Proton Beam Radiati On Therapy
Proton beam radiation therapy capitalizes on a unique physical property of high energy protons generated from a cyclotron. The accelerated charged particles travel through tissue until reaching a depth determined by their energy. Once they reach that depth, the remainder of the radiation dose is deposited in a sharp Bragg peak with no dose going beyond that point. When multiple proton beams are used, a very sharp and tight radiation dose distribution is created. This modality is especially attractive when tumors are in close proximity to sensitive organs. PCa is one of the more common indications in which proton therapy is utilized.
At Washington University in St. Louis we are collaborating with investigators from Massachusetts General Hospital and the Harvard Medical School conducting a randomized clinical trial of IG-IMRT versus proton beam radiation in men with low and intermediate risk PCa. The PARTIQoL trial is seeking to measure and compare relative the impact of the two modalities on patient quality of life after treatment. provides a comparison of these two treatment modalities.
Axial CT slice showing conformality of intensity modulated radiation therapy. Radio-opaque markers are apparent in the anterior aspect of the prostate gland. Axial CT slice showing conformality of proton beam radiation therapy in the same patient as panel a. More sparing of the anterior-lateral rectal wall and less dose to peripheral tissues is apparent.
New Treatment Approved For Late
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
In late March, the FDA approved a new therapy for advanced prostate cancer that is metastasizing, or spreading, in the body. Called Pluvicto , and delivered by intravenous infusion, the treatment can seek out and destroy tumors that are still too small to see with conventional types of medical imaging.
Pluvicto is approved specifically for men who have already been treated with other anticancer therapies, including chemotherapy and hormonal therapies that block the tumor-promoting hormone testosterone. The drug contains two parts: one that binds to a protein on prostate cancer cell surfaces called PSMA, and a radioactive particle that kills the cancer cells. Most normal cells do not contain PSMA, or do only at very low levels. This allows Pluvicto to attack tumors while sparing healthy tissues.
To confirm whether a man is eligible for the drug, doctors first inject a radioactive tracer that travels the bloodstream looking for and then sticking to PSMA proteins. Cancer cells flagged by the tracer will show up on a specialized scanning technology called positron-emission tomography. About 80% of prostate cancer patients have PSMA-positive tumors for those who do not, the treatment is ineffective.
What Tests Check For Prostate Cancer
Common tests to check for prostate cancer include:
- Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
- PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
- A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.
If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
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Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
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Treatment Techniques For Benign Prostatic Hyperplasia And Prostate Cancer
Benign Prostatic Hyperplasia , or prostate gland enlargement, is common in males over 50. Over half of men older than 50 years old have this condition. Enlargement of the prostate gland may obstruct the bladder neck and section of the urethra that traverses the prostate. Men with BPH may experience symptoms such as a weak urinary stream, incomplete bladder emptying, or post-micturition urinary dribbling, among others. However, keep in mind that some may have other symptoms.
Treatment of symptomatic BPH usually starts with medications, but sooner or later may require prostate surgery due to progressive severe obstructive symptoms affecting the quality of life.
Urological testing to confirm the diagnosis and evaluate the severity of BPH includes post-void residual urine volume to assess the ability of the bladder to empty uroflowmetry to measure the average urine flow rate, the shape of the voiding curve, duration of micturition, and maximum flow rates pressure flow studies in some patients and prostatic imaging to determine the size and shape of the gland that helps with choosing the optimal treatment approach.
Cystoscopy, an endoscopic examination, may be needed to confirm if the prostatic blockade causes the voiding problem.
Will There Ever Be A Cure For Metastatic Prostate Cancer
Thats a tough one! The research and progress in treating this disease has come so far in just the past few years.
I have to say that someday, there will likely be a treatment so successful that it will effectively cure the disease. We still have a lot of work to do.
In my opinion, current research into theranostics, which incorporates targeted drug delivery with advanced imaging techniques, offers particular promise.
I also believe the key to outsmarting the disease is to stay a step ahead. This means identifying and anticipating the progression of the tumors escape mechanisms and preempting them.
I cannot stress enough the importance of picking the right treatment for each individual. Side effects and the expectations for disease response should be clearly discussed and understood.
Statistically, about one-third of people with metastatic prostate cancer will live more than 5 years. Understanding where your disease is on that continuum can be important for both treatment and lifestyle decisions.
That said, I am consistently amazed by what we as a medical and scientific community can do together. The huge efforts being applied to prostate cancer research hold significant promise for new and better treatment options in the near future.
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Chemotherapy For Prostate Cancer
https://www.youtube.com/embed/O24t-bbE1k4 The decision on when to start chemotherapy is difficult and highly individualized based on several factors: What other treatment options or clinical trials are available. How well chemotherapy is likely to be tolerated. What prior therapies you have received. If radiation is needed prior toâ¦
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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
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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.
Cancer Cells Under A Microscope
If you have had a biopsy,the biopsied tissue is sent to a laboratory where a doctor called a pathologist will look at the cells in the tissue under a microscope. When healthy cells become cancerous, their appearance begins to change. The more changed the cells look, the more dangerous the cancer is likely to be.
The results from a prostate biopsy are usually given in the form of the Gleason score. On the simplest level, this scoring system assigns a number to describe how abnormal the cells appear under a microscope. Grade 1 and 2 are thought of as normal prostate cells. Grades 3 5 are thought of as cancer cells, with grade 5 being the most abnormal.
The doctor will take more than one sample when you have a biopsy. This is because there may be more than one grade of cancer in the tumour. The pathologist works out an overall Gleason score by adding together the two most common Gleason grades.
For example, if the most common grade of the samples is grade 3 and the second most common is grade 4 then the overall Gleason score is 7. Some doctors write the two scores separately, for example 3 + 4, instead of 7.
The grade can only ever give a doctor an idea of how a cancer might behave. It cannot definitely predict what will happen. Most cancers will behave as expected, but not all.
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
Where Could Mrgrt Take Us In Prostate Cancer
MRgRT is currently more resource intensive to deliver compared with standard radiotherapy. In an arena where there are multiple effective ways to irradiate a prostate , MRgRT will have to prove its worth. Hence research is needed to both prove the added value of this technology in prostate cancer and to streamline processes to reduce treatment times and workforce requirements.
At the most practical level, the ability to dispense with CT, and have a MR-only workflow to produce a complete plan, from contouring to checking, in minutes, paves the way for a paradigm shift in our departmental structures. Patients could be scanned, contoured and planned, all while waiting on the bed. With session times of around 45min at present, and scope to reduce this, a streamlined workflow could eliminate patient waits for planning and protracted radiotherapy planning pathways.
The ultimate question asks whether we can reduce fraction number below five, even to a single treatment? This has been done by several groups with HDR brachytherapy, mostly treating to 19 or 20Gy , , although recent reports have shown disappointing biochemical control rates . Early clinical testing is in process to establish whether similar doses can be given with external beam radiotherapy . However, the more accurate IGRT, intra-beam monitoring and the ability to rapidly produce a plan corresponding to the anatomy of the moment, would make MRgRT the optimal way to test this.
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How Prostate Cancer Is Treated
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
The treatment options for prostate cancer can vary based on many factors, including the aggressiveness of the tumor, the stage of the disease, personal preferences, and more. Curative options may include surgery or radiation therapy. With less aggressive tumors, watchful waiting with treatment begun only if the cancer progresses may be an option. There are also a number of different therapies that can be used to control the growth of these cancers, including hormone therapies, chemotherapy, and newer treatments such as immunotherapy. In addition, many alternative treatments are being evaluated in clinical trials.
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Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
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Stereotactic Body Radiation Therapy Delivered By Cyberknife Has Distinct Advantages Over Other Treatments
Having performed more than 1,500 CyberKnife prostate cancer treatments, if I didnt know better I would think that this technology was created specifically to treat this disease. It is completely suited to the specific challenges of prostate cancer treatment. Yet CyberKnife was first used mostly as a treatment for head, neck and spine tumors that were very difficult to reach.
The Food and Drug Administration opened the door in 2001 to the use of CyberKnife to treat other cancers in the body. Since then urologists and oncologists are turning more and more to CyberKnife, as are patients.
CyberKnifes primary advantages relate to reduced damage to healthy tissue surrounding the cancerous prostate tissues. This is largely due to CyberKnifes ability to precisely target a tumor in the prostate without radiating healthy tissue. Damaging healthy tissue is the leading cause of side effects from radiation treatment.
How Is Prostate Cancer Treated
Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are
- Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
- Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
- Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
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