Pencil Beam Scanning: Highly Advanced Proton Therapy For Prostate Cancer
At the New York Proton Center, patients with prostate and other genitourinary cancers receive Pencil Beam Scanning. Its the most sophisticated and precise type of proton therapy.
Pencil Beam Scanning allows clinicians to create a highly customized treatment field based on the unique shape, size and location of the prostate cancer tumorsimilar to traditional proton therapy, only with even greater precision.
As the name implies, Pencil Beam Scanning uses an extremely narrow beamjust a few millimeters wideto dot protons onto the cancer. The process is repeated, layer by layer, like paint applied by the tip of an incredibly fine brush. The treatment is ultra-precise, capable of closely regulating the radiation dose according to the volume of the tumor.
Entrance And Exit Dose Defined
Entrance dose: The dose of radiation that inadvertently makes contact with normal cells before it reaches the cancerous tissue.
Exit dose: Imagine the radiation hitting the tumor, but then continuing on beyond it, taking out normal cells in its path.
The primary difference between proton therapy and Cyberknife is that protons do not have an exit dose, says Dr. Cavanaugh. Both modalities deliver entrance and target dose.
Many insurers have been unimpressed with the differences in outcomes with proton therapy and have declined to pay.
For many patients I prefer HDR brachytherapy to both proton and Cyberknife therapy. HDR stands for high dose rate.
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How Proton Therapy Effectively Treats Prostate Cancer
Proton therapy treats prostate cancer with high doses of radiation that are more accurate, and potentially more effective, than traditional radiation. Our targeted proton beams focus most of their destructive energy at the tumor site, therefore causing less damage to healthy surrounding tissue as they enter the body. Because of this, proton therapy patients dont have to worry about many of the side effects and additional healthy tissue damage that is commonly associated with X-ray therapy.
an effective cancer treatment alternative
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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?
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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What Are The Results Of Using Proton Therapy In Patients
For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.
For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.
Is Proton Therapy Safer Than Traditional Radiation
Traditional radiation therapy delivers radiation to the tumor and to healthy tissues around the tumor. With proton therapy , the majority of the radiation is delivered to the tumor.
A type of radiation treatment called proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.
Traditional radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.
Plus, proton therapy is more expensive than traditional radiation, and not all insurance companies cover the cost of the treatment, given the limited evidence of its benefits. Nevertheless, 31 hospitals across the country have spent millions of dollars building proton therapy centers, and many advertise the potential, but unproven, advantages of the treatment.
In the new study, patients treated with proton therapy were much less likely to experience severe side effects than patients treated with traditional radiation therapy. There was no difference in how long the patients lived, however. The results were published December 26 in JAMA Oncology.
These results support the whole rationale for proton therapy, said the studys lead investigator, Brian Baumann, M.D., of the Washington University School of Medicine in St. Louis and the University of Pennsylvania.
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Cancers Types That Are Treated With Proton Beam Therapy
Proton beam therapy is usually used for localized tumors and is used infrequently for stage 4 tumors . It may be used alone or combined with other treatments such as surgery, chemotherapy, immunotherapy, or traditional radiation therapy. Some types of cancer in which proton beam therapy may be used include:
- Lung cancer: Proton therapy for lung cancer may be used for early-stage cancers that cannot be treated with surgery, or for a recurrence when conventional radiation therapy has already been given.
- Brain cancer: The precise area of delivery offered by proton beam therapy may be beneficial for brain tumors in which even small amounts of damage to nearby normal tissues could have significant side effects.
- Childhood cancers: Proton beam therapy, as discussed below, may do less damage to nearby normal tissues. Since DNA damage to normal cells may lead to secondary cancers, it’s thought that this therapy may be a better option at times for children.
- Head and neck cancers
Some noncancerous tumors, such as benign brain tumors may also be treated with proton therapy.
Open Radical Prostatectomy For Prostate Cancer
During a radicalretropubic prostatectomy, an incision is made in the lower abdomen to remove the entire prostate gland, some tissues and/or seminal vesicles. If there is a reasonable chance the cancer has spread outside of the prostate, your surgeon may perform a lymph node biopsy to test the area before continuing with the surgery as its unlikely it can be cured with surgery alone and the removal of the prostate could lead to other serious side effects. In a radical perineal prostatectomy operation, your surgeon will make an incision between the anus and scrotum to access the prostate. While this operation is shorter, may result in less pain and is an easier recovery, its more likely to lead to erection problems.
Often Recommended for:
- Stage 1 or stage 2 prostate cancer
Possible Side Effects of Open Radical Prostatectomy:
- Erectile dysfunction or sexual impotence
- Urinary incontinence
- Longer recovery times and activity restrictions
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Tougher On Your Tumor Easier On Your Body
Every brain tumor presents its own set of challenges, typically treated with a combination of surgery, chemotherapy and radiation thatâs right for the patient. When it comes to radiation, proton therapy provides a safer option that spares healthy tissue.
With conventional X-ray therapy, surrounding healthy tissue gets a considerable dose of radiation, which can lead to side-effects and secondary cancers down the road. With proton therapy, treatment is delivered precisely to the tumor, so less radiation is delivered to the surrounding healthy tissue.
More precision means less damage to healthy tissue in the brain, eyes, sinuses and spinal cord, potentially offering a faster recovery, and fewer short- and long-term side effects.
Proton therapy takes advantage of a unique characteristic of protonsâthey deliver their largest amount of energy right before they come to a stop. Thatâs how treatment is delivered right to your tumor, and no further.
Who Can Have Permanent Seed Brachytherapy
On its own
Permanent seed brachytherapy on its own may be suitable for men with low risk localised prostate cancer. This is because the radiation from the radioactive seeds doesnt travel very far, so will only treat cancer that is still inside the prostate.
It may also be suitable for some men whose cancer has an intermediate risk of spreading.
With other treatments
If you have high risk localised prostate cancer, you may have brachytherapy together with external beam radiotherapy and hormone therapy. This is sometimes called a brachytherapy boost. Having these other treatments at the same time as permanent seed brachytherapy can help make the treatment more effective. But it can also increase the risk of side effects.
Some men with intermediate risk localised prostate cancer or locally advanced prostate cancer may be offered a brachytherapy boost.
When is permanent seed brachytherapy not suitable?
Permanent seed brachytherapy wont be suitable if your cancer has spread to other parts of your body .
It may not be suitable if you have a very large prostate. If you do have a large prostate you may be able to have hormone therapy before treatment to shrink your prostate.
Not all hospitals offer permanent seed brachytherapy. If your hospital doesnt do it, your doctor may refer you to one that does.
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What Side Effects Will I Have
During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation. Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice a loss of hair or decreased perspiration within the treated area.
These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. If skin changes appear outside the treated area, inform your doctor or primary nurse.
Long-term side effects, which can last up to a year or longer after treatment, may include a slight darkening of the skin, enlarged pores, increased or decreased sensitivity of the skin, and a thickening of tissue or skin.
Another possible side effect is erectile dysfunction and urinary symptoms such as frequency, bleeding, or, rarely, incontinence. Keep these side effects in mind when considering your treatment options. If you have any concerns, don’t hesitate to talk to your doctor about them.
What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Traditionally, we deliver external beam radiation in 45 to 48 sessions over a span of ten weeks, using very sophisticated computer-based planning and enhanced imaging techniques and tumor tracking during the treatment. This is called image-guided IMRT and it is the current standard of care.
But there is increasing interest in giving this radiation in shorter courses of treatment. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. MSK Precise is a form of SBRT that can be given in five sessions instead of the usual 45 to 50. MSK has been doing this for the past nine years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated, with outcomes that are at least equivalent to and possibly better than the standard ten weeks of treatment. Because of its superior precision, MSK Precise has less side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low and similar to what is experienced with conventional external radiation techniques. And of course, its much more convenient for patients.
For patients with more-advanced tumors, we are completing a phase II trial in which were combining sophisticated brachytherapy approaches with MSK Precise. This kind of combination of dose-intense or escalated radiation may end up being a very effective regimen.
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Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
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.
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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.
The Success Rate Of Prostate Surgery
Survival rates can tell you how many people with the same type and stage of cancer are still alive 5 years after being diagnosed. For example, if you have stage 3 colon cancer, there is a 66% chance that 5 years later, you will be alive. But the rates cannot tell you how long you will live. However, they may help give you an idea of how likely your treatment will be successful.
Survival rates are estimates. They are based on data from many people who have had cancer before. These numbers might be confusing because they dont tell you what will happen, but they can help doctors decide treatments. Talk with your doctor to see if these statistics apply to you because they know about your situation.
A relative survival rate tells how likely a person is to survive a particular type of cancer. I.e., if the 5-year close survival rate for prostate cancer is 90%, it means that men who have this type of cancer are about 90% as likely as other men to live a minimum of 5 years after being diagnosed with the disease.
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