Radiation therapy for prostate cancer

We offer the latest in radiation therapy treatment for prostate cancer to ensure you receive the best possible care.

Radiation therapy treatment for prostate cancer

Radiation oncologists use radiation for prostate cancer to destroy cancer cells, reduce their growth or to relieve symptoms of the cancer. Radiation therapy treatment is often used in men with early prostate cancer that hasn’t spread, although it can also be used in combination with other treatments, or if the cancer has returned.1

As you may have the option between surgery and radiation therapy treatment, it is important to talk with your urologist and your radiation oncologist to help you weigh up the advantages and disadvantages of different treatment options and possible side effects like incontinence and erectile dysfunction, availability and cost to help you make an informed decision about the best treatment for you.

There are many different radiation therapy techniques that may be suitable for your prostate cancer. The treatment you receive will depend on the size and stage of your cancer, your general health and treatment preferences.

External beam radiation therapy

External beam radiation therapy (EBRT) uses one or more beams to deliver high energy x-rays from outside the body to the cancerous area. Treatment is usually given over 4–8 weeks; each treatment is about 15 minutes.

Types of EBRT which can be used for the treatment of prostate cancer include:

  • Intensity modulated radiation therapy (IMRT) – a high precision type of radiation therapy that uses computer controlled linear accelerators to deliver high dose radiation to cancerous tumours in the prostate
  • Volumetric modulated arc therapy (VMAT) – a novel radiation therapy technique that delivers the radiation dose continuously as the treatment machine rotates. This technique accurately shapes the radiation dose to the tumour while minimising the dose to surrounding organs. VMAT can be used to treat large areas of the body with uneven boundaries and tumours located close to vital organs, such as prostate cancers, without fear of damage to these organs by high doses of radiation

Image guided radiation therapy (IGRT) is used to ensure EBRT is delivered as accurately as possible. This involves advanced imaging equipment and computer software such as MRI, CT and x-ray to increase the radiation therapists ability to precisely target a tumour with radiation beams.

Ensuring your radiation therapy treatment is highly-accurate

As part of your external beam radiation therapy treatment, you may have Calypso® radiofrequency transponders surgically placed in your prostate tumours to track and adjust radiation treatment beams due to natural movements of the body, such as breathing. The transponders are small, approximately 8mm long – about the size of a grain of rice. This helps ensure that radiation therapy is delivered accurately to a smaller treatment area and less radiation is delivered to surrounding healthy tissue, reducing side effects.

Fiducial markers (gold seeds) are also sometimes used at the discretion of your radiation oncologist, which help to more accurately locate the prostate gland during radiation therapy treatment.

If your treatment is being delivered using the Varian TrueBeam linear accelerator (radiation therapy machine), triggered imaging technology may be used. This enables visual verification that a tumour is being accurately and precisely targeted and is specifically used for prostate cancers. Using markers implanted in the prostate, radiation therapists can visualise your tumour throughout treatment using low dose x-ray images which allow the machine to automatically detect the position of the markers.

Reducing your risk of side effects

Your doctor may talk to you about having SpaceOAR Hydrogel implanted by a urologist ahead of your treatment. SpaceOAR Hydrogel is a gel-like substance that is implanted between the prostate and rectum to reduce side effects during radiation therapy treatment. As the rectum and prostate are very close and separated by only a small space, the rectum can be affected by radiation to the prostate. SpaceOAR Hydrogel moves the rectal wall away from the prostate, protecting the rectum from being damaged during radiation therapy.

Stereotactic radiation therapy

Stereotactic radiation therapy is an advanced technique used to treat small tumours with well-defined edges and can be used to treat both primary and metastatic (advanced) prostate cancer. Stereotactic radiation therapy reduces the overall treatment time to one and a half weeks, delivering high doses of radiation in less than 15 minutes, and monitors the patient’s prostate motion using small gold markers to ensure the radiation is delivered with absolute accuracy. Research published in 2019, which summarised decades of data from thousands of cancer patients, supports the use of stereotactic radiation therapy for prostate cancer and has found the treatment option is highly effective in cancer control, offering improved quality of life and is equally as safe as conventional treatments in terms of side effects.2,3,4 Stereotactic radiation therapy for primary prostate cancer is available at Icon Cancer Centre Midland and Icon Cancer Centre Greenslopes.

Stereotactic radiation therapy can also be used to treat advanced prostate cancer where the disease has started to spread to other parts of the body. Traditionally patients would be treated with hormone therapy and chemotherapy, which are often associated with negative side effects. Icon Group’s recent TRANSFORM study, published in the International Journal of Cancer, found that stereotactic radiation therapy can delay progression to these more toxic treatments for more than two years.

Icon is proud to offer access to this treatment approach at centres in New South Wales, ACT, Queensland, Victoria, Tasmania and Western Australia. If you would like to enquire about stereotactic radiation therapy treatment, please contact your local Icon team or send us a message.

For more information on the latest in treatment for advanced prostate cancer, as discussed by Icon Radiation Oncologist and TRANSFORM Principal Investigator Dr Patrick Bowden, click here.

Seed brachytherapy

Brachytherapy is a special form of radiation therapy where radioactive seeds are placed beside or inside the tumour. It is a very targeted treatment using low energy radiation emmitted by Iodine-125. The seeds are no larger than an uncooked grain of rice, and are strategically injected to treat the prostate and minimise dose to surrounding structures. The seeds remain radioactive between three to four months.

Focal brachytherapy uses the same technique, however it is a highly-targeted treatment as it places the radioactive source into only the tumour itself instead of the whole prostate, preserving the rest of the prostate gland. It involves the implantation of small seeds, usually around 14-30, directly into the cancerous area of the prostate. The seeds are radioactive for three months during which time the cancer is destroyed.

Men with prostate cancer can now access new precision focal brachytherapy at Icon Cancer Centre through the LIBERATE clinical registry, which aims to support the use of this cutting-edge prostate cancer treatment and reduce side effects to preserve men’s quality of life. The registry monitors men who have undergone focal brachytherapy for low to intermediate risk prostate cancer across a five-year period to determine the effects of treatment on long term quality of life and rates of cancer control.

As part of the LIBERATE clinical registry, focal brachytherapy treatment is now available at Icon Cancer Centre Geelong, Icon Cancer Centre Richmond and Icon Cancer Centre Freemasons. If you would like to enquire about participating in the LIBERATE clinical registry, please contact your local Icon team or send us a message.

References

For a full list of references, click here.
  1. Radiation therapy for prostate cancer.(2016). American Cancer Society. Retrieved on 13th February 2019 from https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html
  2. Kishan AU, Dang A, Katz AJ, Mantz CA, Collins SP, Aghdam N, Chu FI, Kaplan ID, Appelbaum L, Fuller DB, Meier RM, Loblaw DA, Cheung P, Pham HT, Shaverdian N, Jiang N, Yuan Y, Bagshaw H, Prionas N, Buyyounouski MK, Spratt DE, Linson PW, Hong RL, Nickols NG, Steinberg ML, Kupelian PA, King CR. Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer. JAMA Netw Open. 2019 Feb 1;2(2):e188006
  3. Jackson WC, Silva J, Hartman HE, Dess RT, Kishan AU, Beeler WH, Gharzai LA, Jaworski EM, Mehra R, Hearn JWD, Morgan TM, Salami SS, Cooperberg MR, Mahal BA, Soni PD, Kaffenberger S, Nguyen PL, Desai N, Feng FY, Zumsteg ZS, Spratt DE. Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6,000 Patients Treated On Prospective Studies. Int J Radiat Oncol Biol Phys. 2019 Jul 15;104(4):778-789
  4. Jiang NY, Dang AT, Yuan Y, Chu FI, Shabsovich D, King CR, Collins SP, Aghdam N, Suy S, Mantz CA, Miszczyk L, Napieralska A, Namysl- Kaletka A, Bagshaw H, Prionas N, Buyyounouski MK, Jackson WC, Spratt DE, Nickols NG, Steinberg ML, Kupelian PA, Kishan AU. Multi- Institutional Analysis of Prostate-Specific Antigen Kinetics After Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys. 2019 Nov 1;105(3):628-636.

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