectum arent appropriate for this technique.
Prostate Cancer Treatment Pros And Cons You Should Know
The American Cancer Society has revealed that one out of nine people in the US is diagnosed with prostate cancer.
Moreover, prostate cancer is more likely diagnosed in men age 65 or older and rare in men under age 40.
Prostate cancer in the US takes more lives annually among men after lung cancer.
If you have a close loved family member or friend who has prostate cancer, it becomes essential that you understand the various options for prostate cancer treatment available.
Prostate cancer treatment is done either with surgery or radiation.
Prostate cancer surgery or radiation, which is better?
Well! Both treatments have different side effects, such as bladder, bowel, and erection problems, although radiation treatment is more likely to cause bowel problems.
Moreover, surgery therapy can lead to leaking urine or erection problems in men.
Moreover, in surgery, it will remove the prostate to treat cancer.
According to research, it has shown that men who had radiation treatment are more likely to die early of any cause compared to those who had surgery.
Lets look after various prostate cancer treatment pros and cons.
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Questions To Ask Your Doctor Radiographer Or Nurse
- Will I have a planning session at a different time to the treatment, or immediately before?
- Will I have external beam radiotherapy or hormone therapy as well?
- What side effects might I get?
- How will we know if the treatment has worked?
- What should my PSA level be after treatment and how often will you test it?
- If my PSA continues to rise, what other treatments are available?
Other Treatment Options For Prostate Cancer
There are several other prostate cancer treatment options that are available for the patients. Chemotherapy is one of the other popular treatment modality that may be used after surgery for patients with the cancer of the prostate.
The following table highlights the average cost of chemotherapy for prostate in some of the top medical tourism destinations in the world:
- Hormone therapy
- External beam radiotherapy
Thus, the total cost of prostate cancer treatment varies greatly from one individual to another, depending on the individual medical case.
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What Is The Radioactive Seed Implant Procedure
During the procedure, radioactive seeds are implanted into the prostate gland using ultrasound guidance. The number of seeds and where theyre placed is determined by a computer-generated treatment plan tailored for each patient. About 100 seeds are commonly implanted.
The implants remain in place permanently, and become biologically inert after about 10 months. This technique allows a high dose of radiation to be delivered to the prostate with limited damage to surrounding tissues.
Radioactive seed implants are an outpatient procedure. Compared to external radiation which requires up to seven to seven-and-a-half weeks of daily treatments convenience is a major advantage of this treatment option.
Surgery For Prostate Cancer
A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.
The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.
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For Prostate Seed Implantation Trust Experience And Skill
The outcome of implantation is highly operator-dependent. As such, it is important for the radiation oncologist to be experienced and proficient with this procedure. The physicians of Princeton Radiation Oncology are among the most experienced and have been instrumental in pioneering this treatment option.
Ebrt Or External Beam Radiation Therapy
The EBRT is a 10-minute radiation therapy where a single radiation beam treats the affected local area.
The main reason why most people undertake EBRT because of its painless treatment.
Few healthy cells are also destroyed, as the single beam is used to treat a specific area.
The patient undertaking EBRT would suffer from loose stools, frequent urination, and bleeding in the rectum area.
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Prostate Seed Implantation At Princeton Radiation Oncology Treats Prostate Cancer Effectively
Prostate seed implantation is a minimally invasive procedure for treating prostate cancer in which radioactive seeds are placed in the prostate gland to target cancer cells while maximizing the preservation of healthy tissue. This outpatient procedure requires general anesthesia and takes only a few hours. Most patients return to normal activities within two to three days.
At Princeton Radiation Oncology, our doctors are experts in treating prostate cancer patients using prostate seed implantation, having pioneered its use more than two decades ago.
Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
What Are The Advantages And Disadvantages
What may be important to one man might be less important to someone else. Your doctor, nurse or radiographer can help you choose the right treatment for you. Theres usually no rush to make a decision, so give yourself time to think about things.
- Recovery is quick, so most men can return to their normal activities one or two days after treatment.
- It delivers radiation directly into the prostate, so there may be less damage to surrounding healthy tissue, and a lower risk of some side effects.
- You will only be in hospital for one or two days.
- If your cancer comes back, you may be able to have further treatment.
- It can cause side effects such as urinary and erection problems.
- You will usually need a general or spinal anaesthetic, which can have side effects.
- It may be some time before you know whether the treatment has been successful.
- You will need to avoid sitting close to pregnant women or children during the first two months after treatment.
What Are The Side Effects
Urinary symptoms are the most common side effects of the procedure. These symptoms include frequent urination and a need to get to the bathroom quickly. There might also be burning with urination and, in a few cases, an inability to empty the bladder completely. These symptoms can usually be managed with medicine, and improve over time. Temporary self-catheterization might be necessary to help drain the bladder if it cant be emptied adequately, but only about 5% of patients require it.
Urinary incontinence is rare in general. The risk might be somewhat increased in patients who have undergone a previous surgical procedure to remove a part of the prostate called a transurethral resection of the prostate . This risk can be minimized by performing a careful prostate ultrasound before the procedure to determine how much prostate tissue is still present to implant.
Rectal bleeding occurs in less than 1% of patients. Diarrhea is rare.
The impotence rate for those fully potent prior to the procedure at five years after the procedure is approximately 25% using brachytherapy alone. If hormone therapy is added, the impotence rate rises to 50%.
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The Main Advantage Of Prostatectomy
This is a very important comment I am gonna make right now. If your cancer ever comes back after surgery, the idea of having a plan B of having low-dose radiation after surgery is feasible. If you start with radiation and cancer comes back, surgery would be very difficult and challenging. So, I want you to know this because not too many people are aware of this.
Again, one more time. If you start with surgery, you still have the radiation as an option. If you start with radiation, surgery would be very difficult because the tissue becomes like a cement attached to the rectum and the surrounding tissues and it would be very difficult to do that operation.
As you get older, because we have removed the prostate with the surgery, you do not have to worry about the old-man disease, an enlarged prostate. With radiation may be some consequences with bleeding from the rectum or bleeding from the bladder. Certainly, in the hands of an experienced radiation oncologist, the results are better. We have superb doctors at St. Francis Hospital. One of my colleagues, Dr. Jay Bosworth, whom I am looking forward to interviewing him at this program, is a fine radiation oncologist and you will have what to learn from him. So, the risks of side-effects in the hands of an experienced radiation oncologist would be less. But there is a small chance of having secondary cancers such as rectal cancer or bladder cancer at some point down the road after radiation.
How To Decide Between Radiation And Surgery For Localized Prostate Cancer
If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options: active surveillance, radiation therapy or surgery. If you arent comfortable with active surveillance, or if its not an advisable option for you, you may have to decide between radiation therapy and surgery to treat your cancer.
Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.
Weve heard of some physicians telling men of their prostate cancer diagnosis and asking them to make a treatment decision at the same appointment. But prostate cancer progresses slowly, so most men have time to think about their options and shouldnt feel pressured into making an immediate decision.
How you feel about the big three possible side effects of treatmenturinary incontinence, sexual dysfunction and bowel healthmay be the deciding factor for you.
To help you through the process of making this decision, this article covers:
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Radiation Therapy Has Most Side Effects
Prostate cancer is expected to be diagnosed in more than 240,000 men in the United States in 2012, according to the American Cancer Society.
Ciezki and colleagues analyzed data on 137,427 men from National Cancer Institute Medicare data collected between 1991 and 2007.
Of the total, 43% of men were treated with surgery , 44% with external beam radiation therapy, and about 13% with brachytherapy. Researchers looked only at side effects that required a procedure to correct them.
Over a six-year period, on average, 8.8% who had external beam radiation therapy, 6.9% of patients who underwent surgery, and 3.7% who had brachytherapy needed a procedure to fix a therapy-related effect.
A total of 7.1% of patients who received external beam radiation therapy experienced problems such as incontinence or bladder bleeding, compared with 6.7% of those treated with prostatectomy and 3.4% of those treated with brachytherapy.
And 1.7% of EBRT patients had gastrointestinal side effects such as rectal bleeding, compared with 0.1% of prostatectomy patients and 0.3% of brachytherapy patients.
Brachytherapy was the cheapest treatment: $2,557.36 per year. Prostatectomy was slightly more expensive, at $3,205.71, followed by EBRT at $6,412.29.
At 5 Years Brachytherapy Shows Quality
Five years after treatment for favorable-risk prostate cancer, men who either chose or were randomly assigned to receive brachytherapy reported quality-of-life advantages in urinary and sexual domains and in patient satisfaction compared to men who received radical prostatectomy, according to a study recently reported in the Journal of Clinical Oncology.1 Favorable risk prostate cancer was defined as Gleason score 6, prostate-specific antigen < 10 ng/mL, stage T1 to T2a.
The men were originally approached at the University Health Network and Princess Margaret Hospital in Toronto for participation in the phase III Surgical Prostatectomy versus Interstitial Radiation Intervention Trial . The trial was closed due to poor accrual, but 168 trial-eligible men who received either radical prostatectomy or brachytherapy completed health-related quality of life assessments 3.2 to 6.5 years later.
Statistically Significant Domain Differences
The associated degree of the problem with these changes, as evaluated by the bother scores of EPIC, also reached significance but at levels of P = .02 to P = .049, the authors reported. The bother score is important because otherwise people assessing treatment side effects will make decisions about what effects might be generally troublesome, rather than what actually bothers an individual patient. That is what quality of life is all aboutthe individuals perception, Dr. Crook noted.
Brachytherapy Chosen for Potency Advantages
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Seed Therapy Offers Faster Recovery
“There are a lot of advantages to the seed therapy,” he tells WebMD. “It’s minimally invasive — no cutting, no suturing. You’re discharged two hours later, with no physical restrictions. The procedure is well tolerated.”
Prostate cancer surgery, on the other hand, can cause incontinence and impotence, Potters says.
John Blasko, MD, medical director of the Seattle Prostate Institute and discussant of Potters’ talk at the meeting, agrees seed implants for prostate cancer offer certain advantages: “ease of treatment upfront, rapid return to normal activities, and lack of incontinence or impotence.”
But, he says, prostate cancer surgery shouldn’t be dismissed outright.
“People have a choice,” says Blasko, who is clinical professor of radiation oncology at the University of Washington in Seattle. “Some men might prefer surgery because it offers answers upfront you know right then and there if the cancer was confined to the prostate.”
Also, PSAblood levels, which rise when a man has prostate cancer, stabilize within a few days to weeks after surgery, while they can take years to normalize after seed therapy. “This makes some people anxious,” Blasko says. “Surgery gives them psychological reassurance.”