What is Prostate Cancer and What are Your Radiation Treatment Options in Dallas-Fort Worth Metroplex

Prostate cancer is the most common cancer in men after skin cancers. There are about 288,300 new cases of prostate cancer per year in the US and approximately 34,700 deaths attributed to prostate cancer. This translates to about 1 in 8 men being diagnosed with prostate cancer in their lifetime and sadly 1 in 41 men will die of prostate cancer. However, it is a very treatable condition and many men go on to beat the cancer and live many years after their diagnosis.  Radiation therapy is a cornerstone of prostate cancer treatment, so read below about different radiation options.

Prostate Cancer in Texas and Dallas Fort Worth Area

In 2023, there are estimated to be 17,230 new prostate cancer cases in Texas and 2,290 deaths attributed to prostate cancer. We strive everyday to create a center of excellence in treatment of prostate cancer. We have many different treatment options available to you depending on your stage, clinical condition and personal preferences. Our treatments are optimized to minimize any necessary side effects and maximize cure rates. So call our office today to schedule a consultation with Dr. Akhtari and the needed next steps for best possible outcomes if you live in the DFW metroplex with a recent diagnosis of prostate cancer.

Early detection and screening in prostate cancer

It is important to be cognizant of symptoms that could be caused by prostate cancer for early detection. One of the earliest signs of prostate cancer is an enlarged prostate, which can cause urinary problems. This is called benign prostatic hyperplasia or BPH. Even though this condition is benign (no cancer), a lot of times prostate hyperplasia can eventually become cancerous.  This can cause difficulty in urination including increased urgency, increased frequency, and more frequent urination at night (nocturia). Occasionally you can also see blood in the urine (hematuria) or if very advanced blood in the stool (hematochezia).

If anyone is experiencing urinary symptoms the first step would be to check PSA. PSA or prostate specific antigen is a blood test that measures the level of this protein in the blood. PSA is made exclusively by prostate cells and also prostate cancer and elevated PSA is a very good test in alerting us if there are early signs of cancer.

If the PSA is indeed elevated, then the next step would be to proceed with a biopsy. A prostate biopsy is when a doctor removes tissues from the prostate and checks the tissues for cancer. This is usually done through the rectum. Traditionally, it would be called a “12 core biopsy” meaning that they took tissue samples from 12 different areas of the prostate. More recently, there is a technique named “MRI Guided prostate biopsy” which means that the doctor tries to biopsy areas that appear suspicious on the MRI.

Staging in prostate cancer

Once a diagnosis of prostate cancer is made via elevated PSA and prostate biopsy, the next step is to use imaging modalities to determine the extent of the disease. Imaging studies usually used include CT scan, MRI, as well as bone scan. Most recently, there are more advanced imaging studies including prostate cancer specific PET-scans such as Axumin scan (PSA PET-CT) or Pylarify (PSMA PET-CT).

Once all the appropriate imaging has been obtained the patients can be staged and classified. Traditionally, prostate cancer patients are put into 4 different categories: Low risk, intermediate risk, high risk, and metastatic disease. Each category can also have its own different subcategories.

Low risk patients are those with early stage disease with prostate confined to the prostate gland and a PSA of < 10. Their Gleason Score (A classification of how aggressive the cancer looks under the microscope) is 3+3=6. These patients have many different treatment options available to them including external beam radiation therapy with IMRT, brachytherapy, SBRT, surgery, and even in some cases active surveillance.

Intermediate risk patients are those with PSA greater or equal to 10 but < 20, Gleason score of 7 (3+4 or 4+3) and/or those whose disease covers a larger portion of the prostate gland. These patients are still eligible for a number of different radiation options including IMRT, brachytherapy, SBRT, or surgery. At times, they might need Androgen Deprivation Therapy or ADT, which are medications such as Lupron, Relugolix, Or Orgovyx who suppress the testosterone in the patient to go along with the radiation. High risk patients are those with PSA >20, Gleason score of 8-10, or those whose disease has spread outside of the prostate to either lymph nodes or extended to the rectum or bladder. These patients need to be treated with 18-36 months of ADT and IMRT radiation therapy. Sometimes they might be candidates for SBRT or additional brachytherapy.

Metastatic patients are those whose cancer has spread to other organs such as bone or lungs. These patients have many different treatment options available to them including ADT, Apalutamide, Xofigo, chemotherapy, etc. Radiation therapy is usually used in these patients to treat sites that are causing them pain or discomfort.

If you or a loved one has been diagnosed with prostate cancer recently in Dallas Fort Worth Metroplex, call today to schedule a consultation with Dr. Akhtari in regards to your treatment options.

Different modes of radiation therapy used in prostate cancer:

Intensity modulated radiation therapy (IMRT)

IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity (strength) of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy (IGRT), lets the doctor take pictures of the prostate  just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

A variation of IMRT is called volumetric modulated arc therapy (VMAT). It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasn’t yet been shown to be more effective than regular IMRT.

IMRT treatment for prostate cancer take up to 8 weeks of daily treatment Monday-Friday. Because a little bit of radiation is given over a long period of time, usually it is very well tolerated.

Stereotactic Body Radiation Therapy (SBRT)

SBRT is a very pinpoint form of radiation therapy where very high doses are used over a short time period (usually 5 sessions only!) to treat the prostate cancer. It is a very convenient, highly effective, and well tolerated form of treatment. However, not all men qualify and depends on your stage. To see if you qualify for SBRT, call Dr. Akhtari to schedule a consultation today.

Proton beam radiation therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they aren’t available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time. However, to see if you qualify and your insurance might cover it call us today for a consultation.

Brachytherapy

Brachytherapy is a form of treatment where radioactive seeds are placed into the prostate in the operating room. Although it can be effective, it is an invasive procedure and comes with risks of infection bleeding and death. In our practice SBRT has replaced brachytherapy although certain practices continue to offer it.