Episode 087: Prostate Cancer Series: Pt. 4- Radiation Oncology in Prostate Cancer
Jan 4, 2024
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Dr. Jacob Hall, Senior Radiation Oncology resident and Chief Resident at UNC-Chapel Hill, discusses patient selection and key terms in radiation oncology for prostate cancer. They cover the role of radiation in metastatic disease, brachytherapy, and the use of proton therapy. The podcast also includes humorous camping stories and discussions on treatment options and hypofractionation in prostate cancer radiation therapy.
Radiation therapy can be used for low-risk, unfavorable intermediate-risk, and even high-risk prostate cancer, with the goal of providing curative treatment while minimizing side effects.
External beam radiotherapy (EBRT) and brachytherapy are two methods of delivering radiation for prostate cancer, each with its own side effect profile and considerations for patient selection.
Deep dives
Radiation therapy is a valuable treatment option for prostate cancer patients
Radiation therapy has a role in the treatment of prostate cancer, and it is part of definitive curative therapy. It can be used for low-risk, unfavorable intermediate-risk, and even high-risk disease. The goal is to provide the best curative intent treatment while minimizing side effects and symptomatic burden. Radiation therapy can be delivered through external beam radiotherapy (EBRT) or brachytherapy.
External beam radiotherapy (EBRT) for prostate cancer: Side effects and patient selection
External beam radiotherapy (EBRT) for prostate cancer involves aiming X-rays at the patient to deliver the desired dose to the prostate. The side effect profile of EBRT includes urinary frequency and urgency, diarrhea, and potential erectile dysfunction. Patient selection for EBRT depends on factors such as medical comorbidities, life expectancy, and the risk of biochemical recurrence. In some cases, hypofractionation can be used, which delivers higher doses of radiation in fewer treatments.
Brachytherapy as a treatment option for low-risk prostate cancer
Brachytherapy involves the implantation of radioactive sources directly into the prostate to deliver the desired radiation dose. It is commonly used for low-risk prostate cancer, although active surveillance is the preferred approach for such patients. Brachytherapy can provide effective tumor control and is a good option for patients who do not want surgery but still want definitive treatment. The side effect profile of brachytherapy can be more intense, particularly for patients with large prostates or those at risk of urinary obstruction.
Proton therapy for prostate cancer: Limited data, patient demand, and cost considerations
Proton therapy is a form of radiation therapy that uses protons instead of X-rays to deliver radiation. It is often perceived as a more advanced and effective treatment option, but there is limited data to support its superiority over other forms of radiation therapy for prostate cancer. Patient demand for proton therapy is high, despite the lack of evidence for better side effect profiles. Proton therapy is expensive and resource-intensive, raising questions about its cost-effectiveness and allocation of healthcare resources.
Last, but not least, in our multidisciplinary discussions regarding the management of prostate cancer, we are thrilled to present a special episode featuring soon-to-be attending Radiation Oncologist Dr. Jacob Hall. Dr. Hall is a senior Radiation Oncology resident and Chief Resident at UNC-Chapel Hill. Today, he helps us better understand patient selection for radiation and helps define key terms.
As a reminder, we previously discussed the fundamentals of Radiation Oncology with Dr. Evan Osmundson in Episode 027!
Content:
-What information should we include when referring a patient to radiation oncology?
-How to counsel patients about effects of radiation oncology for prostate cancer
-What is brachytherapy?
-Is there a role for proton therapy?
-What is the role of radiation for metastatic disease?
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