New Treatments for Prostate Cancer
Radiation therapy
There have been many advancements in Radiation treatment over the years. External beam radiotherapy (EBRT), intensity modulated radiotherapy (IMRT), and 3D-Conformal Radiation Therapy (CRT) all accelerate subatomic particles called electrons to generate waves of high energy photon radiation. Proton beams use a subatomic particle called protons. Neutron beam therapy uses the subatomic particles called neutrons.
In 2008, SCCA brought in new technology that improves external beam radiation treatment by Calypso Medical that manufactures the Calypso® System now referred to as GPS for the Body®. SCCA radiation oncologists were critical in developing this system for use. This system provides clinicians with an innovative solution for target localization and continuous monitoring of the prostate in real time during radiation therapy delivery to make sure that radiation therapy treats just your cancer and not your surrounding organs.
Proton beam therapy
Proton beam therapy uses a different type of subatomic particle than the other types of therapy. At present, there are only a few centers offering proton beam radiotherapy in the United States. Greater precision in administering radiation is claimed for this approach, and with reduced scatter of the proton beam, a higher dosage of radiation can be administered in a precise way to the tumor reducing side effects. The results of studies done thus far suggest excellent outcomes in patients treated with proton beam therapy, which are approximately like those seen in patients treated with high doses of IMRT. The potential improvements in side effects remain a topic of some debate, as some studies suggest a higher rate of rectal toxicity than with IMRT.
Proton beam therapy will be available at Seattle Cancer Care Alliance in the near future.
Therapy for high risk cancer
Some men have cancer that is considered to have a high risk of recurring despite potentially curative treatment. SCCA is at the forefront of developing new ways to improve the effectiveness of both prostatectomy and radiation therapy. These treatments involve the use of treatment to treat both the cancer in the prostate and any cancer that might have spread early in the development of the disease. These approaches are available for patients who prefer either an operation or radiation therapy, and all are designed by physicians at SCCA using leading-edge research into how prostate cancer grows and spreads.
Active surveillance
Approximately half of men diagnosed with prostate cancer and treated with surgery or radiation have cancer that is at very low risk for causing serious problems for them in the future. Although it seems counterintuitive that men who have cancer may not need therapy, it is clear that most men with low-grade cancer, particularly those men above 70 years of age, will have evidence of prostate cancer that never causes problems over their lifetimes. This suggests that many prostate tumors grow very slowly and never progress to clinical cancer, even over decades. The very extensive use of PSA screening over the past 20 years has also increased the number of men diagnosed with cancer, even though many would never have needed treatment.
The open issue of how to best measure PSA or other markers to diagnose cancer is a different question from who needs treatment after a diagnosis of prostate cancer. There are a large number of men for whom therapy can be safely delayed, perhaps indefinitely. This approach is termed “active surveillance,” which is different from the old concept of “watchful waiting” which may have involved too much waiting and not enough treatment when it was needed.
In active surveillance, men are carefully monitored with serial PSA measurements and repeated prostate biopsies to carefully monitor for any changes that may suggest the need for treatment.
SCCA is leading a multi-institutional study of how best to determine who needs therapy and how to detect clinically significant and insignificant cancer, sponsored by the Canary foundation.
Clinical study
Some promising new treatments are only available in clinical trials. Ask your doctor if there is a clinical study that might be right for you.