Treating Prostate Cancer
When you’re diagnosed with prostate cancer, your first instinct may be to get the cancer out as quickly as possible. However, before making any decisions, you’ll want to learn about your treatment options and study the pros and cons of each one. Many treatments for prostate cancer often cause long-term side effects, including urinary complications and impotence. Now more than ever, you need to be your own healthcare advocate.
Taking charge of your health and learning about your treatment options is an important first step. We have put together a prostate patient guide to explain clinical evidence on the use of proton therapy in prostate cancer to help you make the right treatment decision.
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PROTON THERAPY REDUCES THE RISK OF SIDE EFFECTS
The greater precision of proton therapy significantly reduces the dose of radiation delivered to nearby organs.3,4 In one study, proton therapy delivered 35% less radiation to the bladder and 59% less radiation to the rectum compared with X-ray/intensity-modulated radiation therapy (IMRT).3-4 Delivering less radiation to nearby organs reduces the likelihood of long-term side effects.3,5
Radiation to the bladder and surrounding areas can cause incontinence. Proton therapy limits the radiation delivered to this area, reducing the risk of incontinence.3
The images below show the amount and location of radiation that the body receives during treatment with proton therapy and X-rays/IMRT.
Click image above to enlarge.
In a recent study of 76 prostate cancer patients who received proton therapy, patients reported having exactly the same urinary and bowel function three months after treatment as they did before treatment.12 With other treatment options, it typically takes about two years after treatment is completed for urinary and bowel function to return to the pre-treatment level.
View the full study»
In a study of men receiving proton therapy for prostate cancer, patients reported no difference in urinary and bowel function before and after treatment.12
The advantages of proton therapy over standard X-ray radiation
When treating cancer with radiation, it’s important to achieve the right balance of getting enough radiation to the tumor without harming healthy tissue. Proton therapy allows this delicate balance to be achieved, making it an excellent option for treating prostate cancer.3,5,6 The dose of radiation that a patient can receive with standard X-ray radiation is limited because of the risk of damage to the bladder and rectum, which are in close proximity to the prostate. With protons, a higher dose can be delivered to the tumor site, which can result in better tumor control, while largely sparing the bladder and rectum from radiation damage.3,5,6
Click image above to enlarge.
Protons significantly reduce excess radiation to non-target areas like the rectum.3 Studies show that less radiation to the rectum reduces the likelihood of gastrointestinal side effects.5
In one study, proton therapy delivered 35% less radiation to the bladder and 59% less radiation to the rectum compared with X-ray/intensity-modulated radiation therapy (IMRT).3
Protons are more effective
Recently, a number of researchers have studied the effectiveness of using higher doses of radiation for tumors. The three trials shown in the charts below found that patients who were treated with a higher dose of radiation were more likely to have PSA levels within a desirable range over a 5-year period than those treated with a lower dose. The trial that used proton therapy to increase the dose had the best control rate and the lowest rate of severe side effects.7-9
Click image above to enlarge.
Click image above to enlarge.
What to expect when getting treated
Proton therapy is safe, non-invasive, and painless. Depending on the patient's diagnosis, treatments are usually given five days a week for up to 8 weeks. The time spent actually delivering the protons to the tumor is about one minute, but a prostate cancer treatment session can range from 15 to 30 minutes due to time spent positioning the patient for this precise treatment. Patients continue with normal activities before and after treatment. Many patients choose to work or go on a “radiation vacation” and spend their days doing recreational activities.
Treatment Options for Prostate Cancer
Proton therapy – A type of external beam radiation therapy that uses proton radiation to kill cancer cells by preventing them from dividing and growing. Proton therapy is a non-invasive treatment that is effective in treating prostate cancer.3,10 The benefit of this type of radiation over standard X-rays is the precision in targeting the tumor. Because of the precision, proton therapy can significantly reduce the dose of radiation to the rectum and bladder.3 As a result, there is a reduced risk of short- and long-term side effects.3,5
Recovery: In most cases there is no recovery time. Treatment lasts up to 8 weeks, and most patients can continue with normal activities before and after treatment. Patients who receive proton therapy experience fewer short- and long-term side effects and a higher quality of life compared to standard X-ray radiation.
Because of the precision, proton therapy can significantly reduce the dose of radiation to the rectum and bladder.3 This reduces the likelihood of short- and long-term side effects.3,5
Standard X-ray radiation – This includes IMRT, 3-dimensional conformal radiation therapy (3-D CRT), CyberKnife®, RapidArc™ radiation, IGRT, and TomoTherapy®. This commonly used form of external beam radiation therapy uses X-ray radiation to kill cancer cells by preventing them from dividing and growing. Common side effects include damage to the rectum and bladder11 and the possibility of incontinence and impotence.
Recovery: Treatment lasts up to 8 weeks. It’s common for patients to experience tiredness and nausea during treatment. Other common short-term side effects include GI disruptions, urinary complications, and sexual dysfunction.
Brachytherapy – The placement of radioactive seeds in the prostate. The main benefit of this invasive form of radiation therapy is that patients can leave the hospital immediately after the radioactive seeds are implanted. The major disadvantage with brachytherapy is that seeds can move after implantation, resulting in uneven treatment of the cancer cells.
Recovery: There is no predetermined recovery time for brachytherapy. Side effects may last as long as the seeds are active (usually a few months), or they may continue and become chronic. In a study, many patients noted a significant decrease in health-related quality of life at 1 and 3 months post-treatment.11 Urinary issues are the most common side effect of seed implantations.11
Surgery – A radical prostatectomy is an operation to remove the prostate gland and tissues surrounding it. Because so many nerves surround the prostate, damage to the nerves is a significant risk for all patients undergoing surgery. Patients electing to have surgery will want to find a surgeon who specializes in this procedure and has many years of experience.
Recovery: Most men stay in the hospital 2 to 3 days after the procedure. A urinary catheter is inserted during surgery, and some men may need to wear it home for a few days or weeks. Common short-term side effects include pain around the incision, urinary complications, and sexual dysfunction. Surgical centers that conduct a high volume of prostatectomies report incontinence rates between 5% and 20% at 12 months.11
- “Watchful Waiting” – For this choice, patients are regularly tested and not given therapy unless their cancer progresses.
- Hoppe BD, Henderson R, Nichols RC, et al. Early outcomes following proton therapy for prostate cancer in men 55 years old and younger. Int J Radiat Oncol Biol Phys. 2010;78(3):S373-S374.
- Talcott JA, Rossi C, Shipley WU, et al. Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer. JAMA. 2010;303(11):1046-1053.
- Vargas C, Fryer A, Mahajan C, et al. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(3):744-751.
- Fowler JF. What can we expect from dose escalation using proton beams? Clin Oncol. 2003;15(1):S10-S15.
- Mendenhall NP, Li Z, Morris CG, et al. Early GI and GU toxicity in three prospective trials of proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2009;75(3):S11-12.
- Mayahara H, Murakami M, Kagawa K, et al. Acute morbidity of proton therapy for prostate cancer: the Hyogo Ion Beam Medical Center experience. Int J Radiat Oncol Biol Phys. 2007;69(2):434-443.
- Peters STH, Heemsbergen WD, Koper PCM, et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24(13):1990-1996.
- Dearnaley DP, Sydes MR, Graham JD, et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007;8(6):475-487.
- Zeitman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate [published correction appears in JAMA. 2008;299(8):898-899]. JAMA. 2005;294(10):1233-1239.
- Chera BS, Vargas C, Morris CG, et al. Dosimetric study of pelvic proton radiotherapy for high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2009;75(4):994-1002.
- Michaelson MD, Cotter WE, Gargollo PC, Zietman AL, Dahl DM, Smith MR. Management of complications of prostate cancer treatment. CA Cancer J Clin. 2008;58(4):196-213.
- Keole S, Zeidan O, Rodriguez R, et al. Uniform Scanning Proton Therapy for Prostate Cancer: The ProCure Oklahoma Experience. Presented at the 54th Annual Meeting of the American Society for Radiation Oncology; 2012 Oct 28-31; Boston, MA.