EXTERNAL-BEAM RADIATION
This is the general term for radiation applied from outside the body. Until fairly recently, this involved roughly calculating the position of the target and the amount of radiation it required. Computerization, cat scans, and other innovations allowed radiologists to refine this, and led to the conformal approach. This hits the tumor from more than one angle, which means that it is less likely to harm other organs than single-beam radiation is. For example, conformal techniques have been shown to significantly lower the risk of radiation-induced proctitis (an inflammation of the rectum) following radiotherapy for prostate cancer. Lancet 1999 Jan 23;353(9149):267-272
RADIATION: GENERAL
External Beam Radiation Therapy: Advantages and Disadvantages
Explanation of EBRT
Radiation FAQ
Radiation in general
Glossary of radiology terms
Understanding Radiation Therapy: A Guide for Patients and Families
General intro to radiation therapy
Radiation safety concerns
VITAMINS AND RADIOTHERAPYAlthough the antioxidant vitamins A, C, and E help repair damaged cells, it is probably not a good idea to take large amounts during radiation treatment. The object of radiation is, after all, to damage cells. It is believed that normal cells often survive the attack and that cancerous cells do not. Antioxidants, however, appear to counteract the process, according to Dr. Rudolph Salganik's report to the annual meeting of the American Society for Cell Biology (December 1999). He pointed out that antioxidants like vitamin A and vitamin E dramatically reduce apoptosis in cancer cells, and suggested that patients avoid taking any more than a normal amount of these vitamins during, and for a while after, radiation treatment.
EXTERNAL-BEAM, CONFORMAL
By targeting the tumor from several angles, the organs near the prostate receive less radiation than they do from a single angle.
External beam radiation therapy
Results Of 3D conformal radiation therapy
INTENSITY MODULATED RADIATION THERAPY (IMRT)This form of conformal radiation therapy employs a number of small beams of variable intensity rather than a single, uniform beam. IMRT is replacing 3-D conformal as the standard form or radiation.
A patient-centered guide
Detailed description
PROTON RADIATION THERAPYProton beams do not lose energy as they pass through the body, so a lower dose can be used, with less damage to other organs. This is also 3-D conformal technique.
Loma Linda Center
National Association for Proton Therapy (extensive information)
Conformal Proton Beam Radiotherapy
Northeast Proton Therapy Center
Return to external radiation, Overview
INTERNAL RADIATION
The name for this type of procedure is interstitial brachytherapy. There are two forms: permanent and temporary.
Choosing a brachytherapistBRACHYTHERAPY, PERMANENTUltrasound is used to place 50 to 120 tiny pellets ("seeds") in predetermined sites. They deliver a constant (but slowly diminishing) dose of radiation over 3 to 6 months.
Brachytherapy FAQ
Permanent seeding FAQ
Brachytherapy: advantages and disadvantages
A summary of prostate brachytherapy literature (abstract)
A surgeon looks at seeds
PERMANENT SEEDS PLUS EXTERNAL RADIATIONIf the patient has a Gleason score of 7 or more, treatment may be combined with EBRT. In a 1997 interview, Dr. Peter Grimm of the Swedish Medical Center's Prostate Institute in Seattle stated that "some patients have a higher risk of disease outside the gland and therefore would benefit from the external beam radiation. . . . [They] generally receive a short course of external-beam radiation (5 weeks) prior to seed implantation." (From the Permanent seeding FAQ, above.)
In 2000, a paper by Grimm and others compared patients treated with brachytherapy alone with others who received external-beam radiotherapy as well. All were believed to have early-stage prostate cancer. They were unable to demonstrate that the additional radiation was beneficial. Radiotherapy and oncology 2000 Dec;57(3):273-8
BRACHYTHERAPY, TEMPORARYHighly radioactive materials are inserted in the prostate through temporary tubes for a few minutes at a time. This is followed (or, in some cases, preceded) by a regular course of EBRT.
Article on temporary seeding, from the patient's point of viewPROSTATE VOLUME AND BRACHYTHERAPY
Links to detailed information on HDR
According to Dr. Strum on P2P, "glands larger than 40 ccs should have their volume reduced to allow for more effective and less toxic radiation." A volume of about 15-20 ccs appears to be the smallest that brachytherapists can treat. (For reference: a golf ball is about 40 ccs.)
Shrinking the prostate
MAPPING THE PROSTATEBefore radiation or cryotherapy, the patient's prostate and surrounding organs will be "mapped," usually with a cat scan and ultrasound. The cat scan "slices" of the region are used to create a 3D computer image that the physicians and technicians will use to model the treatment.
About cat-scans
About ultrasound
Return to brachytherapy, OverviewPROSTATECTOMY (Surgery)
RETROPUBLIC APPROACH
The retropubic approach is made through the lower abdomen (the pubic region).
Radical prostatectomy, detailed
A radical prostatectomy FAQ
Risks involved in radical prostatectomy
Survival after radical prostatectomy
Radical prostatectomy survival handbook (an extensive patient history)
The pathology report following prostatectomy
PERINEAL APPROACHThe perineal approach is made behind the testicles.A French study found that the perineal approach is "associated with a significantly higher risk of capsular incisions and surgically induced positive margins." Journal of Urology, 1998 Oct;160(4):1383-1385 However, a Canadian study found that the two were comparable, with the perineal approach offering a few advantages. BJU International 2000 Jan;85(1):95-100
General description of a radical perineal prostatectomy
More-detailed description of a radical perineal prostatectomy
An illustrated description of a radical perineal prostatectomyLAPAROSCOPIC RADICAL PROSTATECTOMY
This technique does not involve opening up the entire abdomen. Instead, small incisions are made. The surgeon inserts the instruments in one of these and puts a tube with a tiny camera (a laparoscope) into another.
Upside. The procedure is much less invasive than traditional prostate surgery and therefore involves less pain and a shorter hospital stay.Downside. The technique is still new, so long-term results are still unknown. No in-depth clinical studies have been done. The technique is very difficult to learn.
Laparoscopy Technical Manual (pdf)
Return to prostatectomy, Overview
LYMPH NODESAbout lymph node dissection
NERVE SPARINGBecause the nerves that play a role in erections run along the surface of the prostate, they are usually removed with the organ or may be be damaged in the process. The object of "nerve sparing" surgery is to remove the organ without harming the nerves. However, it is not as common as one might expect, and even when attempted is not always successful. It is not easy to get at the prostate, and blood obscures the tiny nerves. Moreover, a surgeon should remove the nerves if they show any evidence of cancer. Some surgeons prefer to remove the nerves in any case because of this possibility.
Nerve sparing
The nerve-sparing technique: an illustration
Nerve mapping
Positive margins
Nerve sparing: comments by Dr. Patrick Walsh
NERVE REPLACEMENTWhile nerve-replacement itself is not a new procedure, it has only recently been tried with the cavernous nerves on the surface of the prostate. That section of the nerves is removed with the organ. The severed nerve is then rejoined with a short (about five mm) section of the sural nerve, taken from the back of the lower leg. (This leaves a small numb spot on the outside of the ankle.) A 12-18 month study of a dozen men who received grafts found that nine of the twelve "had return of erectile activity. No demonstrable erections occurred before 5 months postoperatively. The greatest return of function was observed at 14 to 18 months after surgery." J Urol 2001 Jun;165(6 Pt 1):1950-6
Sural nerve graft (abstract)
Nerve grafting after prostatectomy
ASPIRIN AND SURGERYBecause aspirin and similar products (for example, Bufferin, AlkaSeltzer, and Anacin) can cause excessive bleeding, you should stop taking them at least 10 days before surgery. Anti-inflammatory medications (such as Advil and Ibuprofen) should also be avoided. If you must take one of these, clear it with your surgeon.
NEOADJUVANT HORMONE THERAPYWhile radiologists seem to be generally convinced of the value of shrinking the prostate before treatment, surgeons appear to be divided.
Neoadjuvant hormone blockade in prostate cancer
Localized prostate cancer: neoadjuvant treatment
Neoadjuvant hormone therapy and radical prostatectomy
Neoadjuvant hormone therapy (part of a page on this site)
CRYOTHERAPY
Cryotherapy FAQ
Cryotherapy, general treatment
Cryosurgery: advantages and disadvantages
The theory behind cryotherapy
Return to cryotherapy, Overview
WATCHFUL WAITING
Watchful Waiting: advantages and disadvantages
When watchful waiting leads to treatment
Return to watchful waiting, Overview
COMPLEMENTARY and ALTERNATIVE
Each year, Americans spend several billion dollars more on alternative and complementary therapies than they do on regular medicines. Smart Money, April,1999 This is particularly true of cancer patients, and it can put their lives in danger.
Which one is it? It is a common mistake to believe that these are two names for the same thing. An alternative therapy is promoted as a cure with no scientific evidence to support the claim. An example is shark cartilage. A complementary therapy is one that is used to complement or supplement a medical treatment. An example is biofeedback to regain control of pelvic muscles following prostate surgery.
Check with your doctors before you do anything. A survey by researchers at the University of Virginia found that 43 percent of men with prostate cancer were using some form of alternative medicine. The most striking revelation of this study was that three-quarters of them had not mentioned it to their doctors. Cancer 1999;86:2642-2648 Another researcher, from the University of Pennsylvania, reported that only 13 of 196 cancer patients interviewed said that they were using an alternative therapy. Yet, when asked about specific treatments, it turned out that 79 were using other therapies. American Society of Clinical Oncology meeting,1999
Dangers. What many patients fail to understand is that it can be very dangerous to mix treatments. Supplements of any sort may affect the levels of things physicians use to monitor the progression of prostate cancer. For example, both saw palmetto, a popular herbal supplement, and Propecia, a prostate drug that is cross-marketed as a hair-restoration product, can lower your PSA, leading to errors in assessing your cancer. Another popular herb, St. John's wort, which is believed to act as an antidepressant, can be dangerous when taken at the same time as a pharmaceutical antidepressant, such as Zoloft or Prozac.
Reliability. Another part of the problem is that the companies that sell herbal remedies are not regulated by any federal agency. They are not required to list the ingredients of their products or to actually supply the amounts of each herb that they claim to.
Complementary Therapies
Drug Checker—to avoid possible drug and herb conflicts
Complementary and alternative therapies, by approach
Quackwatch, a site that exposes known cancer frauds
Standards problems
National Center for Complementary and Alternative Medicine (NCCAM)
National Cancer Institute: complementary and alternative treatments FAQ
National Cancer Institute: shark cartilage, hydrazine sulfate, laetrile, and other therapies
Return to advanced cancer, Overview page
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