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Proton Radiation Treatment For Prostate Cancer

Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy

Benefits of Proton Therapy for Prostate Cancer

Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.

External Beam Radiation Therapy

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

Protons: A Different Mechanism

Protons can also be administered by two methods. The older method includes large beams of passively scattered protons that are shaped with the use of high-density blocks or apertures to shape the large beam as it exits the nozzle. Compensators are employed within the beam to alter the beam profile to better conform the SOBP to the actual tumor. A second, newer method employs a very narrow, pencil thin beam to paint the dose on the target, and no blocks or compensators are needed. The pencil beam is swept in a raster pattern back and forth across a target guided out of the nozzle by magnets . This allows the delivery of intensity-modulated proton beam therapy , with a greater ability to conform the dose to an irregularly shaped target. Although not widely available, many new facilities are being planned with pencil beam-only systems.

Pencil beam scanning. The pencil beam is swept in a raster pattern back and forth across a target. Reproduced with permission from Mayo Clinic News Network.

aAs determined by Phoenix criteria. bAs determined by American Society for Therapeutic Radiology Oncology criteria. c Determined by a rise in prostate-specific antigen to > 50% than the nadir and > 2 ng/mL.

2D, two-dimensional 3D, three-dimensional GI, gastrointestinal GU, genitourinary HD, high dose IMRT, intensity-modulated radiation therapy LD, low dose.

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Potential Benefits Of Pt And Reported Clinical Outcomes Of Prostate Treatments

Given the different beam characteristics of protons and photons, a modulated proton beam confines dose deposition to the target region, with a rapid depth- and lateral-dose fall-off favoring normal tissue sparing and target dose escalation. Several dosevolume comparison studies showed that both passive scattering and pencil beam scanning PT reduced the mean dose and percentage of volume receiving low dose in the rectum and bladder compared with IMRT. In the prostate, PT maintained dose coverage, demonstrating superior dose conformity over IMRT. In most circumstances, a simple bilateral proton beam is employed for localized prostate cancer. Other arrangements, such as anteriorposterior or anterioroblique beams may be used in patients with a hip prosthesis or previously irradiated hip . Nevertheless, PT has consistently been shown to have a smaller irradiated volume of normal tissue and lower integral non-target dose , as illustrated in Figure 1. A systematic review showed that the risk of radiation-induced second primary cancer appears to be small , but does increase over time . As prostate cancer survival improves, the risk of radiation-induced second malignancies becomes more relevant .

Integral dose comparison of volumetric modulated RapidArc therapy -full rotation and photon therapy -bilateral in prostate treatment plans. The most significant differences were in the 10% and 30% isodose distributions of the 78-Gy prescription.

Proton Vs Photon Radiation

Proton Beam Therapy for Prostate Cancer

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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What Will The Future Bring Will Cancer Be Curable For All Patients

The AiroMedical team can look into the future. Thanks to new treatment methods, cancer will be treated not as a fatal disease but as a chronic sickness. With careful treatment, including proton therapy, patients can expect a longer life and a higher quality of life, despite a cancer diagnosis. On our website, you can find the best clinics in Germany that treat many types of cancer with proton therapy. That fully corresponds to the concept of the “future” in oncology treatment.

Delivery Of Postprostatectomy Radiation Therapy

Postprostatectomy radiation therapy is indicated in the adjuvant or salvage setting after surgery, depending on the pathologic risk factors of recurrence after surgery. With conventional radiation therapy doses, biochemical disease control is achieved in only 50% to 60% of patients requiring radiation therapy as salvage treatment for prostate-specific antigen progression after prostatectomy . Meanwhile, tumor control probability curves have consistently shown that doses > 70 Gy when delivering conventional fractionation may be needed to prevent recurrence or progression of prostate cancer . Proton therapy may offer the potential for safe dose escalation in this setting. Deville et al recently reported outcomes for patients treated with proton therapy to the prostate bed after prostatectomy. Patients were treated to 70.2 GyRBE at 1.8 GyRBE per fraction. The median follow-up was 55 months. The 5-year biochemical relapse-free survival rate was 56%. Toxicity was not reported. Additional studies will soon be reported evaluating the outcomes after adjuvant and salvage proton therapy for prostate cancer. These studies along with the findings of Deville et al will further inform the medical community on the role of postprostatectomy proton therapy.

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This part of cancertreatment is called palliative care or supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease. Coping with physical side effects. Common physical side effects from each treatment option for prostatecancer are listed in the Types of Treatment section.

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Proton Therapy Vs Other Prostate Cancer Treatments

Proton Therapy Intermediate-Risk (Teal) Prostate Cancer | Prostate Cancer Staging Guide

Is proton therapy superior to hormone therapy or chemotherapy? The answer might not be that simple because it depends on what you need.

Each treatment method has its pros and cons. They also have specific applications, and using them or not in a determined patient depends on comprehensive studies that evaluate what works better for most.

However, for educative purposes, lets make a brief comparison between proton therapy and other prostate cancer treatments:

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Proton Therapy Advantages And Disadvantages

Proton radiation may represent an incremental improvement over IMRT due to the reduced exposure of surrounding normal body tissues to radiation. Therefore, in the situations outlined above where IMRT would normally be considered, men may prefer to choose proton radiation over IMRT. The purported advantages of proton radiation over IMRT remain theoretical and clinically unproven. No head to head studies comparing the IMRT and proton radiation exist.

Disadvantages associated with proton radiation are related to its high cost and the fact that not all insurance programs cover proton radiation. In addition, there are relatively few centers doing proton radiation, so geographic inconvenience can be a major factor considering that numerous visits are required over a 5 to 9-week period.

Men considering treatment for prostate cancer need to do their homework. Side effects from radiation can be irreversible. The selection of optimal radiation varies with patient circumstances. Many factors need to be considered when radiation is contemplated.

Proton Radiation Therapy For Prostate Cancer

Proton radiation is an enhanced type of radiation gaining in popularity for the treatment of prostate cancer. Men who are contemplating proton radiation need to compare and contrast it with all the other types of radiation to determine if proton therapy is advantageous for them in view of their specific circumstances.

A full course of proton radiation requires five treatments per week continued for eight or nine consecutive weeks. During each visit, patients are positioned in front of an invisible beam of protons that target the prostate gland.

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Clinical Benefits Of Proton Therapy

Proton therapy is the most advanced form of radiation therapy for cancerous tumors currently available. More than 800 clinical studies have been published on proton therapy. Recent research published in the journal JAMA Oncology found that people who have proton therapy are two-thirds less likely to experience side effects requiring hospitalization than people who have traditional X-ray or photon radiation.

Most solid, localized tumors can be treated with proton therapy. This includes tumors in the central nervous system and lymphatic system, as well as recurring tumors. Proton therapy may be a treatment option for a number of adult and pediatric cancers, including cancers of the brain and central nervous system, breast, esophagus, head and neck, liver, lung, lymphatic system, eyes, pancreas, prostate, bone and others.

High-level benefits

  • Less damage to nearby healthy tissue
  • Fewer short- and long-term side effects
  • Lower risk of secondary cancers
  • Increased quality of life

The Initial Causes How Much Does Proton Therapy For Prostate Cancer Cost

Proton Beam Therapy for Prostate Cancer

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

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Lifesaving Proton Therapy Close To Home

If you are receiving cancer treatment, you want the latest, most innovative therapies available.

The Proton Therapy Center at The University of Kansas Cancer Center offers the most advanced form of radiation therapy available for cancer today. Ours is the first proton center in Kansas and in the Kansas City region. If you or a loved one is facing cancer, you no longer need to travel out of the region to receive this innovative treatment.

Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

  • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
  • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
  • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
  • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

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How Can I Help Myself

Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.

Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.

  • Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
  • Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
  • Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
  • If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
  • Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
  • Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
  • Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
  • Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
  • If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.

Cancers Treated With Proton Therapy

Proton Therapy, IMRT, and SBRT | Mark Scholz, MD | PCRI

Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue. Children may receive proton therapy for cancers of the brain and spinal cord. It is also used for cancer of the eye, such as retinoblastoma and orbital rhabdomyosarcoma.

Proton therapy also may be used to treat these cancers:

  • Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma

  • Eye cancer, including uveal melanoma or choroidal melanoma

  • Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers

  • Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone

  • Noncancerous brain tumors

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Active Surveillance For Prostate Cancer

Also known as watchful waiting, active surveillance is a non-treatment option that involves continued monitoring of prostate cancer. More frequent checkups are often required to keep an eye on any changes through PSA blood tests, Digital Rectal Exams and ultrasounds. Biopsies may also be done to assess the aggressiveness of the cancer and its risk of growing and spreading. Studies have found that, after 15 years on active surveillance, less than 1% of men developed a metastatic disease. Additionally, over 30% of men have prostate cancers so slow-growing that non-treatment may be a better option.

Often Recommended for:

Possible Side Effects of Active Surveillance:

  • No treatment-related side effects

Pros & Cons of Active Surveillance for Prostate Cancer

Pros:

  • No surgery or hospital stays
  • New technologies continue to improve imaging and testing

Cons:

  • Frequent checkups for testing and biopsies
  • May face a greater risk of prostate cancer growing and spreading
  • Stage of your prostate cancer may advance
  • May limit future treatment options and chances of curing the cancer
  • Diagnosis can create stress and anxiety

How Do You Determine Whats Right For You

Whether youve recently been diagnosed with prostate cancer or youre dealing with recurrent or metastatic cancer, you may be facing difficult decisions about your treatment. Its normal to be unsure about what steps to take, and most patients have more than one choice.

Start by talking to your oncologist about the specifics of your case and your options. The American Society of Clinical Oncology has a helpfullist of questions to ask your doctor about prostate cancer you may want to reference.

If possible, see a multi-specialty cancer care team to get a bigger picture of your case and your options. This is also important because, sometimes, factors outside of your cancer stage may impact your treatment options. For example, you may have an obstruction in your urinary tract that makes surgery a more appropriate choice than radiation. Or maybe you have another health condition that makes surgery more risky for you. In that case, radiation may be a better choice. You want these doctors to talk to one another about your case each has expertise that makes an important contribution to the decision-making process. To facilitate this coordination, you may have to set up appointments to see multiple doctors and ask them to discuss your case.

If youre interested in getting a second opinion for prostate cancer, or if youd just like to talk with someone at CTCA about your cancer care, or chat online with a member of our team.

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A Special Bond: The Radiation Therapist’s Role In Proton Therapy

With a bachelors degree in biology and experience as an EMT, Taek developed a passion for patient care very early on. While pursuing his degree at Virginia Commonwealth University , he was introduced to proton therapy when he had the opportunity to rotate through a nearby proton center during his junior year. At the time, there were only 10 proton centers in the country, and Taek found his niche.

After graduating from VCU in 2017, Taek worked at the Maryland Proton Center as a staff radiation therapist and then joined us here at NYPC in 2019.

As a Lead Radiation Therapist, Taek manages NYPCs 25 staff radiation therapists and oversees treatment scheduling among the four treatment rooms. In doing so, he acts as a liaison between many of the various departments at NYPC, including Patient Coordinators, Nursing, Physics, and Dosimetry. He also administers proton radiation therapy to patients. This involves carefully positioning patients using immobilization devices and laser beams to ensure that the patient is in the correct position so that the pencil beams are delivered with absolute precision.

Taek wants patients to know that he understands beginning radiation treatment can be anxiety provoking, but that proton therapy is completely painless, and the entire staff at NYPC is eager to make the process as comfortable and seamless as possible.

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