Thursday, September 24, 2015

Scanning the Horizon: Advances in Radiation Treatment for Prostate Cancer - Page 1

After James Levy finished his high-dose-rate (HDR) brachytherapy to treat his localized prostate cancer, he celebrated by getting a tattoo that included the StandUp2Cancer logo, the date his treatment ended and the word “radioactive.” It was his way of acknowledging his successful treatment with this relatively new approach.

“I’m a big fan of HDR brachytherapy,” says Levy, of Richmond, Va. “I went in Friday and was back at work on Monday. There was nothing to it.”

HDR brachytherapy, which involves placing strong sources of radioactivity in or near the cancerous tissue for a few minutes and then removing them, joins other, more established forms of radiation as a treatment option.

These techniques include one other type of brachytherapy and many forms of external beam radiation therapy (EBRT), which sends beams of radiation into the prostate from outside the body. In addition, for men whose prostate cancer has metastasized to the bone, a fairly new radiopharmaceutical is available. These approaches give patients a variety of choices if they select radiation treatment as either a first-line or follow-up therapy.

The common variable that internal and external radiation share is their increasing ability to deliver higher doses to the prostate while reducing exposure to nearby healthy tissues. Nonetheless, the treatments can cause side effects, including temporary fatigue or later development of permanent urinary incontinence, bowel problems and erectile dysfunction, among others.

For Levy, 57, who completed treatment about a year ago, side effects have not been an issue. “I’ve had none of the common long-term effects, like incontinence, erectile dysfunction or bowel issues,” says Levy. This is likely because of HDR’s ability to direct radiation specifically at the tumor and avoid nearby tissue and organs — and its short duration.

Photo by Liza Bishop, VCU Massey Cancer Center
To treat his localized prostate cancer, James Levy chose high-dose-rate brachytherapy, and has not experienced any long-term side effects. [Photo by Liza Bishop, VCU Massey Cancer Center]
While that outcome is compelling, HDR may not be right for everyone. In fact, sifting through possibilities to arrive at the best radiation option for each patient can be challenging, says James B. Yu, a radiation oncologist at Yale University School of Medicine in New Haven, Conn. The decision, he says, is as individual as the man and his cancer.

“It depends on what you’re looking at — cure rates or complications,” he says. “Patients care about some complications more than others, such as erectile dysfunction, so the choice of treatment is intensely personal.”

Questions about the relative value of newer radiation methods may, in particular, give men pause.

For instance, in administering EBRT, “Physicians are looking at shortening the number of radiation treatments by increasing the dose per treatment,” Yu explains. He says there continues to be concern that giving more intense radiation treatments, even if there aren’t as many, could be more toxic overall. Adding to the confusion is that current research is mixed, highlighting “the complexity of comparing these treatments and saying that one is better than the other.”

Yu urges patients to learn as much as they can about the pros and cons of various treatments before making a decision, and to discuss any questions they might have with their health care providers. Levy agrees, adding that “the Internet makes it possible to become really well-informed.”

When is Radiation Appropriate?

For men with localized prostate cancer (meaning it hasn’t spread outside the gland), often the first step after diagnosis is choosing between active surveillance (particularly for lower-grade tumors, as indicated by the level of prostate-specific antigen [PSA] in a man’s blood and the Gleason score doctors use to describe aggressiveness); surgery to remove the prostate gland (called a radical prostatectomy), or radiation therapy. If a man has localized prostate cancer and plans to undergo treatment, he should know that surgery and radiation are considered equally effective when it comes to preventing the advancement of the disease, according to the American Cancer Society

Contribution by Yaribeth Galvez club memberships white coat

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