Safety First How The Product Is Packaged For Transportation
Bayer designed a special container for transporting its radiopharmaceutical product. After all, it is important to be 100 percent certain that no radiation inadvertently escapes from a radioactive substance. From a transportation point of view, it is considered a hazardous material, and extremely strict safety requirements must be met during transportation, be it by road, by water, by rail or in the air.
Bayers targeted alpha therapy was licensed for market in May 2013. A year before, work had already begun on solving the packaging issue. Ocklenburg says the transportation container was optimized over several stages. The radioactive saline solution in the 10-milliliter vial is first contained in a lead box, which itself is surrounded by a polystyrene casing. A little cube with a lead container, Ocklenburg calls it, and its task is to ensure the medication gets safely from its place of manufacture to the patient.
Packaged ready for transportation, it is contained within a radiation-proof cube measuring approx. 20 cm x 20 cm x 20 cm. According to Ocklenburg, the goal is to make the cube even smaller and easier to handle. In doing so, however, there are safety regulations to consider there are minimum dimensions for hazardous goods containers. Safety first.
Radiotherapy For Advanced Prostate Cancer
This page has information for people having radiotherapy for advanced prostate cancer.
We explain how radiotherapy can be used to treat advanced prostate cancer, what treatment involves, and the advantages and disadvantages of having radiotherapy for advanced prostate cancer.
If you’ve been diagnosed with localised prostate cancer that hasn’t spread outside the prostate, read our information on external beam radiotherapy for localised or locally advanced prostate cancer instead.
What Are The Side Effects
Like all treatments, external beam radiotherapy causes side effects in some men. But they affect each person differently and you might not get all of them, or any of them. Ask your doctor, radiographer or nurse for more information on your risk of side effects.
Side effects after external beam radiotherapy to the prostate, as a first treatment
If youre having radiotherapy to treat the prostate itself, healthy tissue near the prostate may get damaged and this can cause side effects. These may only last a few weeks or months, but some side effects can last for longer or develop months or years after treatment.
Your doctor, radiographer or nurse can tell you more about the possible side effects of radiotherapy to the prostate, which may include:
Metastatic spinal cord compression
MSCC happens when cancer cells that have spread from the prostate grow in or near to the spine and press on the spinal cord.
MSCC is a serious condition. You need to know about MSCC if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. Your risk of MSCC is highest if the cancer has already spread to your spine. Speak to your doctor, radiographer or nurse for more information about your risk. Read more about MSCC, including what symptoms to watch out for.
Side effects after external beam radiotherapy to treat symptoms
The possible side effects will depend on the part of your body thats treated. They may include:
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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.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
Also Check: Side Effects After Prostate Surgery
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
You may also find it helpful to visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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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. 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. We will often obtain next-generation imaging and do genomic testing. 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 one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. 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. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We 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.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
Also Check: Gleason Scores For Prostate Cancer
Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
Read Also: What Does Metastatic Prostate Cancer Mean
Prostate Cancer Bone Mets
When prostate cancer spreads to the bones, it is no longer able to be cured. Instead, therapies are aimed at controlling/reducing the bone lesions, preventing or slowing further cancer spread, strengthening bone, and managing pain. Treatments include chemotherapy, bone-strengthening drug protocols, fracture repair, and surgery or ablation as indicated.
Isotopes are elements that emit radiation. Certain isotopes have been used successfully with prostate cancer bone mets to control pain, improve quality of life, and to a lesser extent prolong survival. These include Strontium-89, Samarium-153, and Rhenium.
A more recent entry into the field is Radium-223 which has unique clinical properties. Because it selectively seeks bone and bone formation, it binds with prostate cancers tumor-forming activity. Radium-223 emits high-energy alpha-particle radiation that has a toxic effect on the DNA of tumor cells. The path of the radioactive particles emitted by Radium-223 is extremely short, so there is little-to-no effect on neighboring healthy tissues.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Ra Mechanism Of Action
223Ra is a radioactive isotope that decays to stable lead after a complex disintegration path with several radioactive daughters that produce four alpha particles . 223Ra decay chain is as follows: 223Ra 219Rn 215Po 211Pb 211Bi 207Tl 207Pb . 223Ra can be produced quite easily and in high amount from elution of an actinium-227/thorium-227 generator system . 223Ra physical half-life of 11.4 days allows long-distance shipment.20,21 The average particle energy per decay of 223Ra is 5.7 MeV. The combined energy for the complete decay chain of 223Ra including daughter radionuclides is 28.2 MeV.22 This is much higher than that of beta-emitter bone-targeting radiopharmaceuticals, such as 89SrCl2 and 153Sm-EDTMP, with, respectively, 0.58 and 0.22 MeV.23 Gamma particles are also emitted during 223Ra disintegration, allowing scintigraphy imaging . After intravenous injection, 223Ra acts as a calcium analog and about 25% is taken up by bone. It concentrates in sites of active mineralization with high osteoblastic activity .24 223Ra is mainly excreted by the gastrointestinal tract, and < 1% of the injected activity remains in the blood 24 hours after injection.25 Bone endosteum is the organ with the highest dose after 223Ra injection at therapeutic dose , and the corresponding absorbed dose to the red bone marrow is 1.6 Gy.24 No significant redistribution of 223Ra radioactive daughters has been observed in preclinical22 and clinical studies.26
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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Radium 223 For Metastatic Prostate Cancer
Radium 223 is a type of internal radiotherapy treatment. Internal radiotherapy means giving radiotherapy to the cancer from inside the body. You might have it for cancer that began in the prostate and has spread to the bones. This is metastatic or advanced prostate cancer.
Radium 223 is a mildly radioactive form of the metal radium. It’s brand name is Xofigo . You have this treatment in the nuclear medicine department. It takes around an hour.