Special cases: treatment for advanced prostate cancer

Special cases: treatment for advanced prostate cancer

Irradiation of the lymphatic

It may be necessary that at you the lymphatic drainage of the basin must be irradiated. About the lymphatic metastases of prostate cancer smallest can get into the bloodstream and, for example, absiedeln in other organs such as the bones. Practically, this means that the radiation fields must be increased significantly in the first 5 weeks of radiation. For this reason, something changed acute reactions and delayed reactions may occur under irradiation. For more information, see the section " Possible complications and consequences of radiotherapy . "

Radiotherapy after radical prostatectomy

A special situation may arise when it is determined after the radical surgery that the tumor had crossed the organ capsule of the prostate ("pT3 carcinoma") and / or the tumor could not be safely removed in the healthy and still went into the surgical resection margin (" R1 resection ").The urologist can not detect this problem before surgery, only the pathologist can determine conclusively under the microscope whether the tumor has been completely removed in healthy upon review of the preparations. In this case, you may receive a post-exposure of the former prostate region are recommended to possibly destroy remaining smallest residual tumor.

This radiation is technically performed exactly as previously described "percutaneous" radiotherapy. However, it has the advantage that the entire dose of radiation is less than for the sole external radiation. Thus, the risk is even lower, to suffer from late effects of therapy. It is important for you that the irradiation usually only 8 - starts 10 weeks after surgery, when the continence (ability of Harnhaltens) is mostly present again.

Due to the radiation therapy is continence, who have already reached again, not degraded.Under certain circumstances, however, the desire of the radiotherapist, you irradiate with full bladder, be a problem after surgery. If you do not fill the bladder enough and the urine can then stop, it may be necessary to use a so-called "penis clamp" to create. However, this occurs only during the time of the irradiation, it can then be deposited again.

A now common situation that can affect over the years after surgery almost 50% of patients with prostate cancer depending on the tumor stage, the re-increase in PSA from the non-measurable range ("zero-range") or that the PSA value after the operation has not reached the desired zero range. In this situation, the percutaneous radiation therapy is the only option to cure you of this recurrent tumor still can. It is important that radiation therapy is initiated early, when the PSA level is not very high. A result, the chances of cure are much higher than if you are being treated only with a high PSA level. It may be that is performed on the possible localization of the "recurrent tumor," a PET-CT scan or a magnetic resonance imaging (MRI) of the pelvis. If you can see here the tumor, radiation therapist can draw conclusions from this in terms of the irradiation technique and the irradiation total dose. In principle, this radiation is technically performed exactly as previously described percutaneous radiotherapy. Even when you can reduce the risk of potential acute and late effects by special techniques such as the use of "image-guided radiotherapy - IGRT" be further reduced.

When you again reach after irradiation with your PSA level is not the measurable range, you have another chance of healing.

Radiotherapy in combination with hormone deprivation therapy

Prostate cancer is one of the hormones 'sensitive' tumors: it is stimulated by the testosterone (male sex hormone) to the growth and reduced by the withdrawal or blockade of testosterone or at least halted growth. Unlike the surgery or radiotherapy, the tumor is not completely removed or killed by the hormone. The effect of the hormonal therapy continues after repeated application over several years. In most patients, there is then a renewed increase in the size of the tumor.

The effect of hormone therapy makes you right and advantage after radiotherapy in advanced tumors, in order to increase the effectiveness of radiation therapy. In advanced tumors, radiation therapy is usually combined with hormonal therapy. One possibility is a hormone deprivation therapy over three months before the start of radiotherapy ("neoadjuvant hormone therapy"). It (about 3-4 weeks) taken tablets and additionally depot injections (usually a 3-6 month sustained syringe) administered. Through this therapy, the prostate is reduced on the one hand. A smaller prostate also means a smaller radiation field and thus lower risks of acute and late side effects.

On the other hand, the tumor is small, although not all malignant cells respond to this therapy.Since the smaller tumor then from the 4th Month is irradiated, the chances of destruction of the tumor are better. 6 months ended - Frequently hormone therapy is at the end of radiotherapy after 4. In certain cases, however, a continuation of the Hormone years after radiotherapy is needed.

The possible side effects of hormone therapy include impotence, hot flashes, gynecomastia, mood swings and for long-term use, a decrease in bone mineral content, etc. These side effects form after the end of hormone therapy back. In particular, usually the power is to return, if it has not decreased by the radiation treatment.

Radiotherapy with protons

In recent years, radiation therapy is proton shifted to the front. This procedure is currently offered in Germany but only at a few centers. Basically, the proton beam from a physical standpoint theory has some advantages over the photon beam. In theory, thereby more healthy normal tissue could be spared. Basically, the irradiation with protons plays the same as how the radiation therapy previously described with photons.

At the present time are no data that would indicate that the results of proton therapy in the tumor control would be better than an activity with modern technology photon therapy. The results are comparable good. The potentially lower rate of late effects in relation to the rectum and the bladder have not been proven scientifically. However, the cost of this therapy amount to a multiple of the cost of modern photon therapy. Pending resolution of the question whether the proton therapy for tumors of the prostate offers advantages recommends the German Society for Radiation Oncology to bring these patients to the German proton therapy centers in studies. If you want here about more information, please visit the Internet homepage of the "German Society for Radiation Oncology DEGRO".

Image guided radiotherapy (IGRT)

There are different variants of this so-called IGRT. The most common are:

• Goldseedmarker, which are implanted in the prostate and remain permanently,
• the stereotactic ultrasound ("BAT ultrasound")
• the cone beam CT.
  

While the Goldseedmarkerimplantation usually 3 small gold markers are implanted by a few millimeters in length in specific areas of the prostate, this is not in a position check with the ultrasound before irradiation and with the cone beam CT necessary. The gold markers can be reliably identified under a triggered directly before irradiation fluoroscopic irradiation region.The images are then fused to the radiation-planning CT. After this merger, the table movement can be calculated in all directions, so that the beam hits exactly the desired position and thus the prostate. Wherein said stereotactic, ultrasound may also be determined by a specific ultrasonic system, which is connected to the planning system, this difference table.