May 1, 2022
Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.
But if cancer shows a higher risk (a Gleason score of 7 or higher) or has already begun to spread, other treatments are recommended. (A Gleason score classifies prostate tumor cells on a scale from 6 to 10. The higher the number, the more likely cancer will spread.) There are two options: surgery to remove the prostate (called a prostatectomy) or radiation to destroy the cancer cells.
Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and your personal preference. Yet for many men, radiation can be the better option.
“It’s much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony D’Amico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Women’s Hospital.
There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.
|Are you a candidate? Whether your doctor recommends radiation depends on various factors, including your age, health, and personal preferences. The type of radiation is often dictated by your risk group (low, intermediate, or high) and whether the cancer is localized or has spread. Sometimes hormone therapy (called androgen suppression therapy, or ADT) is given before radiation or along with it. ADT reduces levels of male hormones, called androgens, which can slow or even stop cancer growth. Studies have found this one-two punch leads to higher survival rates than radiation alone among men with localized prostate cancer and a Gleason score of 7 or higher.If you opt for surgery, your doctor may suggest radiation afterward, called adjuvant radiation therapy. “You have surgery to remove cancer, and then radiation to eliminate any remaining tumor deposits to keep cancer from returning,” says Dr. Anthony D’Amico, a radiation oncologist with Harvard’s Dana-Farber Cancer Institute. Cancer that has grown beyond the prostate also may require post-surgery radiation. After you’ve had radiation, you’ll have a prostate-specific antigen (PSA) test every three to six months for five years and then annually after that to check for recurrence of cancer. “If your PSA ever rises above 2, then imaging tests are done, and if needed, additional radiation or other appropriate treatment is given,” says Dr. D’Amico.|
External beam radiation
Rays of high-energy radiation are targeted to the site of cancer on the prostate (and sometimes nearby lymph nodes). External beam radiation effectively destroys cancer cells, but it can also damage healthy tissue. A CT scan determines the prostate gland’s exact location to allow for precise focusing and help limit collateral damage to the rectum and bladder. You lie on a table where a device delivers the radiation for five to 10 minutes. In general, treatments are given five days a week for several weeks. There are several types of external beam radiation therapy:
Three-dimensional conformal radiation therapy (3D-CRT). This involves taking three-dimensional pictures of the prostate and surrounding structures before treatment to pinpoint their locations. These images help the radiologist keep radiation away from the bladder and rectum.
Intensity-modulated radiation therapy (IMRT). IMRT is now the most commonly used form of radiation therapy. It is similar to 3D-CRT but is more precise because it allows doctors to change the radiation intensity within each of several radiation beams, increasing total radiation to the cancerous area while reducing radiation to healthy tissues.
Proton beam therapy. This has the same precision as IMRT but uses protons (subatomic particles with a positive electrical charge) instead of photons (light particles) used in conventional radiation. During proton beam therapy, radiation is released in a narrow band, thus minimizing damage to surrounding tissue. The downside is that it is more expensive and not available everywhere. “Also, outcomes appear to be equivalent with IMRT in terms of curing cancer and improving quality of life,” says Dr. D’Amico.
Stereotactic body radiation therapy (SBRT). SBRT uses image guidance and computer-controlled robotics to deliver multiple radiation beams to the tumor. Several systems are available, with brand names like CyberKnife, Gamma Knife, and TomoTherapy. Long-term side effects are still being explored.
Hypofractionated radiation therapy. This delivers larger doses with each treatment, requiring fewer sessions — typically, a total of five treatments spaced out over four to five-and-a-half weeks. A man is eligible for this treatment only if he has good urinary flow, doesn’t need to urinate often at night, has not had prostate surgery, and doesn’t take anticoagulants (blood thinners).
Brachytherapy involves placing radioactive pellets, or “seeds” — each about the size of a grain of rice — in or near the prostate tumor. The number of seeds ranges from 50 to 150, depending on the size of the prostate gland.
After the man receives either general or spinal anesthesia, the doctor places an ultrasound probe in the rectum and a catheter in the bladder. The doctor then uses a needle to insert the seeds through the perineum (the area between the scrotum and anus) and guides them into place. The seeds are left there and, over time, emit less and less radiation until they become nonradioactive. Depending on the type of seeds, this may take anywhere from three months to a year.
If cancer returns, a doctor may suggest high-dose-rate brachytherapy. Here, the more powerful seeds are temporarily placed and then removed several days later, with the process repeated for several sessions.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)
And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)
“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)
Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)
The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)
And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)
Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)
The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)
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