Prostate Cancer Radiotherapy May be Set to Change

Radiotherapy is a common form of treatment for prostate cancer and formed part of my treatment regime. There are welcome signs that this form of therapy is about to undergo a substantial change for the better, but more about that in a moment. First, some scene setting and a little background.

An unwelcome diagnosis

On the 20th of November 2017, I was diagnosed with prostate cancer. My wife came with me to the hospital, where we both received the unwelcome news.

Following the biopsy that confirmed the doctors’ suspicions, we both had heavy loads to carry; me with cancer and my wife with a husband who now had a life-threatening disease. I’d had a few bangs and scrapes over the years but nothing serious, so I had little idea how I was going to respond to the news.

Feeling scared

My wife and I parted at the train station close to the hospital, and we both went our separate ways to our respective offices as most of us did in those dim and distant pre-pandemic days. As my wife left, I cried, not something I’d done in public since I was a kid in school. I was scared and wracked with self-pity. Why me, why cancer?

Most people reading this will have undergone something similar. In many ways it’s unremarkable, but it didn’t seem unremarkable at the time.

Undergoing treatment

Thereafter the oncologists, lab technicians and urologists got busy figuring out the best course of treatment for me. It was decided I was to have immediate hormone therapy for three years together with 39 radiotherapy fractions in September of the following year.

By the time September finally rolled around, the hormone therapy had been doing its work, and my PSA stood at 0.08. It was now up to the radiotherapy to join the fray and take another whack at my cancer.

The radiotherapy

Every morning I would jump on my bicycle and ride the 15 minutes to the hospital, where I was placed inside what looked like a giant donut which then unleashed high-energy X-ray beams targeting the cancer.

All of us who were having the treatment sat in a small waiting room sipping water (a full bladder is required prior to treatment), and I got to look forward to meeting the same guys and swapping stories until their fractions were complete and their places were taken by other sufferers.

Finally, my own treatment was done, but as no treatment was offered on the weekends and on a few occasions the machine broke down, it took almost two months before my rendezvous with the donut came to a close.

Potential changes coming

For future patients, this may be set to change. My course of radiotherapy was at the outer edge of what is generally recommended, with many patients having around 20 fractions. However, a new trial taking place at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust in the UK is looking at the suitability of completing the treatment in as few as five sessions.1

This therapy is known as stereotactic body radiotherapy (SBRT), which delivers high doses of radiation for a period of one or two weeks. It can be delivered by so-called CyberKnife or on standard radiotherapy machines and allows clinicians to target tumors with sub-millimetre accuracy.1

Findings thus far

Tabloid newspapers quickly got hold of the story and have responded in the only way they know how with headlines such as: "Men with prostate cancer could be cured in ONE WEEK." Those who have cancer quickly learn to take these proclamations with a whole bowl of salt.

However, the researchers found about 90% of patients who took part in the trial suffered only mild side effects two years later, which could suggest that high doses of radiation can be given without risk of long-term harm. Reducing the number of sessions required would also likely save money and enable the treatment of many more patients.1

Dr Alison Tree, Consultant Clinical Oncologist at The Royal Marsden said: “Our aim was to understand whether we could safely increase the dose of targeted radiation per day, allowing us to reduce number of treatments required. We wanted to measure whether this could be done without changing the low level of side effects we see with modern prostate radiotherapy.

“This data has shown very promising results that suggest potentially curative prostate radiotherapy can be given with very few side effects for patients with stereotactic body radiotherapy over five days.”1

Professor Emma Hall, from The Institute of Cancer Research, said:“Now we know that longer-term side effects of SBRT are similar to those with standard radiotherapy. If we can also show that cancer control is no worse, then we expect our trial to be practice-changing.”1

Welcome news

Although I enjoyed meeting my fellow patients every day prior to undergoing our treatment, the thought that it could have all been done and dusted in a matter of days rather than two months would have been very welcome. Prostate cancer treatment never stands still.

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