How To Decide Between Radiation And Surgery For Localized Prostate Cancer
If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options: active surveillance, radiation therapy or surgery. If you arent comfortable with active surveillance, or if its not an advisable option for you, you may have to decide between radiation therapy and surgery to treat your cancer.
Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.
Weve heard of some physicians telling men of their prostate cancer diagnosis and asking them to make a treatment decision at the same appointment. But prostate cancer progresses slowly, so most men have time to think about their options and shouldnt feel pressured into making an immediate decision.
How you feel about the big three possible side effects of treatmenturinary incontinence, sexual dysfunction and bowel healthmay be the deciding factor for you.
To help you through the process of making this decision, this article covers:
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What Is Proton Therapy For Breast Cancer
In short, proton therapy is a type of that kills cancerous cells. Radiation therapy comes in several forms including photon therapy and proton therapy . Both work to kill cancer by damaging cancer cells DNA.
Standard radiation utilizes photons to deliver radiation all over your body.
Photons are basically beams of X-ray that enter and exit tissue without stopping, explains Victoria Croog, M.D., a radiation oncologist at Johns Hopkins Sibley Memorial Hospital in Washington, D.C.
This means that theres a risk of damaging healthy tissue in addition to your tumor. However, Dr. Croog notes that techniques for delivering photon therapy have improved a lot over the last few decades, and now have much less late toxicity, meaning complications with toxicity that occur more than three months after treatment.
Protons, on the other hand, have mass and charge to them, so we can make them stop at the end of where the target is, explains Dr. Croog. That means that the radiation can target just the desired area and may produce less damage to nearby tissues. This makes it an attractive therapy choice for cancers like breast cancers which often occurs near vital organs such as the heart or lungs.
If your physician recommends using proton therapy, its likely because theres some concern about how close the cancer is to certain tissues that your doctor may want to protect, Dr. Croog says.
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What Are The Disadvantages Of Proton Beam Therapy
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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Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
New Study Compares Long
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.
Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.
Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.
Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:
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Outpatient Nursing Care Unit
In order to avoid or relieve possible side effects, a nursing outpatient clinic was established at WPE. This is integrated into the outpatient clinic and, in coordination with the physicians, is carried out according to guidelines by certified nurses with different qualifications and professional further training.
Detailed information on this can be found on our Outpatient Nursing Care Unit page.
Proton Therapy Treats Prostate Cancer With A Low Risk Of Side Effects
The five-year results of over 1,300 men treated at UF Health Proton Therapy Institute for prostate cancer were recently published in a peer-reviewed medical journal.1 As reported by UF researchers, the results revealed that the majority of these men are living cancer-free with minimal to no side effects. The five-year survival rates for low, intermediate, and high-risk prostate cancer are 99%, 94%, and 74% respectively with less than 1% having experienced any bowel issues and less than 3% having experienced any urinary issues.
Because of the comparatively low occurrence of side effects such as incontinence, impotence, and fatigue, prostate cancer patients receiving proton therapy are able to continue working, playing, and living relatively normal lives both during and after treatment. Thats why more and more patients with prostate cancer are choosing proton therapy.
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Two Treatment Centers One Expert Team
Mass General has the only proton therapy site in all of New England, with two proton therapy centers.
Since the opening of the Francis H. Burr Proton Therapy Center in 2001, we have treated thousands of adult and pediatric patients with proton therapy. In 2020, we expanded clinical operations on our main campus location with the opening of a second center, the Gordon-Browne Proton Therapy Center, making Mass General the only institution on the East Coast to have two proton therapy centers. Both state-of-the-art treatment centers offer the latest technology for patients and are run by one talented, multidisciplinary team.
Both of our proton therapy centers are located on Mass General’s main campus in Boston, giving patients access to a wide range of world-class care and services.
Proton Therapy Side Effects
Proton therapy side effects are similar to those of traditional radiation therapy. Side effects can develop gradually after treatment, and may include:
- Sore, reddened skin in the area where the proton beam entered the body. It can look and feel like a sunburn.
- Hair loss in the treatment area
- Tiredness or low energy
Additional side effects, depending on the area treated, can include headaches and problems with eating and digestion.
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Tougher On Your Tumor Easier On Your Body
Every brain tumor presents its own set of challenges, typically treated with a combination of surgery, chemotherapy and radiation thatÃ¢s right for the patient. When it comes to radiation, proton therapy provides a safer option that spares healthy tissue.
With conventional X-ray therapy, surrounding healthy tissue gets a considerable dose of radiation, which can lead to side-effects and secondary cancers down the road. With proton therapy, treatment is delivered precisely to the tumor, so less radiation is delivered to the surrounding healthy tissue.
More precision means less damage to healthy tissue in the brain, eyes, sinuses and spinal cord, potentially offering a faster recovery, and fewer short- and long-term side effects.
Proton therapy takes advantage of a unique characteristic of protonsÃ¢they deliver their largest amount of energy right before they come to a stop. ThatÃ¢s how treatment is delivered right to your tumor, and no further.
Cancers Treated With Proton Therapy
Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue. Children may receive proton therapy for cancers of the brain and spinal cord. It is also used for cancer of the eye, such as retinoblastoma and orbital rhabdomyosarcoma.
Proton therapy also may be used to treat these cancers:
Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma
Eye cancer, including uveal melanoma or choroidal melanoma
Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers
Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone
Noncancerous brain tumors
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Why Is Proton Therapy Done
Proton therapy is most commonly used to shrink solid tumors that have not spread to other parts of the body. It’s an effective treatment for many childhood cancers, including:
- tumors in the head, neck, eyes, and spinal cord
Proton therapy is sometimes used along with other cancer treatments, such as standard radiation, , surgery, and .
Possible Advantages Of Proton Beam Therapy
Proton beam therapy may cause fewer, or milder, side effects than standard radiotherapy. This is because:
- the proton beam is likely to cause less damage to normal cells as it passes through them
- the beam stops when it reaches the cancer, which means it does not damage any normal cells behind the cancer this is different to a standard radiotherapy beam which continues through the cancer.
Proton beam therapy can be used to give high doses of radiation to the cancer, with less damage to nearby normal cells.
It can also be used to treat adults with cancers:
- that can be difficult to treat because of where they are in the body
- that are in a position where the side effects of standard radiotherapy would cause serious problems
- where there is a high risk of late side effects from standard treatments
- that do not respond well to standard radiotherapy and would need a very high dose of treatment to be effective
- that have come back after being treated with standard radiotherapy.
Proton is still quite a new treatment in the UK. Research is needed to find out more about its long-term benefits and side effects, and to compare it with standard treatments.
Your healthcare team will give you more information if proton beam therapy is suitable for you. It may be given as part of a research trial .
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What Is Proton Therapy And How Is It Used
Protons are particles that carry a positive charge. Just as x-rays are used to treat both benign and malignant tumors, protons beams can be used to irradiate tumors in a similar way. There is no significant difference in the biological effects of protons versus photons . However, protons deliver a dose of radiation in a much more confined way to the tumor tissue than photons. After they enter the body, protons release most of their energy within the tumor region and, unlike photons, deliver only a minimal dose beyond the tumor boundaries. Therefore, especially for smaller tumor sizes, the dose of radiation may conform much tighter to the tumor and there may be less damage to healthy tissue. As a result, the treating physician can potentially give an even greater dose to the tumor while minimizing unwanted side effects. This is especially important when treating children, because protons help reduce radiation to growing and developing tissues.
Proton therapy is being used to treat tumors in these areas of the body with encouraging early results:
Inflammation In The Region Where Proton Therapy Is Given
When proton therapy is given to the chest, lung inflammation referred to as radiation pneumonitis may occur. It is important to recognize lung inflammation , as radiation pneumonitis should be treated in order to reduce the risk of developing pulmonary fibrosis . Inflammation may occur in other regions as well, such as to the esophagus and more.
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Safety And Efficacy Of Proton Therapy
Many people with locally advanced cancers are treated with a combination of chemotherapy and either traditional or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority, Dr. Baumann said.
He and his colleagues analyzed data from nearly 1,500 adults with 11 different types of cancer. All participants had received simultaneous chemotherapy plus radiation at the University of Pennsylvania Health System between 2011 and 2016 and had been followed to track side effects and cancer outcomes, including survival. Almost 400 had received proton therapy and the rest received traditional radiation.
Those who received proton therapy experienced far fewer serious side effects than those who received traditional radiation, the researchers found. Within 90 days of starting treatment, 45 patients in the proton therapy group and 301 patients in the traditional radiation group experienced a severe side effectthat is, an effect severe enough to warrant hospitalization.
In addition, proton therapy didnt affect peoples abilities to perform routine activities like housework as much as traditional radiation. Over the course of treatment, performance status scores were half as likely to decline for patients treated with proton therapy as for those who received traditional radiation.
Does Insurance Cover Proton Therapy
Does health insurance cover proton beam therapy? Medicare generally covers proton beam therapy. Coverage varies by insurance company and disease type. Mayo Clinic specialists work with each patient and the health insurance company to determine if proton beam therapy is covered, if that is the recommended treatment.
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Spaceoar Hydrogel: Reducing Radiation Exposure
The prostate and rectum are located very close to each other and are separated only by a small space. When undergoing proton therapy for prostate cancer, your doctor will determine if you are eligible for placement of a special hydrogel between the prostate and rectum . The SpaceOAR hydrogel creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum, thereby minimizing unwanted side effects and potential injury to the rectum during treatment. More than 50,000 patients worldwide have been successfully treated with SpaceOAR Hydrogel.
The placement of the hydrogel is a minimally invasive procedure done within our center and the hydrogel remains inside the body throughout treatment. The material that the SpaceOAR Hydrogel is made from has been used in other implants such as surgical sealants used in the eye, brain and spine. The biodegradable material naturally dissolves after a few months and is cleared in your urine.
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Magnetic Resonance Image Acquisition
MR images were acquired with a 1.0 T small animal MR scanner using a mouse head coil. Mice were anesthetized with 12 % isoflurane . The eyes were protected with Bepanthen eye cream .
A field of view covering the mouse brain was defined. In each imaging session, first a T2-weighted MR scan was acquired with a 3-dimensional fast spin echo sequence = 1,000 ms, effective echo time = 97.7 ms, FOV = 31.3 mm, 128 × 128 matrix size, slice thickness = 0.23 mm, number of slices = 90). Afterwards, Magnevist® contrast agent was injected intraperitoneally 10 min before running a CE 3D gradient echo spoiled T1-weighted sequence .
MR scans were recorded in the week prior to irradiation and biweekly thereafter, starting either in the first or second week after treatment. Measurements of the sham-irradiated animals as well as selected internal control scans, i.e. scans before irradiation, can be found in Supplementary Figure S1. After three months, the measurement interval was increased to up to five weeks. An additional diagnostic MR scan was acquired in case of decreasing health status of an animal.
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