Wednesday, December 7, 2022

Long Term Side Effects Of Proton Therapy For Prostate Cancer

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Proton Therapy Treats Prostate Cancer With Minimal Side Effects

Proton Therapy, IMRT, and SBRT | Mark Scholz, MD | PCRI

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Many men half his age would be hard-pressed to match AlbertoGonzalezs energy, enthusiasm and determination.

After undergoing treatment for prostate cancer over the past year or so, Mr. Gonzalez, who turned 80 in August, is itching to get back on his bike. In fact, hes already thinking about an around-the-state ride to help draw awareness to prostate cancer and raise funds for Miami Cancer Institute at Baptist Health South Florida, where he was treated.

Mr. Gonzalezs prostate cancer was caught in the spring of 2018 during an annual check-up. A PSA level of 25 and a Gleason Score of 9 indicated he was at high risk for cancer. An MRI confirmed the presence of a tumor on his prostate gland that was on the verge of metastasizing into his colon.

What Is Intermittent Adt

Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

Radiation Therapy: What It Is

This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.

This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.

For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.

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Proton beam therapy may cause fewer side effects than standard radiotherapy. This is because normal cells are exposed to less radiation. The possible side effects will depend on:

  • the area of your body being treated and what structures are close by
  • the amount of proton beam therapy you have
  • other treatments you are having, such as chemotherapy.

Below are some of the side effects of proton beam therapy. They will not affect everyone who has this treatment. Your cancer doctor, specialist nurse or radiographer will explain any possible side effects to you before you start treatment. It is important to tell them about any side effects you get.

Prostate Cancer And Proton Treatment: Side Effects Facts And Benefits

Cancers Treated with Proton Therapy

However, there is a downside to this kind of treatment. As the X-rays pass across the various vital organs in your body, they are bound to harm even the healthy cells in these organs. Recent medical practices have led to the discovery of intensity-modulated radiation therapy or IMRT that is a far less harmful alternative to traditional radiotherapy .

Prostate cancer proton therapy releases the radiation in form or proton beams to minimize the risk of damage to surrounding healthy tissue. After these beams have relayed their energy on the targeted area, they now stop being produced. This ensures that the cancer cells are fully targeted without compromising the healthy cells around the area.

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

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, donât hesitate to talk to your doctor about them.

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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.

Protons In Prostate Cancer

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

In prostate cancer the benefits are less clear. A big advantage of protons is the reduction in the total dose delivered to the patient. However, the main side effects associated with this are much less significant in adults: delays in development are not a factor, and the risk of additional cancers are much lower as they typically take decades to develop.

Instead, the main side effects are seen in organs close to the prostate that also receive a high dose, such as the bladder and rectum. A high dose must be delivered to a region that includes the prostate and some additional healthy tissues, to make sure the disease is treated fully. The extra margin allows for the variation that occurs during treatment, such as differences in the way the patient lies down, to make sure the cancer gets a full dose each day. As these patient variations are independent of the radiation type, protons and X-rays typically deliver similar high doses to these healthy tissues.

Despite this, proton therapy has been widely adopted because it is argued the physical benefits are clear, even if small, and will become apparent with time as more people reach the five and ten-year survival mark. But the results of studies investigating the effects of proton therapy on prostate cancer are mixed. While protons have been shown to an effective treatment for prostate cancer, no consistent advantage has been seen for either long-term survival or quality of life.

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Who Might Benefit From Radiation Therapy

Your doctor might recommend radiation therapy in several situations.

It can be the first treatment for cancer that hasnât spread outside your prostate gland and is âlow grade.â The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are â and, in general, the more likely your cancer is slow-growing.

Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.

If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldnât remove all of the cancer or if the cancer comes back in the area of your prostate.

If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.

Swollen Legs Or Scrotum

You might get swelling in the legs or the sack of skin around the testicles . The swelling is called lymphoedema . It happens when the lymph channels that drain fluid from the legs are damaged by the radiotherapy. The swelling can be uncomfortable.

You can do various things to lower your risk of getting lymphoedema. Early treatment can reduce the swelling and stop it from getting worse.

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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.

Benefits And Risks Of Proton Beam Therapy

Cancers Treated with Proton Therapy

There are many new treatments for cancer that have arisen in the last decades, and this is wonderful. At the same time, however, when there are different treatment options, you and your oncologist will need to make a decision about what treatment is best for you as an individual.

Some people list out potential treatments and then weigh the options based on how effective the treatments may be as well as the possible side effects . Listing out the pros and cons of proton therapy may help with this process.

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Proton Therapy Versus Photon And Other Radiation Therapies

Unlike traditional photon radiation therapy that uses radiation in the form of X-rays or gamma rays, proton therapy uses proton particle radiation. Both photon and proton radiation damage the tumors DNA, but researchers say damage to the tumor cells caused by protons is more direct and harder to repair.

More importantly, protons only travel a certain distance into the body before they stop, and they deliver the highest dose of radiation at the end of their pathway. This burst of energy can appear on a graph as what is called the Bragg peak. Radiation oncologists plan proton therapy treatments so the maximum dose hits the tumor cells. In this way, proton therapy reduces radiation exposure and potential damage to healthy tissue, especially in sensitive areas such as the brain, eyes, spinal cord, heart, reproductive organs, major blood vessels and nerves.

In regular radiation therapy, such as photon therapy or gamma knife treatments, the beam of high-energy gamma rays or X-rays goes into the body, through the tumor and out the other side. Photons release energy along the entire path they travel, which means they radiate healthy tissues beyond the tumor. It is estimated that 30% to 40% of the photon dose passes through the tumor. This exit dose of radiation can damage the DNA of healthy cells. Proton therapy generates virtually no exit dose.

Proton Therapy | Targeted Cancer Treatment

Difficulty Getting An Erection

Radiotherapy can damage the nerves that control getting an erection.

Whether you have problems getting and keeping an erection depends on:

  • whether you have other health conditions
  • whether you had erection problems before the treatment
  • if you have hormone therapy before or after the radiotherapy
  • whether you have internal radiotherapy as well as external radiotherapy

Tell your doctor or specialist nurse as soon as possible if you have erection problems. They should refer you to a specialist to help you with this.

Early treatment with medicines such as sildenafil or apomorphine hydrochloride might help you to get and keep erections.

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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.

What Are The Disadvantages Of Proton Beam Therapy

SBRT for the Intermediate-Risk (Teal) Prostate Cancer | Prostate Cancer Staging Guide

Proton therapy is not the right choice for everyone. Some negatives of proton therapy include:

  • Availability: There is a small number of proton therapy centers in the U.S., which means you may need to travel for treatment that may last several weeks.
  • Longer planning time: Your radiation oncologist will need a few weeks to plan proton therapy. They may recommend traditional radiation if you need treatment sooner.
  • Insurance coverage/cost: Proton therapy costs more than photon radiation therapy because the machines and equipment for proton therapy are very complex, and they are expensive to make and operate. Some insurance providers may not approve proton therapy if there is no definitive evidence that it is a better treatment option. It is important to check with your insurance provider about coverage. Many proton therapy centers, including the center at Johns Hopkins, have insurance authorization specialists who can assist you in obtaining treatment authorization.

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What You Need To Know About The Prostate Long

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

What Types Of Hormone Therapy Are Used For Prostate Cancer

Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:

  • reducing androgen production by the testicles
  • blocking the action of androgens throughout the body
  • block androgen production throughout the body

Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:

Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:

Treatments that block the production of androgens throughout the body include:

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When Is Radiation Therapy Used

There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:

  • As the first treatment of cancer, which is still confined to the prostate gland.
  • It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
  • After the reoccurrence of cancer in the area, it was before surgery.
  • To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.

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