More Than 2 Options

In 2013 I learned that despite a PSA reading of just 2.3 and a fully contained prostate cancer, it was my Gleason 9 score that would limit my treatment options for a diagnosed prostate cancer.

Making a treatment choice

For me the choices were either surgery or radiation. I also learned that active surveillance was typically only offered to men with slow-growing, low-risk cancer, and then discovered that the placing of radioactive seeds in or near the prostate cancer (brachytherapy) was recommended for men who scored 7 or lower on the Gleason scale.

A second opinion confirmed both my diagnosis and my available options. Which option you choose is largely up to personal preferences, your MD, your health specifics, and the disposition of the cancer at the time of diagnosis.

Changes in surgery and radiation

While surgical techniques have improved with the use of robotic-assisted devices, the basic principle of removing the cancerous prostate has largely remained the same. One newer surgical approach (when possible) is to remove only part of the prostate and keep the rest of the gland intact.

Where lots of change has occurred is in the field of radiation. If you are considering radiation vs surgery or radiation after surgery, here are a few basic terms and descriptions you may find helpful.

Radiation advances

Shorter treatments

Before radiation treatment begins, a patient undergoes a CAT scan along with the placement of some small markers on the skin or internally that allows the radiation oncologist to map out the target area and look for ways to minimize possible damage to the patient’s bladder and rectum. Once the target is identified, the patient is scheduled for treatment.

In 2018 when I underwent radiation, my course of treatment at that time was 5 days a week for 8 weeks. Today patients may be offered shorter treatment protocol but receive higher doses of radiation.

More targeted

Original radiation treatments were 2-dimensional, meaning the oncologist basically drew a target for the radiation on film using bone and anatomy as a reference. While effective, the treatment could impact a wide area and cause damage to healthy tissue in addition to the cancer cells.

When computers were added to the equation, radiation oncologists were able to generate 3-dimensional images of the target area. The development was called three-dimensional Conformal Radiation Therapy (3D-CRT). Suddenly treatment plans could pinpoint a more specific treatment area, reducing the likelihood of damaging surrounding healthy tissue.¹

I personally benefited from the next development in radiation technology, which is called Intensity-modulated radiation therapy (IMRT). My oncologist explained the new treatment this way. While this was like 3D-CRT, the approach allowed him to vary the intensity of the beams depending upon the level of attack as the device rotated about my body. While that sounded good, I was still filled with anticipation that proved to be worse than the actual treatment.

About the same time there was another radiation process called Stereotactic body radiation (SBRT), which delivers multiple radiation beams via computer-controlled robots. I believed that the long-term effects of SBRT (10 years or longer) were not well-known, so I decided to stay with the better-known IMRT.

Considering the options

More recently and depending on availability and cost, men may opt for proton therapy that uses subatomic particles vs the light particles used in radiation. While the treatment offers the same precision treatment as IMRT, proton particles are not suppose to penetrate beyond their intended target.²

As noted earlier, I was not offered radioactive seed implant therapy due to a high Gleason score of 9. The seeds when placed around the prostate can number between 50 to well over 100 depending on the size of the prostate. What I found interesting in researching this treatment option was there are different kinds of seeds: some are left in the body after treatment while others are temporary. Additionally seeds can also come in different levels of potency.

If you are contemplating radiation as a treatment option, I hope this brief overview allows you to come up with a few more questions you can ask when you next visit your MD. ·