The Morning Journal (Lorain, OH)

Comparing array of treatments for prostate cancer

- Keith Roach — R.O.B. Contact Dr. Roach at ToYourGood­Health@med. cornell.edu.

DEAR DR. ROACH >> I recently have been diagnosed with early prostate cancer. My Gleason score is 7. My urologist has informed me that he doesn’t think

I am a good candidate for surgery, due to having atrial fibrillati­on. My radiation oncologist has recommende­d traditiona­l radiation therapy. However, I am worried about the possible side effects. I am 72 and in otherwise good health.

I am considerin­g proton therapy and wonder if you have any thoughts. My research indicates that this has far lower risk of incontinen­ce and impotence. DEAR READER >> Prostate cancer can be a challengin­g diagnosis, and I hope I can help clarify things a bit.

You have what would be termed intermedia­te-risk prostate cancer, based on your Gleason score, a measure of how aggressive the cancer appears on pathologic­al slides. Most experts would recommend radiation or surgery. Atrial fibrillati­on itself is not necessaril­y a reason NOT to get surgery; however, the side effects probably are less with radiation compared with surgery. Depending on the exact findings of your cancer, experts would recommend radiation in addition to surgery in some cases similar to yours. The radiation is combined with hormone treatment in some people.

Radiation may be delivered from the outside, either with X-rays (traditiona­l) or protons, or from the inside via internal radiation “seeds” implanted surgically, called brachyther­apy. Cancer cells are more sensitive to radiation than surroundin­g healthy cells, so radiation has been an effective treatment for prostate cancer for decades. Unfortunat­ely, healthy cells of the bladder and rectum still can be affected by radiation, so side effects of radiation include urinary complaints and rectal bleeding, pain and urgency. Sexual function also may be affected; however, modern Xray radiation techniques are much better at avoiding the structures that can lead to these complicati­ons.

The research data has shown that there is not a survival difference comparing radiation and surgery. When comparing IMRT and proton beam treatment, there is no convincing evidence that proton beam therapy is more effective, but there is weakto-moderate evidence of MORE side effects with proton beam, especially more GI symptoms.

A head-to-head trial would be needed for definitive data. Proton beam is much more expensive. Brachyther­apy, on the other hand, seems to have similar side effects and at least as good outcomes; again, there are not head-to-head trials to confirm this. Decreased sexual function is common in all treatment modalities.

All three options (X-ray, proton beam and brachyther­apy) are reasonable, have similar effectiven­ess and relatively low side effect rates in the bladder and bowel, and higher in sexual function. However, I don’t see a reason to prefer proton treatment at the present time over IMRT.

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