Prostate Cancer – Our Treatment Options

Prostate Cancer: Detection & Treatment Options

Diagnosing Prostate Cancer

Most men find out they have prostate cancer after a regular prostate screening test. The American Cancer Society recommends that men discuss screening pros and cons with their doctor to determine if they should have prostate screening. Many men begin having one or more of the screenings after age 50. Typical prostate cancer screenings include:

  • Blood Test. During a check-up, blood may be drawn and tested for the protein PSA (Prostate Specific Antigen). If your PSA is high, your doctor will likely investigate further.  A high PSA test does not always mean cancer. There are other diseases than can cause a higher than normal PSA.
  • Physical Exam. The doctor may also perform a digital rectal examination (DRE) to check for any abnormalities in the gland. A positive result for this exam does not rule out prostate cancer.

If your doctor thinks you might have prostate cancer, based on the initial screenings, he or she may order additional tests to confirm the diagnosis. Those tests may include:

  • Biopsy. This outpatient procedure involves doctors removing small tissue samples from the prostate gland using very thin, hollow needles directed by ultrasound. The cells are sent to a pathologist who finds out if the they are malignant (cancerous) or benign (non-cancerous.)
  • Transrectal ultrasound (TRUS). This is another test that is often ordered if you have a high PSA level or an abnormal DRE result.It views the prostate using a small probe that is lubricated and placed in your rectum. Sound waves from the probe create echoes which are turned into black and white images by a connected computer. The procedure can be completed in a doctor’s office or outpatient clinic and usually takes less than 10 minutes. The test can measure the size of the prostate and may help indicate the best type of treatment.

After these tests, if your doctor believes you have prostate cancer, he or she may order imaging tests to determine the shape and size of the tumor and the extent to which it may or may not have spread to other parts of the body. Orange County CyberKnife has convenient access to an advanced imaging center located within their building, allowing them to plan and monitor the success of tumor treatment. Imaging tests that may be ordered include:

  • PET Bone Scan – If prostate cancer is spread, one of the most likely places to find it is in your bones. This type of scan goes beyond the 3D images provided by a CT scan to show what is happening in your tissue at a cellular level. For this test, you are injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. A special camera detects the radioactivity and creates a picture of your skeleton. Using this scan, CyberKnife’s radiation oncologists will develop the best and most focused treatment from the array of advanced technologies at their fingertips for each individual situation.
  • CT Scan – The CT scan will combine many X-ray pictures to make a detailed cross-sectional image of your prostate. A CT scan is more likely to show tumors than a routine X-ray and it can also show more details such as the shape, size, and position of the tumor. CT scans can also show any enlarged lymph nodes that might contain cancer.  Radiation oncologists at Orange County CyberKnife use the Radiology CT scans to monitor growth, size, shape, movement and location of the tumor and surrounding tissues of cancer in patients.
  • MRI Scan – Like CT scans, an MRI can show precise images of the tissue in your prostate. The difference is an MRI uses a magnetic field and pulses of radio wave energy to make the pictures, giving doctors different information about what can be seen.Your prostate MRI, completed at an outside imaging center, is very commonly fused with CT simulation images, completed at Orange County CyberKnife, to help plan your CyberKnife treatment.

SpaceOAR Treatment Aid For Prostate Cancer

SpaceOAR hydrogel is an FDA approved device, clinically proven to minimize urinary, sexual, bowel side effects and it enhances the quality of life for prostate cancer patients undergoing radiation therapy. Placed between the prostate and rectum, SpaceOAR hydrogel creates a space and pushes the anterior rectum out of the high dose radiation region. Like prostate cancer cells, cells in the rectum are also damaged by the high dose radiation. That’s why the rectum is called the Organ At Risk (OAR) during prostate radiation therapy.

SpaceOAR Hydrogel at Orange County Cyberknife

The hydrogel spacer is injected during a minimally invasive outpatient procedure, and — once in place — patients typically can’t feel it. The hydrogel is safe and similar to other products used in brain surgery, cardiology and ophthalmology. This is a biodegradable and classified by FDA as an “Absorbable perirectal spacer”. It remains in place for 3 months during radiation treatment, and is then absorbed by the patient’s body over time- leaving nothing behind.

Orange County Cyberknife and Radiation Oncology Center is excited to offer this treatment aid to our patients wanting a safer and more comfortable experience in treating their prostate cancer.

Types Of Radiation Therapy For Prostate Cancer

Prostate cancer is 99% treatable when caught early, before the cancer spreads to other parts of the body. Sometimes, based on the age and and type of the cancer, you and your doctor may decide to postpone treatment of prostate cancer, but monitor its development. Oftentimes,  cancer treatment will involve surgery, chemotherapy, and radiation therapy. Orange County CyberKnife is the premier cancer treatment center for many types of radiation therapy, offering a variety of options. 

The radiation oncologists at Orange County CyberKnife are uniquely qualified to treat your individual case due to their experience in treating prostate cancer using the most advanced methods. We are also the only comprehensive radiation oncology center in Orange County that offers all of the most advanced, non-surgical treatment options from one convenient center, including: CyberKnife, conventional IMRT, IGRT, HDR brachytherapy, hyperthermia and more. That means our specialists, who are experienced with all of these treatment types, will offer the best treatment option(s) given each patient’s unique situation.

When it comes to treating your prostate cancer with radiation therapy, Orange County Cyberknife and Radiation Oncology Center is your expert choice. The descriptions for your prostate cancer treatment options include:

  • CyberKnife (Stereotactic Body Radiation Therapy, or SBRT)  Orange County Cyberknife was the first comprehensive radiation oncology center in Orange County to offer the CyberKnife, conventional external beam radiation therapies, and brachytherapy for prostate cancer treatments in one comprehensive center. Instead of surgery, the CyberKnife Robotic Radiosurgery System beams high doses of radiation directly to your prostate while you rest on a comfortable treatment couch. It is the most recommended type of dedicated SBRT for Low and Intermediate Risk prostate cases, due to its unique treatment process and accuracy. The flexible, robotic arm of CyberKnife can deliver this radiation directly to the prostate without exposure to the surrounding healthy tissue and organs. Radiation exposure or possible damage through surgery to the bladder, urethra, rectum, or sensitive nerve bundles can result in serious consequences such as incontinence and erectile dysfunction. Unlike other methods of radiation delivery, CyberKnife’s pinpoint precision and constant real-time motion tracking tells the CyberKnife that it is on target on the prostate at all times. Limiting radiation exposure to healthy cells also prevents some of the short and long-term side effects common with conventional radiation treatments and surgery. CyberKnife treatments for the prostate are delivered in four or five short sessions, once per day. Conventional radiation treatments, also offered at Orange County CyberKnife, are given over 25 to 45 days. For many insurance companies, fewer treatments means lower costs – saving patients more money in the long run. CyberKnife provides prostate cancer patients with better outcomes, fewer side effects, more cost-effective treatment, and a convenient treatment schedule.

Low-Intermediate Risk - outlined

  • Traditional External Beam Radiation Therapies
    • Image Guided Radiation Therapy (IGRT) for Prostate Cancer – Orange County Cyberknife and Radiation Oncology Center houses the most advanced equipment including image guided radiation therapy (IGRT) which can track and capture your tumor using high-resolution, three-dimensional images. IGRT is one of the best advancements developed for the gantry designed linear accelerators. Due to gas, and the filling of the bladder and bowels, the prostate can move slightly during treatment. IGRT allows our prostate cancer experts to view and compensate for any prostate movement during treatment, ensuring enhanced accuracy. IGRT provides another tool for our doctors to treat tumors that move with extreme precision.
    • Intensity Modulated Radiation Therapy (IMRT) for Prostate Cancer-  At our center, we determine the best method of treatment given each unique situation. Our prostate cancer experts have compared IMRT to standard or conventional radiation therapy. Due to the increased accuracy of IMRT our doctors can deliver a higher dose of radiation and spare the surrounding tissues of the bowel, bladder, and sensitive nerve bundles. IMRT can also be used if a patient has a returning cancer. Even with prior radiation, IMRT may be a promising option.
    • RapidArc Radiotherapy Technology for Prostate Cancer – With RapidArc Prostate Cancer Treatment, we have combined and enhanced both the IGRT and IMRT, to make this treatment much more precise, giving higher more effective doses, in a shortened treatment time. Patients will still undergo numerous treatments, but each treatment may be shortened from 20 to 30 minutes each to just three to five minutes. Unlike traditional IMRT that requires multiple rotations around the patient or makes repeated stops and starts to treat the tumor from different angles, this volumetric arc therapy delivers precise 3-D doses with a single 360° rotation of the machine. It uses your treatment planning algorithm to simultaneously change the rotation speed, the shape of the treatment aperture, and the delivery dose rate. The shape and position of the tumor are determined from computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) diagnostic studies. This permits improved dose sculpturing over 3-D conformal radiation therapy.
  • 3-D Conformal Radiation Therapy (3-D CRT) for Prostate Cancer – This type of radiotherapy uses 3D images to plan treatment and to deliver a dose of radiation that projects at the best angles for your tumor, avoiding surrounding healthy structures. Usually CT and/or MRI images are used for mapping out the radiation plan. Higher doses of radiation can be sent to cancer cells while much lower doses are received by the healthy tissue. This technology has allowed great improvements in safely treating head and neck tumors to minimize exposure to the spine, eyes, and other important structures.
  • Internal Radiation Therapies
    • High Dose Rate Brachytherapy (HDR) – This extremely precise radiation therapy destroys prostate cancer. It uses an intense source of radiation delivered through temporarily-placed applicators implanted into the tumor site. It is delivered internally via a computer-controlled machine in typically in two to ten convenient treatments. It is pain-free and minimizes the risk of common side effects. The radiation is delivered into the applicators through a wire or cable inserted into a catheter and then removed between treatments. Orange County’s radiation oncologists can vary the position of the wire and the length the radiation is administered to satisfy the shape and need of the cancer. In Interstitial HDR Brachytherapy, often used for prostate cancer, the radiation is delivered directly into tissue.
    • Low Dose Rate Brachytherapy (LDR) – This radiation therapy is similar to its HDR counterpart, except it differs in its treatment delivery and length of treatment. With LDR Brachytherapy, 50 to 100 radioactive ‘seeds’ are implanted permanently into the cancerous tissue and radiation is then delivered to the infected area slowly over the following month or so as the cancerous cells die. Once the seeds emit the radiation, they, too, fade away. To effectively and safely place the seeds, Orange County CyberKnife’s radiation oncologists use a special planning system which uses transrectal ultrasound (TRUS) images to help design and monitor the intended placement of seeds. This one-time treatment may be used to treat a variety of cancers, including cervical, esophageal, head and neck and lung, but it is most often used to treat prostate cancer.
  • Hyperthermia (Thermal therapy or Thermotherapy) – This type of therapy is always used in conjunction with another type, usually radiation or chemotherapy. It focuses on killing cancerous cells by exposing them to extremely high temperatures. Research has proven that this can kill the cancer, even sometimes cells that radiation isn’t reaching, without harming healthy tissues. Hyperthermia may also make some cancer cells more susceptible to destruction from radiation. When hyperthermia and radiation are prescribed together, they are usually given within an hour of each other. Hyperthermia can also enhance the effects of certain anticancer drugs. Ask our Orange County CyberKnife radiation experts about the different types of hyperthermia currently available for your treatment.

Contact Us To Find Out More

We want to make sure you understand all of your treatment options on your first visit to Orange County CyberKnife Our team of radiation oncologists are ready to answer all of your questions about our advanced non-surgical and non-invasive radiation therapy systems available. Read what other patients say about our cancer care. Call us today at (714) 962-7100 to schedule your appointment.

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