Treatment Comparison

Thanks to its millimetre accuracy, proton therapy pinpoints the tumour carrying more radiation directly to the cancer cells. This significantly reduces the levels of radiation received by the surrounding tissue, preventing side effects and aiding recovery so that the patient can return to normal as quickly as possible.

Prostate cancer is highly specific, and a range of treatment options exist for this form of cancer. Due to this, it is possible to compare and contrast the various treatment options available, in a detailed way, which can be seen below. If you would like to see comparisons for other diagnosis, please go to Treatment Comparisons for Various Diagnoses

Side Effects Comparison At A Glance

ImpotenceInfertilityUrinary IncontinenceBowel Problems
Proton TherapyVery LowVery LowVery LowLow
Hormone TreatmentHighHighNoneNone
Radical ProstatectomyHighHighHighLow
RadiotherapyMediumMediumLowMedium
BrachytherapyMediumLowLowMedium
CryotherapyHighHighHighHigh
HIFU
(Ultrasound)
HighHighHighHigh

Side Effects Comparison In Detail

TreatmentSide Effects
Proton TherapyThe majority of Proton Therapy patients experience no side effects. However although rare, some people do get minor side-effects, dependent on the site that's being treated.
Read More

For brain tumours the temporary side-effects could occasionally be:

  • Headaches
  • Tiredness

The most common short-term side-effects for prostate cancer might be:

  • Burning pain when urinating
  • Need to urinate more often than usual
  • Weaker urine stream

For head and neck cancers, temporary side effects could be:

  • Very mild skin reddening that does not inconvenience the patient in any way
  • Sore throat
  • Difficulty swallowing
  • Throat irritations
  • Dry mouth
  • Temporary skin reaction
SurgerySurgical risks- with any surgery there can be complications during and after the operation, including wound infections
• Bleeding during and after the operation
• Heart attack
• Reaction to anesthesia
• Infection at the incision site
• Risk of urinary incontinence (being unable to control urine)
• Impotence (being unable to have erections)
• Lymphedema
• Inguinal hernia: A prostatectomy increases a man’s chances of developing an inguinal (groin) hernia in the future.
• Injury to surrounding tissues (i.e. rectum, bladder, and ureters)
Read More

Long-term symptoms for prostate cancer surgery

• Urinary incontinence

• Stress incontinence (leaking urine when coughing, sneezing, laughing etc)

• Overflow incontinence(Taking longer to urinate or straining to urinate)

• Sudden urges to urinate

• Erectile dysfunction

• Loss of fertility

• Lymphedema (swelling and pain in legs or genital region.

• Change in Penis length (Caused by shortening of urethra if a portion is removed during operation)

• Inguinal hernia: A prostatectomy increases a man’s chances of developing an inguinal (groin) hernia in the future.

• Injury to surrounding tissues (i.e. rectum, bladder, and ureters)

Other risks associated with surgery

  • Blood clots in the legs that could travel to the lungs
  • Stroke

 


Conventional Radiotherapy:
Three dimensional
conformal radiation
therapy (3D-CRT)
Radiation can irritate the large intestine and rectum and cause a condition called radiation proctitis. This can lead to diarrhoea, blood in the stool and rectal leakage.
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  • Bladder problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. Patients might need to urinate more often, have a burning sensation while you urinate, and find blood in their urine
  • Urinary incontinence: Inability to control urine or have leakage or dribbling
  • Tiredness: There is a low risk that 3D-CRT can cause fatigue that may not go away until a few months after treatment stops.
  • Erectile dysfunction: a percentage of men may experience erectile dysfunction, however the rate of erectile dysfunction reported in the literature varies significantly
Conventional radiotherapy:
Intensity-Modulated Radiotherapy
(IMRT)
Bowel Problems: it can irritate the large intestine and rectum and cause a condition called radiation proctitis. This can lead to:
• Diarrhoea
• Blood in the stool
• Other symptoms are the same as Conventional Radiotherapy 3D-CRT as seen above, but more mild.
Read More
  • Bladder problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. Patients might need to urinate more often, have a burning sensation while you urinate, and find blood in their urine
  • Urinary incontinence: Inability to control urine or have leakage or dribbling
  • Tiredness: There is a low risk that IMRT can cause fatigue that may not go away until a few months after treatment stops.
  • Erectile dysfunction: a percentage of men may experience erectile dysfunction, however the rate of erectile dysfunction reported in the literature varies significantly
Conventional radiotherapy:
Cyberknife
Erectile dysfunction
Read More
  • Urinary retention
  • Sudden Urge to urinate
  • Urinary incontinence
  • Increased frequency to urinate
  • Risk of urethral stricture
  • Blood in stool
  • Injury to rectal or bladder wall / nearby tissue
BrachytherapyThe procedure itself can cause side-effects such as:
• Soreness and bruising between the legs where the needles or thin tubes went through the perineum (area between the anus and the scrotum)
Read More

15% of men require a catheter for up to a month post-treatment

    • Blood in the urine and semen
    • Difficulty or discomfort passing urine
    • Rare bowel movements
    • Proctitis
    • Erectile dysfunction
    • Urinary Problems and incontinence

 

CryotherapyCryotherapy can cause a loss of sensation if nerves are affected in the treated area, as well as pain
Read More
  • Bruising
  • Constipation
  • Blood in urine
  • Impotence (in 50% of cases)
  • Urinary incontinence (18% of cases)
  • Urethra blockage and problems passing urine. May require an operation known as transurethral resection of the prostate (TURP) to help improve this.
  • Fistula - damage can occur to the back passage (fistula) requiring surgical repair (in rare cases)
  • Infection after treatment
  • Loss of sensation if nerves are affected
High Intensity Focused UltrasoundInfections in the area treated
Read More
  • Leakage of urine (incontinence) pain
  • Erectile dysfunction
  • Difficulty passing urine due to swelling
  • Blood in urine
  • Bowel problems: burning sensation or rectal bleeding
  • Fistula (hole) between the urethra and the back passage (1% of cases) requiring surgical repair

Time Comparison

TreatmentTimeThings to Consider
Proton Therapy2.5-4.5 weeks as an outpatientNot available in the UK for Prostate Cancer

UK centres under construction
Minimal Side Effects

Hormone Treatment
"Androgen deprivation therapy (ADT)"
3 months to several years Used for advanced cancer treatments.
Sometimes in combination with other treatment options.
(Consider the side effects)
Radical Prostatectomy
(NOT ROBOTIC)
2-3 hour operation
2-4 days in hospital to recover
Consider the side effects
Radical Prostatectomy
(ROBOTIC - "DA VINCI")
2-3 hour operation
2-4 days in hospital to recover
Consider the side effects
Conventional Radiotherapy: 3D_Conformal radiotherapyusually from 6-8 weeksConsider the side effects
Conventional Radiotherapy:
IMRT
4-8 weeksConsider the side effects
Conventional Radiotherapy: Cyberknife5 x 45-60 minute sessionsConsider the side effects
BrachytherapyA day surgery procedure performed under general anaethetic or spinal anaetheticConsider the side effects
CryotherapyTreatment under local anaesthetic or with general anaesthetic.
Takes between 1 to 2 hours. Day procedure but may require an overnight stay afterwards.
Consider the side effects
HIFUDay surgery. May require overnight stay after the procedure.
Performed under spinal anaesthesia and takes 2-3 hours to complete.
Consider the side effects

To find out if your patient is eligible to receive Proton Beam treatment visit the What To Do Next page.

Michal Čada 8:14 pm