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Balancing aggressive treatment and quality of life for men with prostate cancer

By Ronald Chen, MD, MPH, Chair of Radiation Oncology

September 04, 2020

Prostate cancer is the most common cancer among men and the 2nd leading cause of cancer death in men. About I in 9 U.S. men will develop prostate cancer in his lifetime. Medical, surgical and technological advances like those available at The University of Kansas Cancer Center, along with research discoveries taking place, provide more options and more hope than ever before.

Treatment options

Not all prostate cancer patients need treatment. According to the American Society of Clinical Oncology and American Urological Association guidelines, which I helped develop, patients with the earliest stage of prostate cancer (termed low-risk disease, usually defined by PSA <10 ng/mL and biopsy Gleason 6) should consider active surveillance. Active surveillance involves routine monitoring of the prostate cancer. It avoids unnecessary treatment and side effects for patients with slow growing disease and offers treatment for patients whose cancers show growth.

For patients who are not low risk, treatment is likely necessary. The 2 main options - surgery and radiation therapy - are equally effective, but there are different types of radiation therapy depending on a patient's diagnosis. Most early prostate cancers can now be treated in as little as 1 week, using the stereotactic body radiation therapy technology.

Patients with more aggressive (high-risk) prostate cancer will likely need a combination of treatments. External beam radiation plus radioactive seeds (brachytherapy) and hormonal therapy achieve the highest chance for cure in this patient population. The cancer center has the most experience with the stereotactic body radiation therapy technology in the Kansas City region and is the only center in the region to offer prostate brachytherapy.

I am a recognized expert in both, and my book on stereotactic body radiation therapy, Hypofractionated and Stereotactic Radiation Therapy: A Practical Guide, is used by cancer centers worldwide to expand the knowledge and application of this technology.

Quality of life

Different prostate cancer treatments impact patient quality of life differently. I have published extensively on high impact studies examining the short-term and long-term effect of modem surgical and radiation treatments on quality of life. In general, surgery causes more urinary incontinence and erectile dysfunction than radiation therapy, while radiotherapy can cause urinary irritative symptoms and rectal symptoms.

However, with advancements in surgical and radiation techniques, we have been able to significantly reduce the negative quality of life impact from treatment. For example, a hydrogel spacer (SpaceOAR®), which temporarily increases the anatomical distance between the prostate and the rectum during radiation treatment, has been shown to significantly reduce rectal side effects. This technique is available for patients at our cancer center.

Clinical trials

The University of Kansas Cancer Center is one of the few centers in the country to be a member of all 4 of the National Cancer Institute's clinical trial groups:

  • NRG Oncology
  • Alliance for Clinical Trials in Oncology
  • SWOG Cancer Research Network
  • Eastern Cooperative Oncology Group

As a result of these affiliations, we offer many clinical trials for prostate cancer patients ranging from early-stage to metastatic disease. I am the national principal investigator of the INNOVATE trial (NCT04134260), which is the only phase 3 clinical trial focused on patients with node-positive prostate cancer. This trial will determine if adding novel hormonal treatments (abiraterone and apalutamide) will improve the cure rates for this aggressive form of prostate cancer.

 

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