SBRT for the Intermediate-Risk (Teal)  Prostate Cancer | Prostate Cancer Staging Guide

SBRT for the Intermediate-Risk (Teal) Prostate Cancer | Prostate Cancer Staging Guide


Hi, I’m Dr. Scholz. Let’s talk about prostate
cancer. This video is about stereotactic body radiation
therapy (SBRT). Radiation therapy when it’s delivered by a beam involves going to a specialized
facility, sitting in front of a machine for a brief period of time on a daily basis (Monday
through Friday) for a period of one or more weeks. Traditionally radiation therapy required
anywhere between 5-9 weeks of therapy. SBRT is different because by giving larger doses
on a daily basis, the treatment can be completed within a week or two—maybe 3-5 visits to
the radiation therapy facility. This is certainly a lot more convenient.
Radiation therapy has progressed most rapidly in the area of beam radiation. If you’ve
done even a little bit of research you are probably aware of IMRT (intensity modulated
radiation therapy) and IMPT (intensity modulated proton therapy). SBRT is beam radiation but
packaged over a much shorter period of time. This type of radiation has been under investigation
for about 10 years, and there has been concerns about the delivery of such high doses over
short periods of time. It does appear that the cure rates are equal and it’s certainly
a more convenient approach. The real question is whether the side-effects would be worse.
With the beam radiation the concerns for serious side-effects consist of erectile dysfunction–which
no one really believes is any different between SBRT, IMRT, or IMPT. Because the rectal wall
is very close to the posterior portion of the prostate, the possibility of a long-term
non-healing burn to the rectal wall has been a concern, and some of the early studies suggested
that the incidence of rectal burns called “Proctitis” is a little bit higher with
SBRT. This has been one of the reasons that I had hesitated to use SBRT because if that
side effect occurs it’s a real disaster. Whether or not that’s the case, there’s
a new type of technology out now called SpaceOAR. SpaceOAR is a treatment that involves injecting
a gel between the rectal wall and the prostate, spreading the two apart so that the rectal
wall no longer needs to be radiated in the course of a normal radiation program. With
the advent of SpaceOar, it appears there’s no reason for concern that SBRT would be more
toxic. Therefore, it compares favorably with IMRT and IMPT. Apparently, it has similar
cure rates, it’s clearly more convenient, and if there are no additional side-effects
it may be the best way to go. So does this mean that SBRT (or CyberKnife)
is going to completely replace proton therapy and IMRT? Well there are a few areas where
it certainly could, and one area looks particularly attractive and that would be the possibility
of doing more focal treatment. Many patients are unaware that standard radiation (SBRT,
IMRT, IMPT) involves targeting the prostate gland–not the tumor within. The borders of
the gland are the borders of the radiation. Someday, especially now that imaging is improving
so much we may be able to radiate the tumor itself and spare much of the prostate. This
could further reduce the potential for side-effects. So SBRT might shine in that department, but
radiation therapy via a beam delivery is used commonly also to treat lymph nodes in the
pelvic region and there’s little of any experience now with using short courses like
SBRT to accomplish that. The other thing that is not quite clear is whether SBRT should
be combined with seed implant radiation as IMRT is, or whether it can be used instead
of seed implantation therapy. So there’s a lot of unanswered questioned still, but
for the Teal patient (those that have intermediate risk prostate cancer) SBRT in expert hands
with the use of a SpaceOAR appears to be a very attractive alternative for curative therapy
for prostate cancer.

4 thoughts on “SBRT for the Intermediate-Risk (Teal) Prostate Cancer | Prostate Cancer Staging Guide

  1. Thank you for your very informative talks Dr. Scholz. You introduced me to Space Oar today. Please address HIFU therapy in the not so distant future.

  2. I'm just about ready to choose SBRT (CyberKnife) with SpaceOAR for my treatment plan and this video makes me feel more comfortable with that decision.

  3. I wish i knew what to do,having ibd,increaaes my risk for radiation colitis,thats what the top guy at msk says ,so im lost

  4. Thank you these excellent talks Dr Scholz I have 3+3 in most of the prostate and 1 core at 3+4 Gleason, psa under 10 have been talked into signing up for surgery but hoping i can get out of that and go for one of the radiation options.

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