Technological Advancements In Prostate Cancer Treatment
The strategic use of ionising radiation or photons to damage the DNA and kill cancer cells is called Radiation Therapy. For localised prostate cancer, radiation therapy is as effective as surgery in curing the disease. With technological advancements and a better understanding of tumor biology as well as radio-biology of radiation treatment, radiation therapy has now become more comfortable, economical and less time-consuming for patients than it was a decade ago.
External Beam Radiation Therapy or EBRT scores over surgery in a few ways:
It is an out-patient procedure - so no prolonged hospital stays.
It does not require anaesthesia or sedation.
It does not interfere much with patient’s daily activities.
It is suitable for patients who are not surgical candidates (due to heart problems or other health issues)
Technological advancements in the field of Radiation Physics, Radiation Therapies have helped develop better treatment machines and formulate finer treatment techniques that can deliver Radiation Therapy very precisely to the tumor while sparing the surrounding normal tissues. Focussed radiation treatment techniques like IMRT (Intensity Modulated Radiation Therapy) and RapidArc or VMAT (Volumetric Modulated Arc Therapy) are capable of shaping the radiation beams precisely to the shape of the tumor. These techniques also vary the intensity of the radiation dose deposited inside the tumor - depositing a concentrated dose where the tumor is thick or more active, resulting in more cancer cell kill, which translates into better tumor control.
IGRT or Image Guided Radiation Therapy is a novel technique of treating the prostate very accurately. The newer Radiation Therapy machines are equipped with on-board imaging equipment which is used to determine the exact position of the prostate in relation to the surrounding organs ( urinary bladder and rectum ) and then deliver radiation to the prostate. This eliminates uncertainties in the position of the prostate which can move due to changes in bladder filling with urine or gas in the rectum. This also results in the amount of rectal and urinary bladder tissues getting irradiated reduced considerably, which means that the side effects related to these organs is also minimised.
Generally, Radiation Therapy for cancer involves treatment over the course of 25 - 35 days, sometimes even more. This is necessary, but quite tedious as far as the patient is concerned. A better understanding of the course of events leading to radiation induced death of the cancer cell, as well as recovery of normal tissues from radiation damage, has brought about paradigm changes in the duration of treatment required to deliver the total radiation dose. Treatments which would take 7 to 8 weeks to be completed can now be completed in 4 - 5 weeks or sometimes even less in select patients.
The latest to join the armamentarium of Radiation Therapy for prostate cancer is a technique called Stereotactic Radiation Therapy. This is a very advanced technique of using highly focussed radiation beams to deliver a high radiation dose and kill the cancer cells. This technique has been successfully implemented in the past couple of decades to treat brain, liver, lung and spinal cord tumors. Evidence indicates that SBRT for prostate cancer is an excellent option as prostate cancer responds well to a higher radiation dose per treatment. Published evidence suggests that SBRT is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.
From a mode of treatment that was perceived to be fearful because of side effects, Radiation Therapy is now perceived as being more patient friendly. Rapid progress in digitisation, automation, and our biological understanding of cancer will influence radiation oncology and patient care for the better in the years to come.
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