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.
Consensus Statement On Proton Therapy For Prostate Cancer
Corresponding Author:
Curtis M. Bryant, Randal H. Henderson, R. Charles Nichols, William M. Mendenhall, Bradford S. Hoppe, Carlos E. Vargas, Thomas B. Daniels, C. Richard Choo, Rahul R. Parikh, Huan Giap, Jerry D. Slater, Neha Vapiwala, William Barrett, Akash Nanda, Mark V. Mishra, Seungtaek Choi, Jay J. Liao, Nancy P. Mendenhall, the Genitourinary Subcommittee of the Particle Therapy Co-Operative Group Consensus Statement on Proton Therapy for Prostate Cancer. Int J Part Ther 1 September 2021 8 : 116. doi:
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How Proton Therapy Works
A machine called a synchrotron or cyclotron speeds up protons. The high speed of the protons creates high energy. This energy makes the protons travel to the desired depth in the body. The protons then give the targeted radiation dose in the tumor.
With proton therapy, there is less radiation dose outside of the tumor. In regular radiation therapy, x-rays continue to give radiation doses as they leave the person’s body. This means that radiation damages nearby healthy tissues, possibly causing side effects.
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Treatment Options For Prostate Cancer
Early-stage prostate cancer is often slow-growing. Here, it is hard to balance treatment benefits against its side effects. Therefore, delaying treatment until there is evidence of cancer progression is one way to avoid unnecessary side effects.
In some cases, a doctor may recommend watchful waiting or active surveillance to avoid unnecessary treatments.
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.
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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 Vs Photon Radiation
Proton radiation is different from other types of radiation, which rely on photons. Photon radiation comes in three types: intensity-modulated radiation therapy , radioactive seed radiation , and stereotactic body radiation therapy . Sometimes a combination of brachytherapy in conjunction with one of the other types of beam radiation is used.
All types of radiation are effective, resulting in the death of cancer cells. All can potentially cause side effects if the radiation touches adjacent normal organs, such as the bladder, rectum, and urethra.
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More Than 10000 Prostate Patients Treated With Proton Therapy At Llumc Proton Treatment Center
The James M. Slater, MD Proton Therapy Treatment and Research Center has treated more than 10,000 prostate patients with proton therapy since it opened in 1990. No other proton treatment center in the world has such a contribution to health. And as proton research continues, the proton treatment will continue to improve the quality of life in men with prostate cancer.
Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
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How To Prepare For Proton Therapy
First of all, it is vital to locate the nearest center because proton therapy is not available everywhere.
This type of treatment is turning into a popular alternative to radiotherapy, but you might need to travel to get your treatment. In that case, you need to make a few decisions in advance and might need to ask someone else to drive for you.
If the center is far from home, you might need to stay in the city in question.
The treatment requires going to the medical center every day, 5 days a week, for a minimum of 4 weeks.
If you can drive to the medical center and back home, it will be easier to get your treatment, and the procedure itself takes 15 minutes.
However, you probably want to save 45 minutes to 1 hour, considering the preparation, talking to the nurse or doctor, and any unexpected event.
Once you arrive at the medical center for the first time, the radiation oncology team will schedule an initial consultation. During that time, a radiation oncologist will interview you and evaluate your medical images and records. After they determine the appropriate position and angle to receive proton therapy, you will start your treatment.
The team will likely use an immobilization device to ensure that the protons reach the exact location. It is also very likely that the team will spend considerable time in achieving the proper position.
Throughout the procedure, you want to stay still. It will not be a very invasive procedure, and, likely, you wont feel a thing.
Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
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What Is Proton Therapy For Prostate Cancer
Proton therapy for prostate cancer is a treatment option that involves using a focused ray of proton particles to destroy cancerous tissues. The treatment is capable of delivering precise, high doses of radiation to accurately target cancer cells without causing damage to healthy tissue surrounding the prostate.
What Is Proton Therapy
Proton therapy is a branch of radiation treatment. It works like radiation therapy and can treat different types of cancer. Similar to radiation therapy, proton therapy can be a standalone therapy against cancer. However, in most cases, it is combined with additional methods to fight off cancer cells.
To understand proton therapy, it is essential to understand the basics of radiation therapy.
In conventional radiotherapy, you have high-energy X-rays passing through the body. The X-ray radiation is placed in the area where cancer is. Thus, it should destroy cancer tissue. But in doing so, normal tissue is also destroyed or similarly affected.
In prostate cancer, placing a radiation beam targeting the prostate gland exposes the rectum, the bladder, and other organs. As such, external beam radiation therapy complications include urinary symptoms, rectal bleeding, diarrhea, and more.
In an attempt to solve this problem, intensity-modulated radiation therapy was developed. It is known to cause less damage to surrounding tissues. Another option is using proton therapy treatment, which delivers radiation traveling in proton beams.
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Types Of Prostate Cancer Treated At The New York Proton Center
The New York Proton Center treats the following prostate cancers and genitourinary cancers with proton therapy.
Localized prostate cancer, which includes stage 1, stage 2, and stage 3 cancer, that has not grown into nearby tissues or more distant body parts. There are three types:
- Very-low-risk and low-risk prostate cancer, each of which are unlikely to grow or spread for a long time, if at all.
- Intermediate-risk prostate cancer, which may grow or spread in a few years.
- High-risk prostate, which has the highest likelihood of spreading and, even after treatment, recurring.
Prostate cancer will sometimes grow quickly and spread to lymph nodes, pea-sized pieces of tissue that filter a waste product called lymph. When this happens, a larger area needs to be targeted for treatment that includes the prostate gland and the lymph nodes. Proton therapy is particularly beneficial when treating large areas in the pelvis.
Data suggest that men who have undergone prostatectomy for prostate cancer may benefit from follow-up treatment with proton therapy, depending on several factors:
- Gleason score
- Seminal vesicle and lymph nodes involvement
- PSA levels
Bladder cancers have a high correlation to prostate cancer. The types are named for the cells they affect, usually in the bladder wall.
Kidney cancer patients are at increased risk of prostate cancer.
Proton therapy can treat these recurrent tumors more safely than other methods, giving patients a better chance for a cure.
Limitations Of The Studys Design
The study leaders and other experts noted several limitations to the studys design.
For instance, this observational study cant establish a cause-and-effect relationship between proton therapy and fewer side effects. In addition, all of the study participants were treated at a single institution, which can make it difficult to generalize the findings to a larger population.
Those are very significant limitations that shouldnt be understated, Dr. Buchsbaum emphasized.
Although single-institution studies have inherent limitations, Dr. Baumann noted, all patients in this study received high-quality treatment at a large academic medical center, regardless of whether it was proton or traditional radiation therapy, which suggests that the benefit of proton therapy that we saw is meaningful.
Also, because patients were not randomly assigned to treatment groups, there were differences between patients who got proton and traditional radiation, and that may have skewed the results.
For instance, patients who received proton therapy were, on average, older and had more health issues.
The proton therapy group may also have included more patients from privileged backgrounds, Drs. Park and Yu noted. Socioeconomic status and social support can affect treatment outcomes, they wrote.
In addition, fewer people with head and neck cancerwho are more likely to suffer from radiation-associated side effectswere included in the proton therapy group, the editorialists added.
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Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
To Cut Or Not To Cut: Radiation Vs Surgery For Prostate Cancer
Ishaan Sangwan Nov 16, 2021 5 hits
Since prostate cancer is a slow growing disease, the value of treatment is often questionable. While many patients can be managed with active surveillance, those who do require treatment often have radiation and surgery presented as their two options. This article discusses the risks and benefits of these two treatments, with unique insights from Dr. Jeff Caddedu on the BackTable Urology Podcast. Weve provided the highlight reel in this article, but you can listen to the full podcast below.
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Heres What You Should Know About This Treatment Option
Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.
But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.
Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.
“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.
There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.
Proton Therapy Vs Other Treatments
Which treatment you should have is not as simple as comparing proton therapy to chemotherapy, surgery, or hormone treatments. Each serves a specific purpose.
Your treatment will depend, in large part, on how aggressive the cancer is and its stage at diagnosis. Other things to consider are:
- previous treatments
- age
- other health conditions that might interfere with certain treatments
Proton therapy is more expensive and not widely available. Your doctor will look at the total picture when recommending treatment.
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Safety And Efficacy Of Proton Therapy
Many people with locally advanced cancers are treated with a combination of chemotherapy and either traditional or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority, Dr. Baumann said.
He and his colleagues analyzed data from nearly 1,500 adults with 11 different types of cancer. All participants had received simultaneous chemotherapy plus radiation at the University of Pennsylvania Health System between 2011 and 2016 and had been followed to track side effects and cancer outcomes, including survival. Almost 400 had received proton therapy and the rest received traditional radiation.
Those who received proton therapy experienced far fewer serious side effects than those who received traditional radiation, the researchers found. Within 90 days of starting treatment, 45 patients in the proton therapy group and 301 patients in the traditional radiation group experienced a severe side effectthat is, an effect severe enough to warrant hospitalization.
In addition, proton therapy didnt affect peoples abilities to perform routine activities like housework as much as traditional radiation. Over the course of treatment, performance status scores were half as likely to decline for patients treated with proton therapy as for those who received traditional radiation.
Potential Advantages And Disadvantages Of Pt
The potential advantages and disadvantages of PT result from its dosimetric features. Protons travel only a finite distance, proportional to their speed, which can be controlled during the acceleration process they deposit most of their energy at the end of their range in an area called the âBragg peakâ and, unlike photon-based radiation, there is no exit dose beyond the target. Additionally, the entrance dose is relatively low when compared to external-beam photon radiation. For many target locations, these features reduce the excess radiation dose delivered to surrounding organs and the number of beams needed to treat a target when compared to photon radiation . Multiple dosimetric comparisons have been performed evaluating the extent of the dosimetric improvements that PT offers for prostate cancer and, in general, they have shown that PT reduces the dose of excess radiation provided to OARs in the low-to-moderate range .
Figure 1
Nichols et al. retrospectively reviewed the medical records of 171 men treated with PT for localized prostate cancer and found that PT does not affect serum testosterone levels. PT provides less excess radiation dose to the testes when compared to photon-based radiation. Consequently, while photon-based radiation lowers testosterone by 9% to 27% on average, patients treated with PT can expect no changes in testosterone, which may reduce the risk for fatigue or sexual dysfunction after treatment .
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