What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
Advances In Targeted Therapy
PARP inhibitors are a type of targeted therapy drug designed to prevent the DNA of cancer cells from repairing the damage caused by cancer treatment. In May 2020, the FDA approved two PARP inhibitors, rucaparib and olaparib, to treat patients with metastatic castration-resistant prostate cancer whose cancer tumors have certain homologous recombination repair genetic mutations and who meet other treatment-related criteria. These drugs are the first of their type to be approved by the FDA to treat prostate cancer.
The Stages Of Treatment
Because the stage of your cancer is the most influential factor in how your treatment will progress, weve divided the rest of this article into segments based on the stage of your cancer:
Stage 1 prostate cancer is the least advanced stage. This means your cancer is small and hasnt advanced past your prostate.
In this stage, PSA and Grade Group levels are low. Over 99% of people with prostate cancer caught in this stage survive the effects of cancer for at least 5 years. This means that you can still die of other causes, but you have a less than 1% chance of dying of prostate cancer complications.
for stage 1 prostate cancer usually consists of some combination of active surveillance, surgery, or radiation therapy. You may also be eligible for clinical trials that offer newer treatment techniques.
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Hormone Therapy With Radiation
Prostate cancer cells need testosterone to grow. Hormone therapy aims to drastically lower testosterone levels to slow the cancer’s progression. Although it does not cure the cancer on its own, hormone therapy improves the effectiveness of radiation for high-risk disease and is often recommended in conjunction with radiation therapy for men with intermediate- or high-risk localized disease. However, hormone therapy may have significant side effects. These include loss of libido , hot flashes , changes in mood or memory, loss of bone and muscle density, body fat gain, and adverse effects on sugar or cholesterol metabolism. When offered as short-term therapy in conjunction with radiation, it is often well tolerated. How long a patient should receive hormone therapy remains controversial and depends on how aggressive his cancer is.
Learn more about hormone therapy.
How We Approach Prostate Cancer Treatment At Ctca
When you come to CTCA for a diagnostic consultation or second opinion, your case is reviewed by a multidisciplinary team of genitourinary cancer experts before you arrive for your first appointment. This care team may include a medical oncologist, a urologist or urologic oncologist and a radiation oncologist.
If we determine you need additional diagnostic evaluations, such as imaging or genomic testing, we schedule those procedures for you before your arrival.
Together, we develop a treatment plan thats based on your unique needsusually within two to three days. Our goal is to give you and your caregivers a clear understanding of your options to empower you to make an informed decision about your care.
At CTCA, we strive to treat our patients as we would want our own loved ones to be treated: with compassion, dignity and respect. Its the basis of our foundation, and we call it the Mother Standard® of care.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
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How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
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How Prostate Cancer Staging And Risk Group Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
- Localized: Theres no indication that the cancer has spread beyond the prostate.
- Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
- Distant: Theres evidence the cancer has spread to other organs or body parts farther from the prostate.
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
Treatment guidelines for prostate cancer
Quality Of Life With Advanced Stage Prostate Cancer
Since Huggins and Hodges won a Nobel Prize in 1966 for their work describing the relationship between testosterone and prostate cancer, androgen deprivation has continued to be an important component in the treatment of advanced prostate cancer. It is associated, however, with significant cost in terms of morbidity as well as economics. Side effects of androgen deprivation therapy include hot flashes, osteoporosis, loss of libido or impotence, and psychological effects such as depression, memory difficulties, or emotional lability. Recently Harle and colleagues55 reported insulin resistance, hyperglycemia, metabolic syndrome, and metabolic complications being associated with castration and thus being responsible for increased cardiovascular mortality in this population.
Because of the palliative nature of androgen ablation, quality of life is an important component of evaluating competing therapies. Intermittent androgen deprivation is one approach to hormonal therapy that has been developed with the aim of minimizing the negative effects of therapy while maximizing clinical benefits and the patients quality of life. It can be used in any clinical situation where continuous androgen deprivation treatment could be applied.56
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Prostate Cancer Risk Assessment
Prostate cancer represents a wide spectrum of disease. Some prostate cancers progress and need treatment, while others grow slowly, if at all, and can be managed conservatively with a system of careful monitoring called active surveillance. It is important to learn the characteristics of your cancer before making treatment decisions. There are many ways to determine prostate cancer risk, most of which incorporate information from several parameters, including the PSA, Gleason score and tumor extent .
Causes Of Early Prostate Cancer
Certain things called risk factors may increase the risk of developing prostate cancer. If you are Black, you have a much higher risk of developing prostate cancer. You are also more likely to develop it at a younger age. Having a strong family history of prostate cancer is also a risk factor.
We have more information about the risk factors of prostate cancer.
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You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:
- Rectal Examination
The doctor gently inserts a gloved finger into your back passage . The rectum is close to the prostate gland so your doctor can feel for anything unusual in the prostate. A rectal examination test is quick and it should not be painful. It is also sometimes called Digital Rectal Examination .
- PSA test
The PSA test is a blood test to measure the level of prostate-specific antigen in your blood. Prostate cancer often causes a raised level of PSA. But different things such as non-cancerous prostate conditions and getting older can also increase your PSA.
If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor . Your GP may test your PSA level again if it is raised but your prostate feels normal.
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How Prostate Cancer Spreads
- The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
- The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
- The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .
Diagnostic Tests Are Limited
We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.
As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.
Studies estimate that anywhere from 16%56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.
The PCPT was a randomized controlled study the type considered to be the gold standard in research . The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia , but which has also been investigated as a potential treatment for prostate cancer.
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Speak With A Patient Care Expert Now
However, in our clinical opinion, analyzing these factors alone may not be an accurate guide to precision-targetedtreatments. The absence of precision-targeted treatments in standard treatment protocols can lead to metastaticdisease,despite early diagnosis and prostate gland removal via surgeries like radical prostatectomy. Though the prostate isremoved, the micro metastatic cancer cells may be sitting dormant in your blood stream for years before manifestingwithsymptoms, such as bone pain, back pain, blood in urine, and elevated PSA levels.
According to the American Cancer Society, which relies on data compiled and maintained by theNationalCancerInstitute, prostate cancer is thesecond leading cause of cancer death in American men, due to these challenges instandard cancer care regimens.
Prostate cancer survival rates drop dramatically if the cancer metastasizes, pointing to the need forprecision-targetedtreatments to decrease the chances of cancer spread. Medical studies show how variouschemotherapeutic drugs andradiation therapies may allow aggressive prostate cancer cells to gainadvantageous mutations rendering them resistant to treatment.
To address these challenges of overtreatment and sometimes undertreatment instandard cancer care facilities, we useprecision oncology which helps in identifying the key cancer drivers of each patient and the most appropriateanti-cancer medicines to treat them.
Does It Matter Where Treatment Is Performed
A large body of evidence shows that in the case of surgery for prostate cancer, surgical experience matters greatly. Medical centers and surgeons performing a high number of prostatectomies per year demonstrate better outcomes in terms of both cancer control and quality of life than those performing relatively low numbers. We don’t have similar data regarding radiation outcomes, but performing brachytherapy well certainly requires expertise and experience, particularly in prostate ultrasound. Planning and administering EBRT effectively has many subtleties, which likely translate to better outcomes with more experienced doctors. No matter what the practice volume of specific surgeons or radiation oncologists, they should be able to discuss their own demonstrated outcomes both in terms of cancer control and quality of life.
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What Form Of Treatment Is Best For Me
The choice between radiation treatment and surgery for men with early stage prostate cancer mostly comes down to personal taste. According to the facts at hand, cancer treatment results are consistent irrespective of the chosen therapy. The likelihood that the cancer may spread fast or recur after therapy will also influence the decision. Men with favourable intermediate-risk tumours may elect for active monitoring, although this is often only an option for men with extremely low- and low-risk tumours.
Surgery, RT, and active surveillance each have their own special risks and problems.
Men with localised prostate cancer have the choice of treatment or monitoring , with treatment being postponed until there is indication that the disease may be evolving into an aggressive form. Men who are older or who have other significant conditions may choose active monitoring or careful waiting over surgery or RT.
Men with aggressive, high-risk malignancies that might be difficult to treat later on are often advised to seek therapy very away . Short-term androgen deprivation treatment is often advised for males with RT .
Men with locally advanced prostate cancer are not eligible for any one particular therapy that is shown to be effective. The majority of doctors advise a combination of either surgery with adjuvant RT with or without ADT, or ADT plus RT.
Prostate cancer that has progressed The treatment for advanced prostate cancer is covered separately. ).
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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.
What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
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