Radiation Therapy for Prostate Cancer: Prof. Daniel Aebersold Shows Promising Long-Term Outcomes

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00:00:37: Prostate cancer often affects older men.

00:00:41: The good news is, if prostate cancer is detected in time there are good chances of a cure and besides surgery radiation therapy also plays a major role.

00:00:53: I am speaking about this treatment option today with Professor Daniel Ebersault.

00:00:58: he's the director-in-chief physician at the University Clinic for Radiation Oncology.

00:01:07: Professor Ebersault, in which cases does it make sense to treat prostate cancer with radiation instead of surgery?

00:01:14: Yes that primarily depends on two factors.

00:01:17: The first question you always have to ask is... Is the tumour even active enough that needs be treated at all?

00:01:25: So regardless whether surgery or radiation are required should they be treated as well?

00:01:32: There're different activity levels for these tumours and accordingly For less active tumors, there is certainly the option to simply continue monitoring without treating.

00:01:44: That means you really need to have relevant activity... ...to even need treatment.

00:01:48: that's one thing!

00:01:50: The other is that patients should be in good general health with a life expectancy of at least ten more years.

00:01:59: This means for patients who are having serious illnesses where they must expect them will live for less than ten years it is not always worth performing any treatment at all.

00:02:11: What are the requirements for patients to receive radiation instead of surgery?

00:02:18: That is a very common question that patients are interested in, I always say and this has meanwhile been proven by many studies.

00:02:28: For the decision-making process between radiation or surgery, The different spectrum of side effects is much more decisive.

00:02:44: This means that both procedures result in different risks and different side effects And that's what one should use as a guide to choose one therapy option over another.

00:02:54: That leads me on my next question.

00:02:57: because the prostate is important for potency It is located by the bladder near the bowel.

00:03:04: Isn't it difficult to radiate a prostate tumour without damaging these healthy areas around?

00:03:11: Over the last ten-to-twenty years there have been enormous advances in radiation technology.

00:03:18: This now allows us to very effectively spare both the rectum which lies right behind the prostate and bladder.

00:03:27: Another important issue is urethra.

00:03:30: It runs right through the middle of the prostate and usually receives the same dose as the entire prostate.

00:03:38: And we have to ensure that patient has normal bladder function, meaning they can urinate reasonably well... ...and do not have a significantly weakened urine stream!

00:03:51: These are such important conditions for assessing risks there.

00:03:56: What methods you choose from?

00:04:00: There are many different ways to treat prostate cancer with radiation therapy.

00:04:30: As I just described regarding bladder function, how well a patient can urinate and whether there are certain irritative symptoms there or not.

00:04:39: On the other hand it is also very important whether the tumor is confined to the prostate.

00:04:46: as a rule external radiation Can almost always be performed?

00:04:51: And nowadays this is increasingly done using the stereotactic method.

00:04:57: This is a highly precise form of treatment usually performed with the cyber knife, A stereotactic machine that allows the bladder and rectum to be very well protected.

00:05:09: What also still offered internationally Is so called Brachytherapy where radiation is applied from inside.

00:05:16: However this method is semi-invasive.

00:05:19: That's reason why it increasingly being abandoned in favor of this stereotactive radiation.

00:05:26: How does this brachytherapy work?

00:05:28: from the inside?

00:05:30: There under spinal anesthesia, radioactive seeds which are small metal pellets are inserted.

00:05:37: Which then remain in the prostate and deliver their radiation dose there.

00:05:44: It is a semi-invasive procedure only semi invasive in that the prostate is not removed but still invasive in that material must be inserted into the prostate.

00:05:57: And how do other radiation treatments work?

00:06:00: The ones you mentioned as external, what are treatment steps involved?

00:06:05: How often does this have to done and patients has to stay at a clinic is impatient.

00:06:12: Be all or end of radiation therapy is the treatment planning.

00:06:15: for this we always need cross sectional imaging usually both computed tomography and a magnetic resonance imaging scan, which then also forms the basis for carrying out the actual radiation planning.

00:06:29: This means that the radiation oncologist then marks on these images exactly where the prostate is what exactly should be irradiated?

00:06:37: And What Should Not Be Irradiated Meaning Which Organs Should Be Protected!

00:06:42: What should also be added Is That As A Rule Markers Are Implanted Into The Prostate.

00:06:48: These are very small pieces of metal to make them visible on the radiation device.

00:06:55: This is a technique that is then available, to allow for... Very-very precise radiation!

00:07:03: Once the entire plan is complete and the patient begins radiation depending upon type treatment between five and forty sessions must be performed.

00:07:15: Whenever possible, we try to keep the number of sessions as low as we can.

00:07:19: This is when it's possible for us to perform treatment using the CyberKnife.

00:07:23: In that case this treatment is carried out in five sessions every other day which means total duration of therapy will be about ten days.

00:07:33: If the treatment cannot be performed with a Cyberknife but rather standard linear accelerator.

00:07:39: The treatment will take about four to eight weeks depending on how much dose can be delivered per session.

00:07:46: And is general anesthesia required for that?

00:07:49: No, For external radiation no anesthesia or local anaesthetic Is necessary at all.

00:07:55: Placing these markers is also done without anesthesia.

00:08:00: You feel a certain prick.

00:08:01: At the moment These markers are implanted but That does not require anesthesia and the radiation itself, when it takes place during this entire treatment period is an outpatient procedure without any anesthesia at all.

00:08:16: So what actually happens to the irradiated tumour cells?

00:08:20: Do they dissolve?

00:08:21: That's a very good question!

00:08:24: There are often incorrect ideas about these.

00:08:27: We do not work with heat but with a type of energy that is absorbed by the tumour cell and causes damage there which then leads to the death of these tumour cells.

00:08:37: This means that these tumours actually dissolve, not all at once.

00:08:42: it always takes a certain amount time until very last tumour cell has dissolved.

00:08:49: but this is exactly mechanism we can kick start through radiation.

00:08:54: and what are risks or side effects on this radiation therapy?

00:08:58: Various irritation symptoms are in front.

00:09:01: What we have, meanwhile under very good control thanks to this technology or significantly better under control than ten years ago are certain irritation symptoms in the bowel and bladder.

00:09:13: We rarely see side effects there anymore.

00:09:16: If side-effects do occur The patient might feel an increased urge to have a bowel movement Or an increase urged urinate needing go into bathroom more often.

00:09:27: Some patients get up once twice during night Where we, as mentioned at the beginning see somewhat more side effects that is regarding the urethra which passes through the prostate.

00:09:39: There can also be some pain when urinating.

00:09:43: if that should become too intense then anti-inflammatory medication can be used.

00:09:49: We see in about ten to twenty percent of patients they experience such irritation symptoms during treatment.

00:09:58: These usually subside after ten to fourteen days, in about five percent of cases.

00:10:05: certain irritation symptoms occur later even after years which if they become more severe can also be treated with medication.

00:10:16: Regarding sexual function It is generally the case that patients notice a weakening of sexual function immediately after radiation, which often recovers.

00:10:29: Sometimes it does not return to level at before treatment but still good enough.

00:10:36: having sexual intercourse remains possible.

00:10:40: There are also good studies now compared to surgery where one can say that radiation slightly ahead in that overall sexual health after radiation is on average better for patients than after surgery.

00:10:57: And the big question of course, how good are chances recovery with radiation for prostate cancer?

00:11:05: The chances of recovery generally very good.

00:11:08: it depends significantly and how active tumor was at time diagnosis.

00:11:14: For patients with a low to moderately active tumor The survival chances and overall chances of recovery are somewhere between ninety one hundred percent.

00:11:25: so very good prospects.

00:11:28: If the tumor is somewhat more advanced and shows a highly increased activity level then they over all chances of recover still somewhere between seventy and ninety percent, so overall a very good chance of recovery.

00:11:44: what i also always tell my patients is that even if a relapse should occur, whether it's within the prostate in the lymph nodes or in the form of metastasis there are always more highly efficient measures to get the tumour under control again.

00:12:05: I believe those are encouraging words very important for patients at the time.

00:12:14: You

00:12:16: are very welcome.

00:12:43: Join us again next time when we return with our popular segment, which is called Medicine for Your Ears.