Experts describe innovative treatments for prostate cancer
In recent years, there’s been enormous growth in the availability of new treatments for prostate cancer, from newer forms of hormone therapy and radiation therapy to robotic-assisted prostatectomy.
Urologist Stephen Siegel, MD, of Boulder Medical Center, and radiation oncologists Dario Pasalic, MD, and Patrick Richard, MD, of Rocky Mountain Cancer Centers co-presented a free health lecture on the newest developments in prostate cancer treatment, including the TrueBeam® radiotherapy system with ExacTrac® Dynamic — together these technologies deliver an entire course of radiation treatment in just five short visits.
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Watch "What's new in prostate cancer treatment"
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Approaching prostate cancer care as a team
BCH has multidisciplinary cancer care teams, consisting of a range of health professionals who treat cancers. This comprehensive team approach, which is endorsed by the American Society of Clinical Oncology as a “Best Cancer Practice,” can improve quality of care and health outcomes because all the experts are involved in deciding the best treatment option.
For instance, BCH has a multidisciplinary team of specialized physicians and care providers from Boulder Medical Center (BMC) and Rocky Mountain Cancer Center (RMCC) who meet regularly to discuss evidence-based, best-care recommendations for prostate cancer patients. Discussing one patient at a time, the urology, oncology, radiology and pathology team members share their opinions and then, by consensus, determine which care option is in the patient’s best interest, based on clinical, evidence-based medicine.
“Our patients deserve dedicated time and attention given to each of their unique prostate cancer cases. Our bi-monthly cancer conference allows each prostate cancer expert to give undivided attention to each patient and develop unbiased treatment options that focus on efficacy, safety and quality of life,” states Dr. Richard.
Dr. Richard said some important things the prostate cancer multidisciplinary team considers when making a care recommendation include:
- The stage and grade of your cancer (risk stratification)
- Your age and expected life span
- Any other serious health conditions you have
- Your feelings (and your doctor’s opinion) about the need to treat the cancer right away
- The likelihood that treatment will cure your cancer (or help in some other way)
- What kind of quality-of-life outcomes you're looking for given the possible side effects from each treatment
Treatment options
Depending on the risk category of disease, the range of treatments offered for prostate cancer includes:
Watchful waiting - Reserved for patients who are completely asymptomatic with cancer that is localized (has not spread to distant sites). Your physician will monitor your condition without treatment.
Active surveillance - Reserved for patients who have a lower-risk cancer that is localized. “The goal of active surveillance is to try to avoid or delay treatment with the idea of maintaining your life expectancy but not adding to your risk. But if there is any indication that there's progression of disease during active surveillance, we’ll be discussing surgery or radiation as the next step,” said Dr. Siegel.
The American Society of Clinical Oncology recommends the following periodic evaluations while under active surveillance for prostate cancer:
- PSA testing every three to six months
- A digital rectal exam (DRE) at least once a year
- A prostate biopsy at least every two to five years (after the follow-up biopsy within six to 12 months of diagnosis)
Prostatectomy - Surgery is a common choice to try to cure prostate cancer, if it is not thought to have spread outside the prostate gland. Nowadays, it is usually performed laparoscopically, where the surgeon makes several small incisions in the abdominal wall to remove the prostate.
At BCH, robotic-assisted radical laparoscopic prostatectomy is an option and accomplished using the da Vinci® Surgical System, a sophisticated robotic surgery system that allows surgeons to operate on the prostate with enhanced vision, control and precision.
“Robotic surgery is so much better for the patient. When we switch over to robotics, there's certainly fewer complications, a shorter hospital stay, and most of patients don't need any narcotics to control the pain when they go home,” Dr. Siegel said.
Hormone therapy - The goal of hormone therapy is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cells. It’s used if the cancer has spread too far to be cured by surgery or radiation; if the cancer remains or comes back after treatment with surgery or radiation therapy; along with radiation therapy as the initial treatment; or, before radiation to try to shrink the cancer to make treatment more effective.
Chemotherapy - Chemotherapy uses anti-cancer drugs injected into a vein or given by mouth. These drugs travel through the bloodstream to reach cancer cells in most parts of the body. Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working.
Radiation therapy – There are three main types of radiation therapy used for prostate cancer:
- External beam radiation (EBRT) - In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to cure prostate cancer, or to help relieve symptoms, such as bone pain, if the cancer has spread outside of the prostate gland.
Intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are the most common types of external beam radiation therapy for prostate cancer. They use advanced hardware and software to design a conformal radiation plan that can be delivered in a timely and effective manner.
- Brachytherapy (internal radiation) - Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets, each about the size of a grain of rice, or needles. These pellets or needles are placed directly into your prostate gland.
- Radiopharmaceuticals (medicines containing radiation that are injected into the body) that target PSMA or settle in the bones, where they can help treat prostate cancer that has spread there.
TrueBeam® Radiotherapy System: Radiation therapy in just 5 treatment sessions
“The new kid on the block is called stereotactic body radiation therapy, or SBRT, which is similar to IMRT except that the doses that we give are larger each day and they're spread out every other day, typically over the course of about two weeks,” said Dr. Pasalic. “There is really good emerging evidence that this is equivalent to IMRT in properly selected patients.”
Dr. Pasalic added, “For patients with prostate cancer, five treatment sessions for an entire course of radiation therapy—versus the standard of up to 45 treatments—can be a huge relief and help get them on the road to recovery sooner.”
Varian’s TrueBeam® radiotherapy system—along with BrainLab ExacTrac Dynamic—is designed with this kind of improved patient experience in mind. BCH is the only medical campus north of Denver to offer five-visit radiotherapy.
Click here to view/download a PDF of slides shown during this lecture.
To make an appointment with urologist Stephen Siegel, MD, of Boulder Medical Center, call (303) 440-3093. To make and appointment with radiation oncologists Dario Pasalic, MD, or Patrick Richard, MD, of Rocky Mountain Cancer Centers, call (303) 385-2000.