Radiation therapy is an important and effective method in the treatment of patients with prostate cancer. It is an alternative to surgery. Radiation treatment is generally carried out in two ways – external beam radiation therapy, where the radiation source is outside the patient’s body, or brachytherapy, where the radiation source is applied through the skin in the form of radioactive grains directly into the affected prostate. The vast majority of prostate cancer patients treated with radiation undergo external beam radiotherapy. External radiation uses photon or proton beams.
Proton radiation therapy is a form of ionising radiation treatment using accelerated protons. The basic physical property of proton radiation is that protons transfer most of their energy at a location we specify. The goal of modern cancer treatment is to provide patients with the maximum chance of cure while minimizing the side effects associated with treatment.
Proton radiation therapy is a full-fledged alternative to prostate cancer surgery.
Unlike photon radiotherapy, which uses photons to irradiate and destroy cancer cells, proton therapy is more advanced and uses protons. These particles give proton therapy its many advantages. While a regular photon beam travels through the body and transfers much of its energy in front of and behind the tumour, protons have a physical property called the Bragg peak. Because of this property, they can give up significantly less energy on their way to the tumour, transfer energy at the tumour site, and go no further. Thus, the biggest advantage over photon radiotherapy is its precision, minimizing radiation exposure to healthy tissues and organs, and its ability to protect these healthy tissues.
Proton radiotherapy has minimal toxicity (side effects). In recent published papers analysing large quantities of patients, authors talk about severe toxicity of treatment in less than 1% of patients provided the disease is diagnosed at an early stage. Compared with published data for photon radiation therapy and surgery, this is minimal toxicity and is significantly lower than for other methods*.
Compared to surgical therapy, proton radiation therapy does not lead to impotence in most cases and thus significantly improves the quality of life of patients.
In high-risk prostate cancer, proton radiation therapy allows to irradiate pelvic lymph nodes which carry a high risk of being affected. In this clinical situation, the dosimetric and clinical advantage of proton radiotherapy is most pronounced in the investigation of abdominal organs, especially intestinal villi.
Proton radiotherapy is a fully outpatient treatment without the need for medical leave in most cases. For low and intermediate-risk prostate cancer, stereotactic irradiation can be used with a total duration of 10 days, attending radiation every other day, or 21 working days for other stages of the disease.
The probability of cure measured in 5-year PSA relapse-free survival is 97% for low-risk prostate cancer, 85-95% for intermediate-risk prostate cancer and between 75-85% for high-risk prostate cancer, according to the latest published data. Such results are usually not achieved with photon radiation therapy or surgery. *
99% of patients do not suffer from incontinence after proton therapy treatment provided the disease is diagnosed early – the patient will not need to use incontinence aids (pads) after treatment.
97% of patients do not develop impotence problems. Proton radiation therapy is the best for protecting potency, out of the available treatment methods.
*Source: https://www.ptc.clinic/wp-content/uploads/2021/06/ultrahypofracionovany-rezim_ca-prostaty.pdf
Proton therapy is legally covered by public health insurance. The Proton Centre has concluded contracts with all Czech health insurance companies, so the treatment is available to all citizens of the Czech Republic. Every patient can schedule an appointment for a consultation at the Proton therapy center , even without a doctor's recommendation.
Radiation therapy is an integral part of comprehensive cancer care, and approximately half of all cancer patients receive radiation therapy during their treatment. The principle of radiation therapy is that irradiated cells are unable to reproduce and therefore die. Cancer cells are generally more sensitive to radiation than healthy cells and therefore, it is possible to cure a tumour with radiation. Unfortunately, radiation also causes damage to healthy tissues, and this damage can occur during the course of radiation, within 3 months of treatment, or months or years after radiation has stopped.
Radiotherapy for prostate cancer is an alternative to surgery.
Photon radiation therapy uses radiation where the radiation source (photons) is placed outside the patient's body. However, the photons present a property that, as they pass through the patient's body, they transfer their energy not only at the site of the tumour where it is desired, but also in front of and behind the tumour. This results in unwanted irradiation of healthy tissues and organs in the vicinity of the irradiated tumour (organ) and the development of adverse effects.
With a prognosis of low-risk prostate cancer, the patient undergoes radiation in 20-35 sessions (called fractions). If the prostate is in a higher risk group, the radiotherapy is preceded by about 6 months of hormone therapy (usually two injections are given three months apart). The reason for this treatment approach is to try to reduce the tumour volume enough to make radiation safer for the surrounding organs. For the highest-risk prostate cancer, hormone treatment is then continued for a further two years after radiation.
*Source:
https://www.pcf.org/about-prostate-cancer/prostate-cancer-side-effects/erectile-dysfunction/
Brachytherapy is radiation therapy at a close range (brachys = Latin for short), in direct contact with the tumour. Its advantage is that the radiation dose decreases rapidly with distance from the radiator so the tissue behind the tumour is only minimally irradiated.
In prostate cancer brachytherapy, the radiation source is injected in the form of radioactive grains through the skin of the perineum directly into the tumour-affected prostate. The indication for this treatment has strict criteria and is performed at specialised centres. Brachytherapy treatment is particularly suitable for patients with early prostate cancer who cannot or do not wish to undergo radical surgical treatment.
The CyberKnife is a robotically controlled irradiation device that enables stereotactic radiosurgery. It is the application of very high doses of radiation to very small volumes in the body, a non-invasive alternative to surgery for certain malignant and benign lesions in areas throughout the body (brain, spine, lungs, liver, pancreas, prostate).
The CyberKnife uses a lightweight linear accelerator mounted on a robotic arm with 6 degrees of freedom to apply high doses, providing a non-surgical treatment for patients with tumours that cannot be operated on.
CyberKnife is suitable for tumour deposits that are small in size and also small in number. The indications are brain tumours and metastases, small tumours of the lung, spine, pancreas, liver, prostate. The limit for irradiation, is the size of the tumour up to approximately 5 cm or the presence 3 distant tumour foci at maximum.
The treatment can be done on an outpatient basis or in an inpatient setting, depending on the patient's preference. CyberKnife can be done in single or several applications.
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