Dr, Scholz, can SBRT be given with brachytherapy instead of IMRT?
So, just to define some terms SBRT
is beam radiation, but it's given in a very short duration over about 10 days—five visits
over 10 days—whereas IMRT is the same type of beam radiation given over maybe five to eight
weeks and there is preliminary research being done at UCLA that is allowing in most cases for men to
substitute SBRT for most types of IMRT, There are certain advantages to SBRT in,
for instance, treating metastatic lesions, but I'm assuming we're referring to talking
about treating the prostate. Men with high-risk disease seem to have better cure rates with a
combination of seed implants plus beam radiation, but the beam radiation being drawn out over five
weeks is certainly inconvenient, and so the preliminary research at UCLA that shows that
we can get away with just five visits over 10 days seems to be working very nicely.
So, our next question is, "Is there an
upper limit regarding the prostate size where radiation becomes inappropriate?"
Theoretically, yes. The — perhaps, you know, 100cc glands, you're starting to target such a big gland
that the amount of radiation is more likely to cause side effects, long-term side effects.
This varies based on the geometry and the anatomy of the individual and oftentimes the radiation
therapists can't tell you what that upper limit is until they've simulated the patient and looked at
where the beams are going to come in. The other good thing about having a very large prostate
is more and more, we are doing focal therapies with radiation and other methodologies,
and men that have large prostates actually are in a better position for focal therapy than men with
small prostates. So, there's possibly an advantage if there's a single lesion in a large prostate.
It's — a bigger margin can be put around the tumor and you're still leaving a lot of the prostate
untreated. Men that have small prostates that are thinking about focal therapy, you can put a margin
around the tumor and you end up encompassing the whole gland because it's not a very big prostate,
and you don't really accomplish that much with focal therapy in men with small prostates. So,
the issue of having a big prostate precluding radiation used to be a concern,
and sometimes these men have more urinary symptoms and we worry about that, those being exacerbated
by radiation, but now with big prostates and doctors who have skill in doing focal therapy,
we we aren't as concerned about as we used to be.
If someone about 65 is diagnosed with advanced prostate cancer and begins radiation treatment
what happens if and after the treatment is successfully completed?
The prostate continues to grow normally like benign enlargement
and will he need to get some sort of treatment to reduce the size? Is a resection—you know,
if it's going to grow—going to be an option? They're kind of wondering...
Radiation, I mean pretty much shuts down the prostate. Men don't make semen after they have
radiation therapy for the most part, and no, the prostate will shrink after radiation. The
impact on urinary function immediately after radiation is typically, you know.
the side effects of you know urethritis, and frequency, and nocturia increase for three to
six weeks after radiation, and then they tend to steadily improve over the next year or two,
and then the the prostate has not been erased but it's certainly been put on a non-functioning
basis, and it's unlikely to grow or progress into a occlusive problem, you know,
BPH is not much of an issue after radiation. There is a possibility of long-term scar
tissue which has thankfully been greatly reduced with more modern types of radiation,
but there's always a small risk of delayed scar tissue called stricture where there's
some blockage of the urinary passage but that's really nothing to do with prostate enlargement.
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