PROSTATE PROS Episode 6: Breakthroughs in Radiation

Listen: https://soundcloud.com/prostate-oncology/breakthroughs-in-radiation 

“What makes modern radiation so special compared to the older technology is the precision targeting.” — Dr. Scholz

With unwanted side effects and poor cure rates, radiation used to be an unappealing treatment choice.  Fortunately, there have been huge improvements in radiation technology over the past 30 years, making modern radiation one of the front runners in prostate cancer treatment.  This new, computerized beam radiation has fewer side effects and improved cure rates compared to the older radiation called conformal beam radiation. Computerized beam radiation rivals surgery for cure rates and has fewer side effects.  

Three Types of Computerized Beam Radiation for Prostate Cancer

  • IMRT (Intensity Modulated Proton Therapy) 
    • “The Standard”
    • Small, daily doses 7-9 weeks–recent studies have shown that 5 weeks just as effective as 9
  • SBRT (Stereotactic Body Radiation Therapy)
    • Large, daily doses in 4 or 5 treatments over one to two weeks
    • May be more convenient- fewer doctor visits
  • IMPT (Intensity Modulated Proton Therapy)
    • Protons instead of photons
      1. Photons “stop” at target means less radiation to other organs
      2. No definitive studies confirming this
    • Daily doses 5 weeks

The decision to choose one type of beam radiation over another comes down to the skill of provider and convenience of the procedure.  SBRT takes place over the shortest period of time, so men may choose this option for that reason. IMPT and IMRT are virtually identical, the skill and knowledge of the administering physician will likely make the biggest difference.  

Side Effects

As with all prostate cancer treatments, the risk of erectile dysfunction is something to consider when deciding on treatment.  The risk for a healthy 60 year old man undergoing radiation with no previous risk of erectile dysfunction is around 40%. Erectile dysfunction usually occurs one to two years after radiation is completed.  If men make it past the two year mark without developing erectile dysfunction, the risk of developing erectile dysfunction is the same as men of the same age.  

Urinary issues such as increased frequency and urgency to urinate may occur.  Men who have pre-existing urinary conditions such as urethritis or BPH may be at increased risk of urinary side effects from radiation.    

With old, conformal beam radiation, permanent rectal burns were an issue for men undergoing radiation therapy for prostate cancer. Now, with computerized targeting and the use of a new technology called SpaceOAR, a gel that is inserted between the prostate and the rectum to protect the rectum from receiving excess radiation and burns, permanent rectal burns are no longer nearly as likely.  

Conclusion

Radiation therapy can be a great chance for cure for men with newly diagnosed prostate cancer who do need treatment.  It can be given as monotherapy or in combination with hormone therapy depending on the patient’s stage of prostate cancer and overall health.  

Remember, the skill of the physician is a determining factor in the success of the treatment.  Choose a physician with proven skill and experience in prostate cancer radiation for best outcomes.  

10 Myths of Prostate Cancer: https://www.verywellhealth.com/myths-of-prostate-cancer-4143590 

7 Tips for Seeking Second Opinions for Men with Prostate Cancer: https://www.prostateoncology.com/2019/06/26/7-tips-for-seeking-second-opinions-for-men-with-prostate-cancer/ 

Take the prostate cancer staging quiz: keytopc.com

Have questions or topics you think would be great for PROSTATE PROS? Email podcast@prostateoncology.com

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