Radiotherapy vs Other Therapies | Prostate Cancer Treatment Singapore

EARLY-STAGE

I have been diagnosed with early prostate cancer and want to know about all the treatment options for cure

What is 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).

Reference

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

Understanding the difference between Surgery and 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.

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

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

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

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.

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