Men's Health Matters
Baltimore's Dr. Edward Leventhal gives you advice on how men can live healthier lives.Radiation Therapy To Treat Prostate Cancer
Today’s discussion will open the topic of radiation therapy as definitive treatment for prostate cancer. Just as there are multiple ways to perform extirpative surgery, there are also multiple ways of treating prostate cancer with radiation. What differs between them is that extirpative surgery removes the prostate irrespective of the approach, whereas the multiple methods of radiation therapy differ in their theoretic rationale for how to treat the disease.
There are multiple methods of dispensing radiation into the prostate gland and while I do not plan to go in-depth with each method, I will take at least a couple of the treatment options and discuss them specifically. This may not be a fully inclusive list but at the present the following are currently the most utilized methods of dispensing radiation to the prostate:
Prostate Brachytherapy - also call prostate seed implantation. Radioactive seeds about the size of a grain of rice are implanted directly into the prostate typically using ultrasonic guidance. This is also referred to as interstitial therapy as the radiation is placed directly into the prostate gland rather than being directed from an outside source.
IMRT (Intensity modulated radiation therapy) A mode of high-precision radiotherapy that utilizes computer-controlled linear accelerators to deliver radiation doses to a the prostate. This is an external radiotherapy treatment.
IGRT (Image guided radiation therapy) The process of frequent two and three-dimensional imaging, during a course of radiation treatment, used to direct radiation therapy utilizing the imaging coordinates of the actual radiation treatment plan. Again, this is an external radiotherapy process.
Proton Beam Therapy - like IMRT and IGRT in that the source is directed externally the difference is that the radiation source is protons rather than photons. There are only a handful of centers in the United States currently offering Proton Beam Therapy.
Cyberknife Sterotactic Radiosurgery - this is the newest treatment that has Medicare approval. While conventional radiation therapy (radiotherapy) administers a broad beam of radiation from one or two directions through normal tissues and requires between over 40 treatments to complete the course, stereotactic radiosurgery delivers highly focused beams from many directions so that the normal tissues experience less radiation and the treatment can be completed in only five sessions.
While it may be a simplistic way of looking at the options, I believe that a helpful way of thinking about the treatment is in the number of treatments needed to complete your course of therapy. Seed implantation in the majority of cases is completed in one treatment. Cyberknife is completed in five treatments typically over the course of one week. The other treatment options all require typically over forty sessions over the course of anywhere from six to eight weeks.
Each of the above mentioned treatments has their proponents and naysayers. All will claim results as good as surgery with less complications. Because of the expense of the external radiation therapy units, typically one center will only perform one type of treatment and there have been cases of financial conflict of interest that are currently being evaluated by CMS (Center for Medicare and Medicaid Services) for privately owned units.
There is no argument that radiation has the ability to eradicate prostate cancer. Like the older version of the radical prostatectomy, the old version of external beam radiotherapy was fraught with serious complications. Modern day radiation treatment has become much more focused and like surgery the goal has become to decrease the morbidity of the treatment while maintaining its efficacy. Over the next few blogs, I will discuss the complications and side effects that are most common to radiation therapy as well as the two versions of radiation therapy that I have used extensively. And while I will not specifically discuss the other radiation treatment options, there is a tremendous amount of information available on the web for those interested in more than I can offer in this forum. Remember however, that many of the sites you will come to are dedicated to their treatment option as the best available to treat prostate cancer. So you will need to look at the information they present and realize that there is very likely some bias in their presentation. I do not mean to imply that they are not being truthful, but there is no oversight of what is presented on the web, so be careful and if you have questions write them down and ask your urologist.
Ravens aside - as a football fanatic, I listen to a lot of sports talk radio. The talk of the week is how the Ravens lost the New England game because of officiating. Personally, I think that’s a copout. And while I will agree that the officiating of the game was poor, if you are going to beat a team like the Patriots and do so in their home you have to play a perfect or near perfect game. Unfortunately, the Ravens did not fill that prescription. Fumbling the opening kickoff, throwing a pick as you are driving to score before the half, and dropping a perfectly thrown pass at the end of the game on a 4th down just doesn’t get it. The fact that we were in position to win the game with 45 seconds left tells us that we have the ability to play with and beat the elite teams in the NFL. We just can’t afford to leave that much on the table and expect to win against the upper echelon of the NFL. That may fly when we are playing the Browns, but to beat the Pats, the Colts, and the Steelers in their home we have got to bring our best. Unfortunately, we came eight yards short last week. Now let’s go take out our anger on the Bengals. Go Ravens!!!!!!
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