Prostate Cancer

MHL is always seeking the best new treatments for prostate cancer as well as outstanding treatment centres to which international patients can apply. Some of the treatments and technologies may not already be well known in some countries so we are pleased to provide an introduction here.

Surgery

The following list of treatment alternatives is not exhaustive, but includes most of the main methodologies in use today.

Surgical removal of the prostate, known as radical retropubic prostatectomy, can be performed manually in the conventional way or as minimally invasive surgery with the da Vinci® 'robotic' surgical system.

Radiotherapy

Radiotherapy can be used where tumours have grown too far for surgery or as an alternative to surgery in the primary treatment of prostate cancer, as well as for localized advanced tumor stages following prostatectomy and for recurrences

There have been many advances on conventional radiotherapy in recent years, particularly in the introduction of image guided treatments, and there are many competing proprietary technologies. We list here a few of these that are in use at the advanced treatment centres today.

Trilogy® radiotherapy

Trilogy stereotactic radiotherapy

With the Trilogy® radiotherapy system, the width of the radiation beam can be adapted to the volume of the tumour and it also has stereotactic abilities in some body areas. This enables it to fix the location of the tumour before and during each treatment session.

The tumour can therefore be targeted more accurately than with conventional radiotherapy. Not only does this reduce damage to surrounding healthy tissue, but it enables greater power to be used, which shortens each treatment session.

Radiosurgery

Radiosurgery differs from radiotherapy in several important respects. Radiotherapy depends primarily on tumour cells having greater sensitivity to radiation than normal tissue. To protect normal tissue as far as possible the treatment is fractionated over many sessions, usually over a period of several weeks.

In stereotactic radiosurgery (SRS), a high power radiation beam is projected onto the target with much greater accuracy. By cross-firing from many different angles the exposure of adjacent healthy tissue is minimised and the number of treatments can be greatly reduced.

CyberKnife® radiosurgery

TomoTherapy® Hi-Art® system

The ring gantry-based TomoTherapy® platform combines integrated CT imaging with conformal radiation therapy to deliver sophisticated radiation treatments with speed and precision while reducing radiation exposure to surrounding healthy tissue.

The Hi·Art® treatment system delivers helical (continuous 360º) IMRT (image guided radiotherapy that uses tens of thousands of narrow beamlets, all targeting the tumour and individually optimised to contribute to the total required dose.

TomoTherapy HiArt system

CyberKnife® is the latest, most precise and most flexible form of radiosurgery and it is currently being used as monotherapy treatment for early stage prostate cancer or as a boost following conventional radiation therapy. CyberKnife treatments may be given in a single dose or over a few days only.

CyberKnife can reproduce the conformality for organ coverage achievable with brachytherapy and local control and complication rates are expected to be similar to HDR (high dose rate) brachytherapy. CyberKnife centres may vary in their approach but as a general guideline up to stage 2a tumours, PSA under 10 ng/dl and a negative Cholin PET CT for body metastases.

CyberKnife radiosurgery for a brain tumour, given in Munich, Germany

Brachytherapy

In brachytherapy, the radiation source is placed in direct contact with the tumour. The advantage is that the radiation takes effect directly in the malignant tissue. This means that the fall-off of in the radiation dose in the surrounding tissue is much higher than with external radiotherapy.

Brachytherapy therefore allows a higher radiation dose to be administered in the shortest possible time. The total duration of treatment is, in general, reduced from six weeks to one week. A further advantage is the significantly lower radiation exposure of patients compared to traditional radiotherapy.

Even with advanced tumours or the recurrence of a tumour following radiotherapy, brachytherapy offers patients considerable advantages. It may be used alone or in conjunction with traditional radiotherapy and/or chemotherapy.

High Intensity Focussed Ultrasound (HIFU)

HIFU is an option for early stage prostate cancer and may be used to treat part of the gland only, where the tumour or tumours are all on the same side, or to treat the whole organ.

Rather than using radio waves, HIFU uses precision focussed ultrasound waves to locally heat the target area and destroy the tumour.

Medical Oncology

Depending upon the age and condition of the patient, not all cancers need to be treated immediately. Treatment may be avoided or delayed by the use of hormomal therapy. Testosterone has a marked effect on the development of prostate cancer, so this may be reduced my medication.

Drug based therapies may also be used to attack the tumour(s), either as a stand-alone treatment or as a prelude to radiotherapy or radiosurgery.

Treatment Centres

Specialist treatments < Prostate cancer

Advanced treatment centres

Latest medical technologies

Private medical centres

Visit the Prostate Cancer Treatment Centres page.

Proton Therapy

Proton therapy uses protons (hydrogen ions) instead of X-rays and the radiation is confined much more closely within the target area. This reduces the unwanted side-effects down to between 20% to 33% compared to conventional radiotherapy.

In general this means no loss of virility or incontinence and prostate cancer patients make up a large proportion of all patients seeking proton therapy.

Treatment at the Rinecker Proton Therapy Centre in Munich, Germany

Visit the proton therapy page for more details.

Proton therapy can require fewer daily treatments and because the radiation exposure to healthy tissue is much lower, it also reduces the risk of new cancers developing in later life, due to the effects of the radiation treatment

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