Prostate cancer radiotherapy

Radiotherapy (also known as radiotherapy) is used for prostate cancer in the various stages of the disease in order to achieve a cure for the disease (curative radiotherapy), either alone or together with urology and medical oncology.

Procedure

Radiation therapy focuses high-energy X-rays on the tumor inside the body to specifically kill it. Radiotherapy is an equivalent alternative to surgery. This means that radiotherapy offers the same chance of curing prostate cancer as surgery. At the same time, radiotherapy is characterized by very good tolerability. It is also used if surgery is not possible or if a relapse occurs after an operation.

Radiotherapy can also be used if the prostate cancer has already spread: radiotherapy can then prevent or alleviate symptoms caused by metastases, e.g. in the bones(palliative radiotherapy).

Radiation therapy is performed as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can thus be easily integrated into everyday private and professional life. Depending on the extent, risk classification and location of the tumor, radiotherapy can in some cases be carried out in one or a few treatment sessions as radiosurgery, or in other cases as fractionated treatment over several weeks. Occasionally, depending on the risk category, radiotherapy is combined with anti-hormonal therapy to improve its effectiveness. Your doctor will discuss with you which treatment options are suitable in your case. Close and personal support is a matter of course for us.

The Department of Radiation Oncology at the USZ uses only the most modern techniques for precise and low-side-effect radiation treatment of prostate cancer. You will be looked after by proven experts in the treatment of prostate cancer.

For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of prostate cancer to make it even more effective and tolerable. To the overview of currently open studies.

There are a variety of different techniques and types of radiation for the treatment of prostate cancer. During the initial consultation, we discuss which technique and therapy concept is best suited to the stage of the tumor and the individual patient’s medical history. In the following, we will describe radiotherapy for the different types and stages of prostate cancer.

Patient information about prostate cancer

Stereotactic radiotherapy

If the size of the prostate allows, prostate cancer in the low and medium risk categories is treated using so-called stereotactic radiotherapy (SBRT). This highly focused radiation kills the tumor in just a few radiation sessions: typically 5 outpatient radiation sessions of 20 minutes each, every 2 days, so that the therapy is completed after just two weeks. This is made possible by highly focused irradiation with an accuracy in the millimeter range.

The high precision of this treatment requires continuous monitoring of the position of the prostate. There are two methods for this:

In one method, so-called “Calypso transponders” are inserted into the prostate by urology colleagues before the radiation treatment. These are three small markers that emit an electromagnetic signal and thus allow the position of the prostate to be continuously determined during irradiation.

Alternatively, stereotactic radiotherapy can be performed without the use of transponders. This is only possible on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is then carried out under continuous MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Radiotherapy for prostate cancer is one of the main focuses of our clinic and is represented by us both clinically and scientifically. We pass on our knowledge in international courses and congresses. We are also active in international committees for quality assurance in studies. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in urology and medical oncology to guarantee “one-stop” treatment.

In clinical trials, we are continuously working to improve the treatment of prostate cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Hypofractionated radiotherapy

In the low and medium risk classes, when stereotactic radiotherapy of the prostate is not possible for medical or technical reasons, the prostate cancer is divided into several medium “portions”: the therapy is fractionated over around 20 treatment sessions every working day and over a period of around four weeks. This distribution of radiation over several weeks improves the tolerability of treatment for large prostates. It is carried out on an outpatient basis and can be easily integrated into everyday private and professional life. Image-guided adjustment with daily CT images on the irradiation device also allows highly focused irradiation with an accuracy in the millimeter range.

Radiotherapy for prostate cancer is one of the main focuses of our clinic and is represented by us both clinically and scientifically. We pass on our knowledge in international courses and congresses. We are also active in international committees for quality assurance in studies. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in urology and medical oncology to guarantee “one-stop” treatment.

In clinical trials, we are continuously working to improve the treatment of prostate cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Radiotherapy in the high-risk class

In patients with prostate cancer that is classified as high risk (e.g. due to local spread, metastases in the lymph nodes, a PSA value of over 20 mg/ml or a Gleason score of 8 or more), radiotherapy of the prostate is extended to the lymphatic drainage areas in the pelvis. In order to optimize the tolerability of this somewhat larger therapy area, the therapy is divided into many small “portions” in addition to the most modern technical procedures: the therapy is carried out fractionally over approximately 33 treatment sessions per working day over a period of about 7 weeks. It is carried out on an outpatient basis and can be easily integrated into everyday private and professional life. Image-guided adjustment with CT images on the irradiation device also allows highly focused irradiation with an accuracy in the millimeter range.

It goes without saying that patients receive close medical care during this time in order to provide the best possible support during therapy.

In these cases, radiotherapy is often combined with anti-hormonal therapy in the form of depot injections every three months for 18-36 months to improve its effectiveness.

Radiotherapy for prostate cancer is one of the main focuses of our clinic and is represented by us both clinically and scientifically. We pass on our knowledge in international courses and congresses. We are also active in international committees for quality assurance in studies. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in urology and medical oncology to guarantee “one-stop” treatment.

In clinical trials, we are continuously working to improve the treatment of prostate cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Irradiation of the prostate region after surgery

After prostate cancer surgery, PSA levels rise again in a third of patients during the course of follow-up care. This is known as a relapse. As a rule, PSMA-PET imaging is used to check whether metastases have formed. If this is not the case, the former prostate region is irradiated as a curative therapy approach, i.e. with the intention of bringing about a cure. This is often referred to as “salvage” radiotherapy. In order to optimize the tolerability of the therapy in the pre-operated area, the therapy is divided into many small “portions” in addition to the most modern technical procedures: the therapy is carried out fractionally over approximately 33 treatment sessions per working day over a period of 7 weeks. It is carried out on an outpatient basis and can be easily integrated into everyday private and professional life. Image-guided adjustment with CT images on the irradiation device also allows highly focused irradiation with an accuracy in the millimeter range.

It goes without saying that patients receive close medical care during this time in order to provide the best possible support during therapy.

Radiotherapy for prostate cancer is one of the main focuses of our clinic and is represented by us both clinically and scientifically. We pass on our knowledge in international courses and congresses. We are also active in international committees for quality assurance in studies. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in urology and medical oncology to guarantee “one-stop” treatment.

In clinical trials, we are continuously working to improve the treatment of prostate cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Oligometastatic prostate cancer

If the prostate cancer has spread, i.e. metastasized, it was historically believed that a cure was no longer possible; consequently, patients used to be treated “only” with anti-hormonal therapy. Today we know that this has to be considered in a more differentiated way: if the prostate cancer has only formed a few metastases (maximum 5) then we supplement the anti-hormonal therapy with radiotherapy (or surgery) of all cancer foci: The aim is not just to shrink the cancer, but to eliminate it completely. In a relevant proportion of patients, a cure or at least long-term tumor control can be achieved. In some cases, anti-hormonal therapy can also be postponed or prevented.

Body stereotactic radiotherapy (SBRT), a highly focused radiation treatment in just a few outpatient treatment sessions, is the best-studied local treatment method in this situation of oligometastasis. Body stereotactic radiation can combat metastases in almost all regions of the body highly effectively and with few side effects: metastases in lymph nodes, bones, lungs, liver, adrenal glands and the brain. Tumor foci in distant regions can also be treated in one treatment session, as can directly adjacent ones. This means that two separate procedures are not required, as is the case with surgery.

The concept of oligometastasis is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in urology and medical oncology to guarantee “one-stop” treatment.

In clinical trials, we are continuously working on improving the treatment of prostate cancer to make it even more effective and tolerable. To the overview of currently open studies.

Multiple metastases of prostate cancer, e.g. in the brain or bones

Prostate cancer is a type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.

For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery.

Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. Metastatic prostate cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.

State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.

In clinical trials, we are continuously trying to improve the treatment of prostate cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

  • Kishan A et al, Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer, JAMA Network Open. 2019; 2(2):e188006. February 8, 2019
  • Delaney 2016, Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomized, non-inferiority, phase 3 CHHiP trial; Lancet Oncol. 2016 Aug; 17(8):1047-1060. Epub 2016 Jun 20.
  • Roach M et al, Sequence of hormonal therapy and radiotherapy field size in unfavorable, localised prostate cancer (NRG/RTOG 9413): long-term results of a randomised, phase 3 trial, Lancet Oncol 2018 ; 19: 1504-15
  • Bartkowiak et al, Acta Oncol 2018 Mar;57(3):362-367. Prostate-specific antigen after salvage radiotherapy for postprostatectomy biochemical recurrence predicts long-term outcome including overall survival
  • Palma D et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomized, phase 2, open-label trial Lancet Vol 393 May 18, 2019
  • Ost P et al, Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial, J Clin Oncol 2018 Feb 10;36(5):446-453.
  • Characterization and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Guckenberger M, Lancet Oncol. 2020(1):e18-e28.

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