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Sbrt Vs Surgery For Prostate Cancer

Why Choose Sbrt For Prostate Cancer

IMRT vs SBRT vs Protons vs Brachytherapy | Ask a Prostate Expert, Mark Scholz, MD

Your radiation oncologist at UCLA will review all of the treatment options with you, comparing the pros and cons of each in great detail. Often, there will be several equally good options, and together with your doctors you will be guided through the decision making process in order to arrive at a treatment that is the most appropriate for you and you feel most comfortable with.

All patients are eligible for prostate SBRT. UCLA has clinical protocols specifically designed for low/intermediate risk patients as well as high risk patients.

There are many good reasons to consider and choose SBRT over the other potential options, including:

  • It is entirely non-invasive .
  • It is a very short treatment course . SBRT is a total of 5 treatment sessions, with each session taking between 15-60 minutes depending on the technology used.
  • The cancer control rates of SBRT are equivalent to those of brachytherapy, conventional external beam radiotherapy, or surgery.
  • Sparing of radiation exposure to the rectum and bladder is equal to or better than with brachytherapy, particularly with advanced radiation techniques.

Can Surgery And Radiation Be Used Together

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

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.

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Prostate Cancer Treatment: The Cyberknife Advantage

CyberKnife has a 97% cure rate for prostate cancer.

CyberKnife treatments can be done in five radiation therapy sessions over 10 days compared to 42 to 45 over three months with other types of radiation treatments.

It has none of the risks that come with surgery.

Its quicker and safer and causes less disruption to a patients life.

Plus, its noninvasive.

The CyberKnife radiation beams, which target and destroy the tumor, are so precise which means there is less risk of side effects including impotence and incontinence.

Listen to Dr. Pomper compare CyberKnife to Robotic Prostate Surgery to health specialist Marilyn Mitzel in this short interview.

How Is Sbrt Delivered

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SBRT is accomplished by delivering a higher radiation dose per day from an advanced linear accelerator, which requires significant precision and accuracy from a team of experts consisting of a radiation oncologist, medical dosimetrists, and radiation therapists. Modern and advanced linear accelerator technology is also required. Combined SBRT planning and treatment delivery requires six visits.

In order to make sure that the prostate is accurately targeted and tracked doctors place 3 implanted markers into the prostate which can be tracked as the prostate moves. This is often referred to as image-guided radiotherapy .

A custom radiation plan is created for each patient using a scan obtained after the implanted markers are placed with a special high-resolution CT called a CT simulation scan. After the simulation scan is performed a customized radiation plan is designed and the radiation is delivered in 5 short sessions.

Patients should discuss the pros and cons of high dose SBRT with their treating physicians. Additional ongoing large. randomized trials, such as the PACE-C randomized clinical trial in the United Kingdom are ongoing and will be critical to confirm SBRT as standard treatment.

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Side Effects Of Surgery For Prostate Cancer

The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.

According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.

While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.

While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.

Radiation Therapy For Prostate Cancer

Radiation therapy techniques have improved over the years. More precise radiation delivery techniques are designed to help spare normal tissue from exposure and reduce the severity of side effects. In addition to the external delivery of radiation, we now also have internal delivery options. In some cases, courses of radiation treatment may be more intense and shorter in duration.

The development and use of hydrogel spacersgel thats inserted between the prostate and the rectummay also reduce damage to tissue surrounding the prostate during radiation, which in turn helps to reduce treatment-associated 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.

Things To Consider When Choosing Treatment For Localized Prostate Cancer

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If youve been diagnosed with localized or locally advanced prostate cancer, you have 3 main treatment options: active surveillance, radiation therapy, or surgery. If you and your medical team have decided that active surveillance is not right for you, and you are deciding between radiation and surgery, you may find yourself feeling stuck or overwhelmed with the choice.

Dr. Dan Spratt, an international leader in the treatment of prostate cancer and lead editor of the PCF Prostate Cancer Patient Guide, often discusses 4 factors that can help patients make this tough decision:

  • Are you a surgical candidate? The older a patient is, and the more additional health problems he hasespecially prior abdominal surgeries, heart or lung issues, and morbid obesity, among otherscan increase the risk of complications from anesthesia and undergoing a major surgery. For example, in the US, less than 5% of men over 75 years old undergo surgery for prostate cancer.
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    Psa Kinetics Following Prostate Sbrt

    The PSA kinetics following prostate SBRT are distinct and may suggest a greater degree of efficacy when compared to those following treatment with CF-EBRT. One study from UCLA compared patterns of PSA response for 439 patients with low- or intermediate-risk prostate cancer following treatment with SBRT, high-dose-rate brachytherapy, or CF-intensity modulated radiation therapy . The authors found that significantly more patients treated with SBRT or HDR brachytherapy had PSA nadirs of < 0.5 ng/mL than those treated with IMRT and that overall, SBRT and HDR brachytherapy caused significantly larger PSA decay rates than IMRT, leading the authors to conclude that this difference in PSA kinetics may present a distinct radiobiological effect, and may be predictive of superior clinical outcomes. Other studies have confirmed that after one year of treatment, when compared to patients receiving treatment with CF-EBRT, the median PSA slope and nadir are lower for patients treated with SBRT .

    Pencil Beam Scanning Proton Therapy

    Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.

    With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.

    However, the difference in outcomes is minimal, according to

    Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.

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    Prostate Cancer Treatment Center Miami

    If you are diagnosed with prostate cancer, call CyberKnife Miami for a consultation or for a second opinion.

    Whatever treatment option your doctor recommends, its always a smart idea to get a second opinion, and it is your right to do so. Whatever treatment you choose, it should be an informed decision on your part, and that responsibility is on you.

    Whether it is CyberKnife or another treatment option, our highly experienced radiation oncology team will help you make the best decision for your particular type and stage of cancer.

    When it comes to CyberKnife treatment, we have one of the most experienced teams in South Florida because we have been doing it the longest. That is why some of the most complicated and difficult cases are referred to us. We have treated thousands of patients nationwide, worldwide, from the Caribbean and right here at home in Miami.

    Our goal is to get you treated as effectively, safely, and quickly as possible so you can get cancer behind you and back to your life before cancer. We will hold your hand every step of the way, helping you and your family get through this process as easy as possible.

    If you would like to find out more about Prostate Cancer Treatment with CyberKnife, call CyberKnife Miami at 305-279-2900 or go to our prostate cancer website now for more information on what we do and how we do it. www.prostatecancertreatmentmiami.com

    Are There Side Effects Of The Combination Approach

    (PDF) Propensity score matched comparison of SBRT versus IMRT for the ...

    There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.

    In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.

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    Tools To Help You Decide

    The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasnt spread.

    It cant tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.

    To be able to use the tool you need to know the following about your cancer:

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    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.

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    When Is Brachytherapy Alone The Right Choice

    For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

    But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

    This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

    Possible Risks And Side Effects Of Brachytherapy

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    Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

    There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

    These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

    Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

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    Da Vinci Robotic Prostatectomy/robotic

    The surgery is performed by a trained and skilled surgeon through the use of a computer-enhanced robotic surgical system. Instead of the large incision used in open surgery, da Vinci surgeons make just a few small incisions similar to traditional laparoscopy. The da Vinci System also features a magnified 3D high-definition vision system and special wristed instruments which precisely translates the hand movements of the surgeon.

    Pros:

    • Catheter removed in just 5-7 days
    • More maneuverability and precision for the robotic surgeon
    • More visibility of prostate and surrounding tissue/organs
    • Prostate cancer is removed with a higher cancer cure rate when performed by a skilled robotic surgeon

    Cons:

    • Possible erectile and urinary side effects post surgery when procedure is performed by a less-skilled and inexperienced surgeon

    High Dose Stereotactic Body Radiotherapy

    High dose stereotactic body radiotherapy treatment of men with newly diagnosed prostate cancer appears to result in shorter treatment times, less severe toxicity and excellent cancer control rates.1-6

    Although prostate cancer generally responds well to radiation therapy, the possibility of radiation exposure to healthy tissue in the genitourinary and gastrointestinal systems can be of concern. SBRT is an advanced technique that precisely targets high doses of radiation to the cancer in a small number fractions, simultaneously avoiding surrounding tissue and reducing toxicity to non-cancerous cells.

    Men with early stage prostate cancer can currently be treated with surgical prostatectomy, brachytherapy or external beam radiation therapy . SBRT, a form of EBRT condenses the radiation treatment for prostate cancer into as few as four to five sessions . The technique has become the standard of care for many non-surgical lung cancer patients, as it limits exposure to the heart and surrounding lungs. When treating tumors in the prostate, SBRT avoids the adjacent bladder, sex organs and rectum.

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