Treatment For Prostate Cancer | Radiation Therapy For Prostate Cancer

About the Prostate

The prostate is a gland found in men that is part of the genitourinary system, a system which also includes the bladder, kidneys and testis. It is located in the pelvis, just below and behind the bladder, and just in front of the rectum. The prostate is located at the “neck” of the bladder, where it funnels down and becomes the urethra, which runs through the prostate. The prostate is a single gland, but it does have a right and left side, or lobes. The prostate tissue is surrounded by a thin rhine, or capsule.

The purpose of the prostate is to aid in making the seminal fluids, which during ejaculation, are used to move the sperm out of the body. Two glands, called seminal vesicles, also contribute to the ejaculate. The seminal vesicles are also attached to the prostate from above, and lie behind the bladder.

As men get older, the prostate can enlarge. This is a benign occurrence, often called BPH, or benign prostatic hypertrophy. Since the urethra runs through the prostate, BPH can sometimes cause the prostate tissue to bulge into the urethra, causing some urinary symptoms such as a weak urine stream or nighttime frequency.

About Prostate Cancer

For a cancer to form, for reasons not entirely known, something in the normal cells of the prostate goes awry, and the normal activity of a prostate cell changes. It loses its ability to know when to stop growing, and becomes malignant – it becomes a prostate cancer cell, which may call for radiation therapy for prostate cancer or another treatment.

Prostate cancer cells grow at first within the confines of the prostate itself. Sometimes the cells are in only one particular area of the prostate, and sometimes they may be in several locations or “zones,” or “lobes.”  Prostate cancer can grow locally and pierce the capsule of the prostate toward the neighboring per-prostatic area or into the seminal vesicles, eventually spreading further away from the prostate gland itself. That’s when metastasis occurs. That typically happens to the lymph nodes in the pelvis, or to the bones.

Signs & Symptoms

In the past, most men with prostate cancer were diagnosed after presenting with new urinary symptoms, including blood in the urine, or a significant change in how they were able to urinate (frequency, weak stream, etc.). This is not a common presentation however, since most men will have some of these symptoms as a normal part of aging.

A more common sign of cancer is the finding of a nodule or abnormality during a routine digital rectal examination, or DRE. Most men will have a DRE during their annual physical exam. If asymmetry, firmness or nodularity is detected, a referral to a Urologist for investigation will likely be made.

However, in the last decade, most men with prostate cancer have a perfectly normal DRE and no urinary symptoms at all, but instead present with an abnormal blood test called the prostate specific antigen (PSA). PSA is a protein that is made only by normal or cancerous prostate cells. All men have a detectable amount of PSA in their bloodstream, which is there because it can “leak” into the blood from the prostate at low levels. Prostate cancer cells also may make this PSA, and cause more of it to leak into the bloodstream where it can be detected during a routine blood test. If the PSA level is high (many labs use a normal range of 0 and 4.0 ng/ml), or if the PSA level has risen significantly over a short time period, a man might be referred to a Urologist for further investigation.  It should be noted that an elevated PSA does not mean that prostate cancer is present, as other benign conditions can cause an elevation in PSA, such as a prostate infection (prostatitis), or the normal enlargement of the prostate with age (due to BPH or benign prostatic hypertrophy), etc.

I've Been Diagnosed with Prostate Cancer, What Happens Next?

Prostate cancer is treated with either surgery or radiation. It is important to understand that prostate cancer is not just one disease, but it has many variations and subtypes based on the extent or stage of the disease, pathologic findings on biopsy (such as the Gleason score), PSA level, etc. and treatment decisions must be individualized for each case. In general, early stage prostate cancer can be cured with equal effectiveness using either surgery or radiation therapy for prostate cancer. More advanced or aggressive prostate cancers may be better treated with radiation. Since radiation therapy can encompass a larger area than surgery, more advanced or aggressive prostate cancers may be better conquered with radiation treatment for prostate cancer. Sometimes hormone therapy is used in conjunction with radiation in these cases to enhance the effect of the radiation.

Radical Prostatectomy for Prostate Cancer

A radical prostatectomy is a surgical procedure in which the prostate gland and some of the neighboring tissue is removed. The operation can be performed either as open surgery, laparoscopically through the belly button, or through robot-assisted laparoscopy.

External Beam Radiation for Prostate Cancer including IGRT & RapidArc

At Advanced Radiation Centers of New York (ARC), since radiation is delivered with the highest degree of accuracy the side effects of treatment are significantly reduced, compared to other forms of radiation, radiation seeds and even surgery.

Seed Implants for Prostate Cancer

Prostate Brachytherapy, also known as a Radioactive Transperineal Protate Seed Implant, uses radioactive seeds implanted into the prostate. This form of therapy delivers photon radiation from the inside-out, as opposed to radiation from the outside-in with external beams.

Seed implants became a very popular treatment for prostate cancer, in large part because of the convenience of this treatment. It is typically performed in about an hour or so.  The pendulum has swung toward Image Guided Radiation Therapy (IGRT) and away from seed implantation, since the cure rates are the same, but the side effects of a seed implant tend to be greater.

What About Hormone Therapy?

Hormone therapy is given to enhance the effect or benefit of radiation. The treatment is actually more of an anti-hormone therapy. In all men, there are naturally-occurring male hormones in the body called androgens. Androgens can “turn-on” or activate both normal and malignant prostate cells. Hormone therapy, also known as Androgen Blockade Therapy serves to block the effect of circulating androgens on the prostate cancer (and normal prostate) cells. The cells are shut-down, and kept from growing for many months. The prostate gland itself shrinks in size, as its component cells are now inactivated and less plump. Men who had received hormone therapy before, during and after radiation had an improved survival rate when compared to the men who just received radiation therapy alone.  The most common side effects can include hot flashes and a decrease in libido and erectile function. Longer term use can have an impact on other parts of the body such as the musculature or heart.

What Happens if my Initial Treatment Doesn't Work?

Treatment options after failed surgery: Post-prostatectomy radiation therapy may be used as a salvage treatment to “mop-up” any microscopic cells that may have been left behind following surgery.  Radiation is started earlier than later. Radiation therapy following prostatectomy is much more effective.

Options after failed radiation: If the PSA does not respond as expected, it may point to residual or recurrent cancer in the prostate. Options for salvage therapy include radical prostatectomy, cryotherapy or, in certain cases, brachytherapy or hormone therapy.

Risk Factors

There is no one or clear reason why someone gets prostate cancer.  There are also very few risk factors for getting it. The one that is most widely known is a family history, or genetic predisposition.  However, most men who are diagnosed with prostate cancer have no family history at all. In addition, African American men have a higher risk over Caucasian American men in developing prostate cancer, and African American men of Caribbean descent have an even higher risk, while various other nationalities and races have lower risks.

Preventing Prostate Cancer

There is not yet one “magic pill” that can prevent prostate cancer. One study looked at the use of a drug called finasteride, which was given to men to see if it prevented them from developing prostate cancer.  The results of this study did show that the men who took this drug versus placebo had a lower risk of developing prostate cancer; however, those that did develop cancer and that were taking finasteride were found to have a more aggressive form of prostate cancer.  The results of this study are somewhat controversial however, and further research is needed before this drug or others can be recommended in the prevention of prostate cancer.

Another study called the SELECT trial randomized men to take Vitamin E and/or Selenium, to see if these supplements might decrease the incidence of cancer. The results of this trial ended early and were reported in December 2008 – showing that neither Zinc or Selenium were able to reduce the incidence of getting prostate cancer.

Although much speculation about diet has been made, including the benefits of Lycopene found in tomatoes and Saw Palmetto, a natural herb, there is conflicting data on even these two substances.  Apart from outright preventing prostate cancer, what can be done then? Clearly, the most important thing that you can do to increase the chance of cure is to ensure early detection of the disease.