What To Expect With Proton Therapy
The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.
Patients with prostate cancer typically undergo a minor procedure to place three small markers in the prostate, called fiducial markers. These markers allow the treatment team to accurately align the treatment each day to the location of the prostate. Your doctor will also determine if you are also eligible for placement of a special hydrogel between the prostate and rectum , which creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum and dissolves after a few months.
After placement of the markers , most patients return another day for a simulation or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.
Protons In Prostate Cancer
In prostate cancer the benefits are less clear. A big advantage of protons is the reduction in the total dose delivered to the patient. However, the main side effects associated with this are much less significant in adults: delays in development are not a factor, and the risk of additional cancers are much lower as they typically take decades to develop.
Instead, the main side effects are seen in organs close to the prostate that also receive a high dose, such as the bladder and rectum. A high dose must be delivered to a region that includes the prostate and some additional healthy tissues, to make sure the disease is treated fully. The extra margin allows for the variation that occurs during treatment, such as differences in the way the patient lies down, to make sure the cancer gets a full dose each day. As these patient variations are independent of the radiation type, protons and X-rays typically deliver similar high doses to these healthy tissues.
Despite this, proton therapy has been widely adopted because it is argued the physical benefits are clear, even if small, and will become apparent with time as more people reach the five and ten-year survival mark. But the results of studies investigating the effects of proton therapy on prostate cancer are mixed. While protons have been shown to an effective treatment for prostate cancer, no consistent advantage has been seen for either long-term survival or quality of life.
Possible Side Effects Of Proton Beam Therapy
Like most cancer treatments, proton beam therapy can cause side effects and complications. Even though proton beam therapy is delivered to a precise area, damage to normal cells near the tumor may occur. Many of the side effects are similar to the side effects of conventional radiation therapy, but due to the precise focus of damage, may be less severe. The most common side effects include:
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease and to the individual person. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are the only center in the world to do MRI-based treatment planning. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. This allows us to make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
For more advanced disease, we have ongoing studies in which we combine novel hormonal therapy agents with radiation to achieve better results. Even the way we follow our patients after treatment is unique, with carefully sequenced MRI checks that give us opportunities to monitor patients extremely closely.
External Beam Radiation Therapy: How It Works
EBRT refers to the external delivery of any type of radiation, and can use several different types of energy including photons, electrons, and heavy particles . Additionally, there has been an evolution in the methods to deliver this energy , progressing from two-dimensional radiation therapy to three-dimensional conformal radiation therapy , and, more recently, intensity-modulated radiation therapy .
Dose distribution curves of photon and proton beams. The spread-out Bragg peak is demonstrated here to cover the entire target with the maximal dosage.
Schematic of multileaf collimator. Individually positioned tungsten leaflets conform the shape of the beam to the target as used in three-dimensional conformal radiation therapy.
Advances in image guidance such as on-board imaging units have helped to deliver the radiation more accurately to the prostate. These have dramatically decreased the uncertainty in target localization and improved the accuracy of radiotherapy to the prostate. However, despite all of these advances, the physical parameters of a photon beam will always include both entrance and exit doses and, ultimately, a significant volume of normal tissue receiving low to moderate doses.
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Risk Factors And Prevention
Risk factors such as age, ethnicity, and family history have been known to influence the chances of a person developing prostate cancer. However, it should be noted that risk factors dont have a direct impact on the development of cancer.
Men over the age of 50 are more likely to develop prostate cancer. In fact, 80% of people who are diagnosed with prostate cancer are over the age of 65.
According to the CDC, African American men are more likely to be at risk for prostate cancer and are more likely to develop aggressive tumors. On the other hand, Caucasian men are just under the average rate of prostate cancer diagnoses. Likewise, Hispanic men also have a lower risk. People of Asian and Pacific Islander descent have the lowest risk of developing prostate cancer.
A family history of prostate cancer can also have an impact on your chances of developing cancer. Only 5% of prostate cancer cases are inherited, but up to 20% of cases are familial, meaning common lifestyle factors and shared genes may have had an influence on the development of cancer.
While risk factors dont have a direct impact on the development of prostate cancer, they can motivate you to monitor your lifestyle more closely. To lower your risk of developing prostate cancer, its recommended to eat a low-fat diet and exercise regularly. However, its best to monitor your health by receiving routine checkups and prostate screenings from your doctor.
Spaceoar Hydrogel: Reducing Radiation Exposure
The prostate and rectum are located very close to each other and are separated only by a small space. When undergoing proton therapy for prostate cancer, your doctor will determine if you are eligible for placement of a special hydrogel between the prostate and rectum . The SpaceOAR hydrogel creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum, thereby minimizing unwanted side effects and potential injury to the rectum during treatment. More than 50,000 patients worldwide have been successfully treated with SpaceOAR Hydrogel.
The placement of the hydrogel is a minimally invasive procedure done within our center and the hydrogel remains inside the body throughout treatment. The material that the SpaceOAR Hydrogel is made from has been used in other implants such as surgical sealants used in the eye, brain and spine. The biodegradable material naturally dissolves after a few months and is cleared in your urine.
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Patient Details And Data Collection
We reviewed 231 patients treated consecutively at our institution with PBT for localized prostate cancer on a prospective IRB-approved registry. Patients were excluded for prior radical prostatectomy, prior radiotherapy, treatment with mixed photon and proton radiation, or follow-up < 1-year. Total 192 patients were included in this analysis. Baseline characteristics are outlined in Table . All patients underwent institutional pathology review of prostate biopsy to confirm Gleason score. Intermediate risk patients by DAmico risk groups underwent computed tomography and/or magnetic resonance imaging of the pelvis. Patients with high-risk disease also had technetium bone scans.
Table 1 Patient characteristics
Dose was verified with an ion chamber measurement performed in water and field shape was verified by comparing the physical shape of the apertures and compensators with the treatment planning system. For PBS delivery, treatment plans were created using the RayStation treatment planning software with single-field uniform dose optimization. Dose and fluence were measured pre-treatment using the MatrixxPT ion chamber array device .
Prepare Your Nulytely Bowel Preparation Solution
On the morning of the day before your procedure, add lukewarm water to the NuLYTELY, filling it to the top of the line on the bottle. Add a flavor pack, if you choose. Use only a flavor pack that was provided with your NuLYTELY.
With the cap on, shake the NuLYTELY bottle until the powder is dissolved. The mixture will be clear, even if you used a flavor pack. If you prefer, you can place the bottle in the refrigerator to chill it. Many people have told us that NuLYTELY tastes better cold. Dont mix the NuLYTELY earlier than the morning before your procedure.
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Proton Therapy Treats Prostate Cancer With A Low Risk Of Side Effects
The five-year results of over 1,300 men treated at UF Health Proton Therapy Institute for prostate cancer were recently published in a peer-reviewed medical journal.1 As reported by UF researchers, the results revealed that the majority of these men are living cancer-free with minimal to no side effects. The five-year survival rates for low, intermediate, and high-risk prostate cancer are 99%, 94%, and 74% respectively with less than 1% having experienced any bowel issues and less than 3% having experienced any urinary issues.
Because of the comparatively low occurrence of side effects such as incontinence, impotence, and fatigue, prostate cancer patients receiving proton therapy are able to continue working, playing, and living relatively normal lives both during and after treatment. Thats why more and more patients with prostate cancer are choosing proton therapy.
Proton Therapy Vs Hormone Therapy
Unlike surgery, hormone therapy is a common treatment option when prostate cancer spreads in other tissues.
In these cases, proton therapy has limited utility because it is designed to treat localized prostate cancer.
Still, even in advanced prostate cancer, proton therapy can slow the progression of the primary tumor.
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A Gel To Prevent Rectal Burns
A lifelong rectal burn is rare, but it can be very debilitating, resulting in pain, bleeding, and loss of rectal control. A revolutionary technology called SpaceOAR greatly reduces the risk of a serious burn to the rectum. SpaceOAR hydrogel is injected between the prostate gland and rectal wall and remains in place throughout the period of radiation. The hydrogel moves the rectal wall away from the prostate gland and out of the radiation field. Thus, the risk of a radiation burn to the rectum is almost eliminated.
What Is The Recovery And Outlook After Proton Therapy
Most people return to their daily activities immediately following a proton therapy session. Many people see benefits from this procedure within 2-8 weeks. The tumors response to proton therapy depends on the type of cancer you have and its location within your body.
If you are diagnosed with cancer, ask your doctor about proton therapy as a possible treatment option. Your doctor will help you determine whether this treatment is a good option for you.
Last reviewed by a Cleveland Clinic medical professional on 05/26/2021.
References
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Who Is Liable Photon Therapy Treatment
Any patient that is fit for radiotherapy as a treatment method can also benefit from photon therapy. Photon therapy is a remarkable treatment option for patients that have been diagnosed while the cancer is in its early stages. It can also serve as a long-term treatment method for the disease if it has already advanced through its late stages.
New Study Compares Long
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.
Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.
Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.
Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:
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Proton Therapy Is Proven To Enhance Quality Of Life
According to a national survey, patients who received proton therapy to treat their prostate cancer reported experiencing a better quality of life with regard to urinary and bowel function during and after proton therapy, compared to those who received traditional radiation. Additionally, more than 70% of prostate cancer patients who received proton therapy noted the treatment had no impact on their quality of life overall.
Two studies conducted by the University of Texas confirm that patients who receive proton therapy treatments for prostate cancer show an improved quality of life compared to those who choose other treatment options.
In general, patients are interested in learning how they will do compared to those treated with other modalities, but, more importantly, they want to know how they are going to do, relative to their own normal state of health, said Andrew K. Lee, M.D., who led both studies. With such a large data set, this study offers us a guide to have that discussion with patients considering proton therapy.
97% of survey respondents who chose proton therapy treatment for their prostate cancer said they would recommend it to other patients, as well.
Will Radiation Therapy Make Me Tired
Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.
If your doctor thinks you should limit your activity, they will discuss it with you.
To minimize fatigue while you are receiving radiation treatment:
- Be sure to get enough rest.
- Eat well-balanced, nutritious meals.
- Pace your activities and plan frequent rest periods.
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What Should I Expect From Proton Therapy
A specialized doctor will plan your proton therapy. Your treatment may involve daily proton beam therapy sessions for several weeks. The length of treatment depends on the type and location of the tumor.
Before your treatment begins, you will have a simulation with a computed tomography scan. Using the scan results, a radiation oncologist identifies the tumors exact size and dimensions. The CT scan guides your healthcare teams decisions about the most effective techniques to deliver proton beam therapy.
For each treatment, a radiation therapist helps you enter and position yourself within the treatment vault. An immobilizing device may help keep your body in a still position for treatment. Generally, proton therapy sessions only last a few minutes.
Proton Therapy Treats Prostate Cancer With Minimal Side Effects
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Many men half his age would be hard-pressed to match AlbertoGonzalezs energy, enthusiasm and determination.
After undergoing treatment for prostate cancer over the past year or so, Mr. Gonzalez, who turned 80 in August, is itching to get back on his bike. In fact, hes already thinking about an around-the-state ride to help draw awareness to prostate cancer and raise funds for Miami Cancer Institute at Baptist Health South Florida, where he was treated.
Mr. Gonzalezs prostate cancer was caught in the spring of 2018 during an annual check-up. A PSA level of 25 and a Gleason Score of 9 indicated he was at high risk for cancer. An MRI confirmed the presence of a tumor on his prostate gland that was on the verge of metastasizing into his colon.
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