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Treatment

Radiation therapy
The National Cancer Institute considers radiation therapy (also called radiotherapy) a viable option for men with any stage of prostate cancer. It may be used instead of surgery, or after surgery to destroy any cancer cells that may remain. Radiation also may be used to help relieve pain for men with late-stage prostate cancer.

Radiation therapy is a highly effective treatment that uses targeted high-energy rays to kill cancer cells. It is used to treat about 1 million cancer patients in the United States each year. Our state-of-the-art equipment enables RAS’ Radiation Oncologists to develop high-precision treatment plans that guard against damaging healthy tissues surrounding the tumor target. ROC dosimetrists and physicians meticulously calibrate the equipment to help minimize or avoid undesirable side effects that can include impotence, urinary incontinence and rectal bleeding. We offer prescribing physicians and their patients choice among several radiation therapy technologies.


Three-dimensional conformal radiation therapy (3-D CRT)

By means of a CT scan and computer mapping of each patient’s anatomy, 3-D CRT creates a three-dimensional image of the tumor. Guided by that map, ROC radiologists use a linear accelerator to concentrate the highest possible doses of radiation at the tumor site from four to six different directions, while sparing adjacent normal tissue as much as possible.  Treatments lasting about 10 to 15 minutes per day are given five days a week over a duration of several weeks. Most men are able to continue their normal activities, including working and driving. Potential side effects may include fatigue, frequent urination, loose bowel movements, rectal irritation and diarrhea. Long-term complications are unlikely, but can occur. Your ROC radiation oncologist will discuss possible short-term and enduring effects.


Intensity-Modulated Radiation Therapy (IMRT)

IMRT is an advanced form of 3-D conformal radiation therapy that also delivers radiation externally from a linear accelerator. While 3-D CRT applies four to six radiation beams, IMRT targets the tumor with 60 to 70 beamlets of different intensities from numerous angles. This technology enables ROC to deliver of even higher doses of radiation to the prostate gland while minimizing exposure of the nearby bladder and rectum to radiation beams. Side effects and potential complications are similar to 3-D CRT, although they are less common and may be less pronounced.


Image-Guided Radiation Therapy (IGRT)

Image-guided radiation therapy incorporates CT, ultrasound, X-ray or other imaging techniques to help ROC radiologists guide the radiation beams during radiation therapy. The imagery can identify the precise location of the prostate, which ordinarily can shift by as much as an inch, depending on the fullness of the bladder and rectum. IGRT significantly improves the accuracy of radiation therapy and helps to reduce damage to healthy tissue.
ROC performs IGRT using three prostate localization methods:

The Calypso® 4D Localization System, which enables RAS’ radiation oncologists to pinpoint a prostate tumor’s location and continuously monitor its position throughout radiation treatment

• Placement of a special ultrasound probe on the outside of the abdomen to assist in targeting the prostate
• Injection of “marker” seeds in the prostate gland, imaged just before treatment using digital X-ray equipment.

All three of these methods ensure that the prostate is irradiated precisely and accurately each day throughout the course of treatment, while minimizing exposure of the bladder, rectum and other tissues to stray radiation.


Other methods

Additional methods available to treat prostate cancer must be performed at a hospital or other setting. They include:

Surgery. Radical prostatectomy – surgical removal of the prostate gland – can be performed either by the traditional “retropubic” method, requiring an incision, or by the da Vinci robotic method. Your urologist can discuss the benefits, recovery times and potential side effects of each approach.

Brachytherapy. Implantation of tiny radioactive seeds in the prostate is called brachytherapy. This procedure, performed in a hospital under anesthesia, involves permanent implantation of about 100 seeds. Brachytherapy may be performed alone or in combination with external beam radiation. The side effects and potential complications are similar to those seen with 3-D CRT.

High-dose rate temporary implant (HDR): This procedure, which also is performed in the hospital under anesthesia, involves temporary placement of radioactive material in 20 to 25 plastic tubes that are inserted into the prostate gland under ultrasound guidance. An HDR temporary implant requires an overnight hospital stay. After being discharged from the hospital, patients are given a reinforcing five-week outpatient course of external beam radiation therapy. The potential side effects and complications are similar to those of 3-D CRT.

Hormonal therapy: Prostate cancer usually is stimulated by the male hormone testosterone. Decreasing the amount of testosterone produced in the body or blocking its effects can kill some prostate cancer cells and also slow its overall growth. Hormonal therapy generally does not eliminate prostate cancer entirely by itself. It is sometimes used in combination with radiation therapy, especially for less favorable prostate cancers. It usually is administered in the form of a shot given every 1 to 4 months, and sometimes in pill form.

Proton therapy: Proton therapy is an external beam radiation approach that help spare the bladder and rectum from radiation exposure. It generally cannot use image guidance, and is available in only a few locations in the United States.

Cryotherapy: This surgical approach kills prostate tissue by freezing it with liquid nitrogen or liquid carbon dioxide. The surgeon inserts a probe through a small incision between the scrotum and anus. The method also is called cryoablation or cryosurgical ablation. Although cryotherapy is a promising approach, no conclusive long-term research studies have been completed yet to compare the results of cryotherapy to standard surgical or radiation approaches.

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