If an oncologist has determined that the time is right to begin treatment, the first course of action for many prostate cancer patients is radiation therapy. This may be followed by surgery, if necessary. Because of this, a radiation oncologist is often the lead physician caring for prostate cancer patients working closely with the patient’s general practitioner and urologist.

The prostate cancer treatment recommended for each patient depends mainly on age, the grade of the tumor (the Gleason score), how fast the cancer is likely to grow, and the state of the patient’s general health.

Before Treatment: Watchful Waiting for Prostate Cancer

After receiving a prostate cancer diagnosis, your urologist will likely refer to you to a prostate cancer specialist who will find out more about your specific prostate cancer type as well as its stage (whether it has spread to other parts of the body). The oncologist will also look at the grade of the tumor (how the cancer cells look under the microscope), which is determined by an approach known as the Gleason score. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. If the tumor is low grade (6 or less on the Gleason score), the specialist may recommend watchful waiting for a period of time.

Watchful waiting is very common for many men and can last several months to several years, depending on how quickly the cancer grows. During this time your oncologist will ask you to come in for periodic tests to evaluate your PSA levels. The higher the PSA, the more likely the cancer has grown. For some men, an increase in the PSA level can take quite a while, meaning treatment can be delayed.

Cancer Patient Prostate Receiving Radiation

Prostate Cancer Radiation Therapy

There are two types of radiation therapy typically used to treat prostate cancer:

Brachytherapy (internal radiation)
External beam radiation

At Silicon Valley Oncology we will assess which is best for you.

Brachytherapy for Prostate Cancer Radiation Therapy

This type of internal radiation therapy is a common treatment that can avoid surgery for some men. Using a long needle, small radioactive seeds are placed in the prostate using guidance from a transrectal ultrasound or computed tomography (CT). The needle is removed after the radioactive seeds are placed. The seeds are then left to give off radiation in that specific area of the body, breaking down over time. There is no need to remove the seeds later. You may also be given external beam radiation therapy, especially if you have a higher risk of the cancer growing outside of the prostate.

External Beam Radiation Therapy for Prostate Cancer

At Silicon Valley Oncology we use IMRT and IGRT external radiation therapy. If external radiation therapy is recommended, one of the following will be used:

Intensity Modulated Radiation Therapy (IMRT): IMRT is a type of external beam radiation therapy that uses advanced technology to manipulate beams of radiation to conform to the shape of a tumor. This makes it possible for the radiation oncologist to vary the intensity of some of the beams of radiation to focus more carefully in some areas than in others, making it especially useful when treating tumors that are surrounded by critical organs or normal tissue, such as prostate cancer. Because IMRT can limit the side effects of treatments, many patients experience a better quality of life.
Image Guided Radiation Therapy (IGRT): IGRT is the use of imaging (CT, MRI, or PET scans) before each external radiation therapy treatment. These scans are processed by computers to detect changes in the tumor’s size and location. The repeated imaging allows for your position or the radiation dose to be adjusted during treatment if needed. These adjustments can improve the accuracy of treatment and help spare normal tissue, which is ideal for tumors and cancers located very close to sensitive structures and organs, such as prostate cancer. IGRT is often used in conjunction with IMRT for the most optimal treatment.

Managing Side Effects of External Radiation in the Prostate Area

While external radiation therapy is a proven prostate cancer treatment, it can also come with side effects— one of which is damage to the rectum. To reduce exposure of nearby organs to radiation, and to reduce the risk of side effects, our radiation oncologists, Dr. Agarwal and Dr. Shumway, may recommend using various treatment technologies, such as the Barrigel® Hyaluronic Acid Rectal Spacer, SpaceOAR® Hydrogel, or The BioProtect Balloon Implant.

Barrigel®

Barrigel® is made from Non-Animal Stabilized Hyaluronic Acid and it creates space between the prostate and rectum to move the healthy organ away from exposure to radiation. It is implanted prior to radiation treatment through a minimally invasive, outpatient procedure.

SpaceOAR™ Hydrogel

SpaceOAR® is a synthetic material with a soft, gel-like consistency. It is implanted before prostate radiation treatment to create space between the prostate and rectum. This helps reduce the risk of damage to healthy tissue during treatment. The gel remains in place throughout the procedure and is eventually cleared from the body naturally.

BioProtect

BioProtect Balloon is a biodegradable implantable device that minimizes radiation exposure to the rectum during prostate radiation therapy, thus reducing the occurrence of rectal toxicity. Implanting the balloon is a quick and minimally invasive procedure. It maintains its shape throughout treatment and is visible with any imaging modality. The balloon spacer gradually degrades after treatment.

Dr. Agarwal and Dr. Shumway specialize in all three of these technologies and will be happy to answer any questions you may have regarding their procedures.

Another side effect that is often asked about is impotence following prostate cancer radiation treatment. Both internal and external radiation can cause some sexual side effects. Talk to Dr. Agarwal, Dr. Shumway or another member of your cancer care team about ways to help prevent or cope with this possible side effect.

dr. agarwal specializes in Barrigel placement for prostate cancer treatment silicon valley

Pluvicto® to Treat Advanced Prostate Cancer

Pluvicto, also known as lutetium Lu 177 vipivotide tetraxetan, is a recently approved treatment option for prostate cancer. This targeted radioligand therapy is specifically designed to treat prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer (PSMA-positive mCRPC), which is a type of advanced cancer. Pluvicto may also be used to treat prostate cancers resistant to other anticancer treatments.

Learn more

Prostate Cancer Surgery

Surgery may be used for early-stage prostate cancer that has not spread outside the prostate gland. The type of surgery depends on several factors including the stage of the disease and the overall health of the patient. Dr. Agarwal and Dr. Shumway will work with your surgeon to discuss what is recommended based on the stage and location of the cancer.

Radical (open) prostatectomy. The surgical removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area may also be removed.
Robotic or laparoscopic prostatectomy. A less-invasive approach to removing the entire prostate. The laparoscopic approach involves using smaller incisions and long surgical tools to take out the prostate. In some cases, the surgeon may perform the procedure with robotic assistance.

What to Expect at your Initial Consultation

At the time of consultation, our radiation oncologists will review your records, X-rays, scans and other test results and perform a physical examination. They may decide that additional tests are needed and will discuss that with you. The radiation oncology nurse will work closely with you and the radiation oncologist during the initial consultation. If Dr. Ankit Agarwal or Dr. John Shumway believe that you will benefit from radiation therapy, a treatment plan will be presented to you during the consultation, based on the results of the evaluation.

Starting Daily Treatments

Most radiation treatments are given five times a week, Monday through Friday. Radiation therapists, who are certified by the American Registry of Radiologic Technologists (ARRT), administer the daily treatment under the supervision of the radiation oncologist. They record and document treatment progress and run tests on the treatment machines daily to ensure that they are working properly.

Care During Treatment

Most people undergoing radiation treatment are able to continue with their normal activities. Some may need to adjust their level of activity temporarily during treatment if recommended. Patients are encouraged to check with their doctor before starting any exercise or fitness program during this time. Good nutrition during therapy is essential to promote healing and recovery and the oncology nurse or nutritionist can help determine the best approach. The patient is weighed regularly during radiation therapy to monitor health and any weight loss. Patients should do their best to eat a normal, well-balanced diet with three or more regular meals. Smaller, more frequent meals and snacks may also be suggested. Patients should also consult with their doctor about the use of multivitamins and other dietary supplements. Nutrition information is also available through the oncology nurse.

Post Treatment Care and Ongoing

Once you have finished a course of treatment, follow up care instructions will be reviewed and you will return for follow-up appointments. These may involve blood work or imaging to determine the outcome of the treatment. Due to the multidisciplinary team approach used to treat cancer patients, other physicians may also be involved in your follow-up care (i.e. medical oncologist, other specialists, surgeon and primary care physician).