Cancer Questions: A new procedure is allowing for better prostate radiation

  • Dr. Michael Yunes

For the Gazette
Published: 11/5/2019 2:17:05 PM

Recently, the Baystate Regional Cancer Program introduced a procedure that greatly minimizes the risk of side effects during prostate cancer radiation, allowing higher radiation doses to be given during each session and by reducing the course of treatment by several weeks.

Cancer of the prostate gland is one of the most common cancers among men.

Though often compared to a walnut in size, the prostate gland plays a large role in the male reproductive system.

The fluid it secretes into the urethra during ejaculation mixes with other fluids to create semen. Its muscle cells help close off the urethra’s connection to the bladder during ejaculation and expel the semen forward.

Treatment for prostate cancer can impact sexual function as well as bowel and urinary functions because the gland is located between the bladder and penis and just in front of the rectum that leads to the anus.

The urethra that carries urine from the bladder to the penis passes through it.

The newly introduced procedure at Baystate Medical Center involves the injection of a temporary hydrogel to move the rectal wall away from the prostate during external beam radiation therapy.

Patients are generally asked to have a full bladder during radiation as one way of moving the bladder and small bowel away from radiation exposure, but shielding the rectum has been more of a challenge because of how it sits right in front of the prostate and its position can change slightly depending on other factors.

The gel essentially creates artificial extra space between the prostate and rectum and this helps minimize radiation exposure especially to the rectum.

The gel is inserted by needle into the skin of the perineum which is located between the anus and scrotum that contains the testicles.

This outpatient procedure is done under light anesthesia by interventional radiologists, and is often undertaken at the same time three small gold metal markers or seeds are inserted by hollow needle through the perineum as well and placed near the tumor in the prostate.

Their placement allows radiation therapists to know the tumor’s exact location during radiation.

Both procedures involve the use of image guidance for placement.

The gel is dissolvable, does not cause any reactions within the body and takes 12 weeks to be naturally eliminated from the body. There are no side effects other than maybe a temporary feeling of fullness.

Its use also addresses the fact that a high dose of radiation to the prostate takes many weeks to deliver. In order to kill off cancer cells it is generally given over this time period because delivering it faster increases the risk of many possible side effects including rectal of bleeding, perforation or ulcers.

The gel as a temporary protective spacer means we can consider hypo-fractionated radiation therapy treatment which only requires five-and-a-half weeks of daily treatment, a newer option to the standard nine weeks of daily treatment.

This is an option that comes with fewer side effects and the same prostate-specific antigen control rate for recurrence as the longer course of treatment.

It has taken several years of planning and collaboration among multiple specialties including radiation oncologists, interventional radiologists and urologists as well as the purchase of specialized equipment to create the program.

Baystate is the first in this region to offer it.

The hydrogel procedure does not eliminate side effects related to urinary incontinence and erectile dysfunction and it cannot be offered to patients whose cancer has spread beyond the capsule that covers the prostate in the direction of the rectum.

We have built our program so that within the first two weeks the seeds and gel are placed, a treatment planning MRI is done as well as a CT simulation for radiation planning and we are ready to begin and finish radiotherapy before the gel begins to dissolve at 12 weeks.

Our first patient to undergo the gel procedure has had zero rectal toxicity, and that is incredible to have no sense of elimination urgency, blood in the stools, or incontinence.

Going forward, patients deciding on the SpaceOAR hydrogel procedure with hypo-fractionated radiation therapy for their prostate cancer will no longer have to give up two full months of their life for radiotherapy.

It expands treatment options for the disease and will be a huge patient satisfier for those who are candidates.

The radiation oncologist and urologist will work together to ensure that the appropriate treatment options are offered.

Dr. Michael Yunes is chief of radiation oncology with the Baystate Regional Cancer Program at Baystate Health. He is one of several Baystate professionals who address issues related to cancer in this space on a rotating basis each month.

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