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Prostate Cancer (cont.)

What is Radiation Therapy?

The goal of radiotherapy for men with localized prostate cancer is to deliver enough radiation to the tumor while minimizing radiation to adjacent normal tissues.

Two types of radiation therapy are used in prostate cancer -- external beam radiation therapy and brachytherapy. Both are used to treat prostate cancer that has not spread outside the prostate. In terms of survival, radiotherapy appears to achieve similar results as those obtained with radical prostatectomy.

  • External-beam radiation therapy (EBRT) involves targeting a beam of high-energy radiation directly at the localized cancer. The rasiation beam may include photons or protons today in most cases, depending on the equipment utilized.
  • Radiation therapy has also been used to treat cancer in which there has been localized spread of the cancer outside of the prostate in combination with other types of treatment (surgery).
  • Side effects of external beam radiation are usually temporary and may include:
    • Skin burning or irritation
    • Hair loss at the area where the radiation beam goes through the skin
    • Severe fatigue
    • Diarrhea
    • Erectile dysfunction
    • Urinary frequency, discomfort at urination, and/or urgency
    • Some studies have shown an increased risk of bladder and rectal cancer with radiotherapy. However, the magnitude of this risk remains small and the risk of dying from a secondary malignancy at 10 to 15 years after treatment is no higher than the perioperative mortality associated with radical prostatectomy.
  • Brachytherapy (internal or implanted radiation) is a variation of radiation therapy in which a small radioactive pellet is implanted into the prostate. An imaging technique, such as transurethral ultrasound (TRUS), CT, or MRI, is used to accurately place the radioactive pellets. This provides radiation to a smaller area than external-beam radiation and minimizes exposure of surrounding normal tissue. The pellets provide radioactivity for weeks to months and can simply be left in place once exhausted. In comparison to external beam radiotherapy, this treatment requires only a one-time treatment, rather than the daily therapy required in EBRT.
  • The main complications of brachytherapy are:
    • Urinary symptoms including transient urinary frequency, urgency, and discomfort at urination
    • Erectile dysfunction
    • Gastrointestinal symptoms

What is Chemotherapy?

Chemotherapy is the also used against prostate cancer.

  • The utility of chemotherapy in the management of metastatic prostate cancer continues as an area of ongoing research.
  • This therapeutic option has been explored most in patients with hormone-resistant disease.

Newer chemotherapy medicines, such as docetaxel (Taxotere), have shown some promise in prolonging the survival of some patients with extensive prostate cancer. They may also decrease the pain related to widespread cancer. However, this comes at the cost of significant side effects that may impact quality of life.

Symptom palliation: The primary approach to the management of symptoms in patients with advanced prostate cancer is systemic therapy with both older and newer forms of hormomal treatments, then chemotherapy. Today immunotherapy and radioactive isotope treatments may be used. Radiation to painful bone lesions may be used. Throughout all of this, optimal pain medicine use and other therapies for cancer-related symptoms should be administered. For patients with castrate-resistant prostate cancer, palliative therapy may be indicated to treat symptomatic bone metastases or symptoms arising from progressive disease.

What Are Other Local Treatment Options for Prostate Cancer?

Besides radical prostatectomy, external beam radiation and/or brachytherapy, cryosurgical ablation of the prostate and high-intensity focused ultrasound (HIFU) have emerged as alternative therapeutic options in patients with clinically-localized prostate cancer.

Cryotherapy and high-intensity focused ultrasound (HIFU) have been used to destroy tissue, either by freezing or by generating local thermal energy. These techniques can be applied focally, sub-totally, or to the entire prostate gland. However, the role of these techniques remains uncertain. Potential advantages in men with localized disease include the ability to destroy cancer cells using a relatively noninvasive procedure. As such, these procedures are associated with minimal blood loss and pain. There is also faster post-treatment convalescence.

Cryotherapy

This technique involves inserting a probe through a small skin incision and freezing areas of cancer in the prostate.

  • This therapy is reserved for cancer localized within the prostate as well as for men who are unable to withstand the conventional therapies such as surgery or radiation.
  • The probe is guided to areas of cancer by using TRUS. Cancerous tissue appears on the ultrasound and allows the surgeon to monitor therapy and limit damage to normal prostate tissue.
  • There are several advantages to using this procedure over surgery and radiation therapy. There is less blood loss, a shorter hospital stay and recovery time, and less pain than with conventional surgery.
  • The long-term effectiveness of this procedure is unknown because it is a newer treatment.
  • The role of cryotherapy in the management of localized disease remains uncertain. Even among men with low-risk disease, it is not yet clear that results with cryotherapy are equal to those with radical prostatectomy or radiotherapy.

HIFU

  • HIFU (high-intensity focused ultrasound) was first developed as a treatment for benign prostatic hyperplasia (BPH) and is now also being used as a procedure for the killing of prostate cancer cells. This procedure utilizes transrectal ultrasound that is highly focused into a small area, creating intense heat of 80° C to 100° C, which is lethal to prostate cancer tissue.
  • The published clinical experience with HIFU for this application is limited and the procedure is not yet approved by the FDA for use in the U.S.
Medically Reviewed by a Doctor on 11/22/2016
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