Quick, painless and bloodless Curative Treatment for Prostate Cancer

Prostate Stereotactic Radiosurgery

Stereotactic Radiosurgery is an ultra-targeted, non-invasive treatment that delivers high doses of radiation to a target, eliminating the cancer cells within.

It is a recognized curative treatment option[1] for localized prostate cancer and is also known as Prostate Stereotactic Body Radiotherapy (SBRT). Please see here for some technical details.

 

What is Prostate Stereotactic Radiosurgery?

 

Surgery involves physically cutting through tissue and bone to reach the tumor so as to remove it from the body.

Radiosurgery does not involve any cutting at all. The name was given because after destroying the tumor with high doses of focused radiation, the body automatically removes the dead cells, and the cure rate is as if surgery was done 

It is completely painless, bloodless and is done as an outpatient procedure.

Prostate Cancer Treatment Singapore

WIth a MRI to target the prostate (red) precisely, smaller treatment margins (pink line) can be used resulting in much lower exposure of the bladder (brown) and rectum (light green) to the treatment dose

Prostate Cancer Treatment Singapore

Radiation is delivered rapidly in a circular motion under direct supervision by a radiation oncologist, with tumour killing doses (red area) delivered to the prostate, and mostly low to moderate doses (blue to green)  going to limited areas of the rectum and bladder

Understanding the difference between Surgery and Radiosurgery

Patient does not need to undergo open surgery and does not suffer from operation risks

Differences between Prostate Radiosurgery and other forms of Prostate Radiotherapy

Radiosurgery and Intensity Modulated Radiotherapy (IMRT)


IMRT requires at least 20 daily treatments in 4 weeks whereas Radiosurgery is completed in 5 sessions every other weekday over 1 and a half weeks. Lower daily radiation doses are used in IMRT as the beams are less focussed than radiosurgery. The amount of rectum and bladder radiated with Radiosurgery is lower than IMRT, with potential reduction in long term side effects. The presence of a radiation oncologist familiar with radiosurgery is essential during every session to ensure the targeting is spot on.




Radiosurgery and Brachytherapy


Brachytherapy is a form of internal radiation therapy whereby needles and tubes are inserted into the prostate to allow release of radiation from within. It usually also involves a hospital stay, anaesthesia and insertion of a urinary catheter. There is a small risk of bleeding, infection and anaesthetic complications with brachytherapy. SBRT is a completely painless and non-invasive technique that is done in the outpatient setting.




Radiosurgery and Proton Therapy


Proton therapy is a form of radiotherapy that uses proton beams instead of x-rays. The unique feature of the proton beam is the ability to control how far it penetrates the body. Presently, there is no evidence that the proton therapy for the prostate is superior to IMRT or Radiosurgery in curing prostate cancer or reducing radiation side effects[2]





 
 

Is Prostate Radiosurgery for Me?

Radiosurgery and Intensity Modulated Radiotherapy (IMRT)


IMRT requires at least 20 daily treatments in 4 weeks whereas Radiosurgery is completed in 5 sessions every other weekday over 1 and a half weeks. Lower daily radiation doses are used in IMRT as the beams are less focussed than radiosurgery. The amount of rectum and bladder radiated with Radiosurgery is lower than IMRT, with potential reduction in long term side effects. The presence of a radiation oncologist familiar with radiosurgery is essential during every session to ensure the targeting is spot on.




Radiosurgery and Brachytherapy


Brachytherapy is a form of internal radiation therapy whereby needles and tubes are inserted into the prostate to allow release of radiation from within. It usually also involves a hospital stay, anaesthesia and insertion of a urinary catheter. There is a small risk of bleeding, infection and anaesthetic complications with brachytherapy. SBRT is a completely painless and non-invasive technique that is done in the outpatient setting.




Radiosurgery and Proton Therapy


Proton therapy is a form of radiotherapy that uses proton beams instead of x-rays. The unique feature of the proton beam is the ability to control how far it penetrates the body. Presently, there is no evidence that the proton therapy for the prostate is superior to IMRT or Radiosurgery in curing prostate cancer or reducing radiation side effects[2]





The Role of Radiosurgery in Stage 4 Prostate Cancer - 

Targeting Tumours beyond the Prostate

Prostate Cancer most often spreads via the bloodstream to the bones or in a step by step manner along lymph nodes in the pelvis and then the abdomen. Traditionally, drug therapy only (hormone treatment and sometimes chemotherapy) has been used to control prostate cancer and prolong life. 

 

It is increasingly recognized that men with Stage 4 prostate cancer that has spread to just a few areas (5 or less) may have a better chance entering into, and maintaining remission for  significantly longer periods of time, through combined drug and local (surgery or radiosurgery) therapy. Local therapy refers to directed treatment to visible tumours on scans which may not be completely eliminated by drug therapy alone. Effective local therapy of all visible tumours can allow deferral of chemotherapy and in some cases even allow deferral of drug therapy altogether.

 

Radiosurgery presents a painless, non-invasive option to achieve elimination of prostate cancer tumours, both in the prostate and sites of spread like bones and the lymph nodes. The treatments are targeted, and completed in 1-5 outpatient sessions, with a high percentage of success.

This illustrates the radiosurgery plan to eliminate prostate cancer in the backbone. Note the precision of the radiation dose (sky blue) covering the backbone (red), while curving round to avoid the spinal cord (yellow)

Targeted External Beam Radiotherapy

Stage 4 Options

Targeted Radionuclide Therapy
Oral Hormone Therapy
Alpha Radium

The Role of the Prostate Oncologist

An oncologist is a cancer doctor who can give an overall assessment, deliver treatment for and coordinate care of a particular cancer. He/she may be trained in treating cancer with drugs, radiation therapy or both.

Further, it is ideal to be seen early by an oncologist who is a subspecialist e.g. further specialised in treating prostate cancer. That way, a holistic, comprehensive and individualised plan can be formulated.

AARO doctors trained as clinical oncologists, having received training in both drug and radiation treatment for cancer. The group offers subspecialty expertise and a balanced, evidence-based treatment philosophy.

No matter which stage the patient is at his prostate cancer journey – right after diagnosis, seeking 2nd opinion or viable treatment alternatives – we are able to advise and provide suitable treatment.

References

  1. ASTRO/ASCO/AUA Guideline on Hypofractionation for Localized Prostate Cancer. November 2018.

  2. Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men with Prostate Cancer. Pan et al, J Clin Oncol. 2018 Jun 20; 36(18): 1823-1830

  3. Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer. Kishan et al, JAMA Netw Open. 2019;2(2)

  4. NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer. Version 2.2020 – May 21, 2020.

 
 
 
 
 

Our Prostate Oncologist

Consultant Radiation Oncologist 

MBBS (SIN), FRCR (CLINICAL ONCOLOGY, UK)

FAMS (RADIATION ONCOLOGY)

Clinical interests:

Stereotactic Radiosurgery (SRS/SBRT), Urologic, Head & Neck, Gastrointestinal, Pediatric Cancers & Sarcoma

Dr Jonathan Teh Yi Hui

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Our Clinic Locations

Farrer Park Hospital

1 Farrer Park Station Road #14-01 Farrer Park Medical Centre @ Connexion, Singapore 217562

Gleneagles Hospital

6A Napier Road, Annexe Block, #05-36C, Singapore 258500

Mount Elizabeth Novena Hospital

38 Irrawaddy Road #06-33 Mount Elizabeth Novena Specialist Centre, Singapore 329563

Mount Alvernia Hospital

820 Thomson Rd #08-53 Mount Alvernia Medical Centre Block D Singapore 574623

Mount Elizabeth Medical Centre

3 Mount Elizabeth #17-05, Singapore 228510

AARO @ Adam

19 Adam Road, Level 2 Specialist Clinic, Singapore 289891