A diagnosis of prostate cancer can be frightening, but thanks to treatment advances, the five-year survival rate for prostate cancer is 98%, with many men living much longer
Radiation therapy is commonly used to treat this type of cancer. At Yale Medicine, our radiation oncologists are at the forefront of diagnosing and treating all types and stages of prostate cancer We continually evaluate new radiation technologies and conduct research to ensure that our patients receive the most cutting-edge treatment available.
Yale Medicine doctors treat a range of diseases with radiation therapy—from localized prostate cancer to tumors that have advanced to organs near the prostate," says James Yu, MD, director of Yale Medicine's Prostate & Genitourinary Radiotherapy Program.
How is prostate cancer classified?
Tumors in the prostate range from slow-growing to fairly aggressive. They’re referred to by a number, known as a Gleason score, which combines a pattern type (numbered one to five, describing how aggressive the cells look under the microscope) and a stage (ranging from one to three and referring to how far the cancer has spread). The resulting score is on a scale from two to 10, where lower scores indicate cells that are more similar to surrounding cells than higher ones; scores below six respond well to treatment.
Who is eligible for radiation therapy for prostate cancer?
Since low-risk cancers can grow slowly, "when a patient’s cancer is small and not aggressive, we recommend observation instead of an immediate course of radiation," says Dr. Yu.
Yale Medicine doctor also look at the patient’s overall health to decide whether he is a good candidate. "Someone with a connective tissue disease, such as lupus, scleroderma, dermatomyositis or an inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, is not a good candidate, because he can suffer an inflated reaction to the radiation," says Dr. Yu.
What is the experience like for a patient?
The experience with our department begins with a consultation.
If you agree to receive radiation, you will have a noncontrast computed tomography (CT) scan to map your prostate and internal anatomy.
Next, we design a radiation treatment plan.
You'll come in for daily radiotherapy sessions, each lasting about 15 minutes. You'll check in, change into disposable shorts and wait in a men-only waiting area.
Yale Medicine radiation therapists then escort you to the treatment room, where you'll lie down in a custom body mold.
When your positioning is confirmed and adjusted, based on a CT scan or an implanted radio-frequency tracking device, treatment begins.
“Men should be in and out of our department like clockwork, with minimal disruption to their day,” says Dr. Yu. Radiation therapy may continue for up to nine weeks.
Once the course is complete, recovery typically requires a few months. “Typically, at their one-month follow-up visit, patients report they are on the mend,” says Dr. Yu.
“By four months, they are back to normal.”
What are potential side effects?
Typically, prostate-cancer patients tolerate radiation well.
During the first several weeks, side effects are minimal.
In the following weeks, you may begin to experience a few changes, including irritative urinary and bowel symptoms.
"We manage those with changes to diet, or medication," says Dr. Yu. "We have helpful clinical nutritionists who can help ease side effects related to treatment, and if a patient has severe side effects, it’s possible to suspend treatment for a week."
There is a small risk of a major medical problem, such as rectal bleeding, after radiation. In recent years, the precision of radiotherapy has helped to reduce such complications. Doctors track their patients regularly after treatment in order to catch any serious symptoms early.
"Our urology group is also exploring focal salvage therapies that may be able to address residual cancer that returns after radiation treatment," says Dr. Yu.
Are there any long-term risks?
Long-term risks are slight, but do exist. It’s rare but possible that a patient will suffer worsening urinary and rectal function, and there is always a risk of radiation causing cancer.
"Because there are some risks, albeit small ones, we do not treat a patient unless we believe that we can have a real impact on his survival," says Dr. Yu. "For a patient with a very slow-growing cancer, we typically monitor instead of advising immediate treatment."
How has radiation therapy for prostate cancer evolved in recent years?
Radiation has evolved dramatically in the last 40 years, and during that time, our ability to plan and deliver treatment has changed at about the same rate as computers have progressed. “Think of your computer 10 years ago and your iPad now,” says Dr. Yu. You might have heard about your father’s or grandfather’s perhaps difficult radiation experience in the 1970s or 80s, so you may be wary. But today’s radiation therapy is so different; we plan, deliver, and aid in recoveries that have better outcomes and fewer side effects than in the past.
Are there any new techniques, devices, or trials in the field that you're enthusiastic about?
There are new radiation methods – some of which we’ve adopted and some of which are still being tested. We now use a therapy called volumetric modulated arc therapy. It shapes the rays to conform to the shape of a tumor; this allows us to be precise and quick with treatment. In the field, there is also growing interest in the hypofractionated radiation technique for prostate cancer, which means that you deliver more radiation in a given treatment but over fewer sessions. There are trials going on to compare the safety and efficacy of this type of treatment compared with standard. treatment
We are actively exploring new technologies that may reduce radiation-related side effects, be they better ways to track and adjust for prostate motion, or ways to reduce the dose of radiation that is delivered to the rectum and bladder.
How is Yale Medicine's approach unique?
"At Yale Medicine, we take a number of approaches that set our care apart," says Dr. Yu. "First, we have a large physics staff that is essential to designing and verifying our radiation treatment plans. Second, we make it a point to evaluate new radiation technologies critically. We don’t hold onto old approaches, but neither do we jump on the latest trends without seriously assessing what they will contribute."
Third, adds Dr. Yu, we are running a growing prostate cancer research program and Yale Medicine is home to leading voices in urology, medical oncology and radiation oncology. "We’re also on the forefront of MRI-guided prostate biopsy," he says, "and, our bedrock is Yale’s multidisciplinary prostate cancer program, which brings together multiple insights collaboratively."