A Suitable and Effective Treatment Option for Localised Prostate Cancer | Proton Therapy in Japan

There are an estimated 17 million new cases of cancer globally each year. The top four cancers occurring worldwide are lung, breast, bowel, and prostate cancer, respectively. In men, prostate cancer is the most common form of non-skin cancer.

There are a variety of treatment options available when treating prostate cancer, and surgery and radiotherapy are the main treatment options presented to patients. These techniques are, however, associated with sexual, urinary, and bowel-related side effects.

One of the standard treatments for localised prostate cancer is conventional radiation therapy. However, conventional radiation therapy brings considerable acute and late adverse effects to the gastrointestinal (GI) and genitourinary (GU) tract. These side effects continue to be a major concern for both patients and physicians. For instance, in a study conducted by Fiorino et al., the risk of experiencing ≥grade 2 GI and GU side effects is about 5%–20% when undergoing conventional radiotherapy. 

With the materialisation of modern conventional radiotherapy techniques, the risk of toxicity on organs at risk, namely the bladder, rectum, and seminal vesicle, have decreased to 5%–10%. The use of proton beams in radiation therapy further reduces this risk with its characteristic Bragg peak, whereby protons can be controlled to stop directly within the tumour, analogous to its energy.

In order to improve life expectancy and overall quality of life, the Japanese government have applied efforts into funding advanced research for the treatment of cancer, with one such effort being proton beam therapy.

Currently there are 14 proton beam facilities within Japan, and as of April 2018, proton beam therapy for prostate cancer is included in Japanese public insurance coverage, thereby removing the financial burden for patients who will undergo this procedure. The number of patients being treated for localised prostate cancer with proton therapy in Japan continues to increase in popularity, due to its promise as a superior treatment for localised prostate cancer.

In a January 2019 literary review of proton therapy for localised prostate cancer in Japan by Japanese researchers in the Journal of Clinical Medicine, proton therapy for prostate cancer was highlighted as superior to other forms of conventional radiotherapy across multiple studies. The incidence of acute and late toxicities concerning the GI and GU tract, as well as radiation doses to organs of risk such as the bladder, bowel and seminal vesicles, were shown to be significantly lower compared to conventional radiotherapy treatments. Proton therapy has also shown its benefits in patients’ prognosis and quality of life. Biochemical control of patients who completed proton therapy are significantly favourable in prostate cancer patients, including high and very high risk cases. The researchers concluded that proton beam therapy is an effective and suitable treatment option for localised prostate cancer.

To find out if proton therapy is appropriate for you or a loved one, please do not hesitate to contact us.

Resources used:

Cancer Research UK. World Cancer Statistics. Available online (accessed on 12 June 2020).

Fiorino, C.; Sanguineti, G.; Cozzarini, C.; Fellin, G.; Foppiano, F.; Menegotti, L.; Piazzolla, A.; Vavassori, V.; Valdagni, R. Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 2003, 57, 953–962.

Hoshina, R.M.; Matsuura, T.; Umegaki, K.; Shimizu, S. A Literature Review of Proton Beam Therapy for Prostate Cancer in Japan. J. Clin. Med. 2019, 8, 48. 

Sakurai, H.; Ishikawa, H.; Okumura, T. Proton beam therapy in Japan: Current and future status. Jpn. J. Clin. Oncol. 2016, 46, 885–892. 

Takagi, M.; Demizu, Y.; Terashima, K.; Fujii, O.; Jin, D.; Niwa, Y.; Daimon, T.; Murakami, M.; Fuwa, N.;
Okimoto, T. Long-term outcomes in patients treated with proton therapy for localized prostate cancer. Cancer Med. 2017, 6, 2234–2243.

Proton Therapy: An Effective Treatment For Prostate Cancer You Should Insist On

Amongst males in the UK, prostate cancer is the 2nd most common cause of cancer death, with around 12,000 deaths in 2017. Prostate cancer accounts for 14% of all cancer deaths in males in the UK. Prostate cancer patients are usually presented with conventional treatment options such as surgery and conventional x-ray radiotherapy. Another option is proton therapy.

This article will explain why proton therapy in Prague is an effective treatment option for many prostate cancer patients.

The Prostate and Prostate Cancer

The prostate surrounds the urethra and is located beneath the bladder. Cancer begins to develop in the prostate when the cells of the gland begin to grow uncontrollably and form a malignant tumour. Left untreated, prostate cancer can spread to other parts of the body such as the bladder, rectum, bones, and lymph nodes where it can become life threatening.

Modern medicine, however, has made the survival rates of prostate cancer reasonably high.

Common Types of Prostate Cancer

The vast majority of prostate cancers involve adenocarcinomas – these are cancers which develop immediately within the gland cells. It is possible to develop other types of prostate cancer, including:

  • Ductal adenocarcinoma – begins in the ducts of the prostate gland
  • Transitional cell cancer – begins in the bladder and spreads to the urethra, prostate, and nearby tissues
  • Squamous cell cancer – begins in the flat cells of the prostate gland
  • Small cell prostate cancer – a type of neuroendocrine cancer made up of round, small cells

Risk Factors and Prevention

Risk factors such as age, ethnicity, and family history have been known to influence the chances of an individual’s chance of developing prostate cancer. Individuals over the age of 50 are more likely to develop prostate cancer.

A family history of prostate cancer can have an impact on your chances of developing cancer. Only 5% of prostate cancer cases are inherited, but up to 20% of cases are familial, meaning common lifestyle factors and shared genes may have had an influence on the development of cancer.

To lower your risk of developing prostate cancer, it’s recommended to eat a low-fat diet and exercise regularly. However, it’s best to monitor your health by receiving routine checkups and prostate screenings (such as the PSA blood test) from your doctor.

Proton Treatment for Prostate Cancer Patients

Also known as proton beam therapy, proton therapy involves the focusing of proton particles into a beam, which is then delivered to the cancer cells in a non-surgical procedure. The positively charged particles can be controlled to stop at the tumour site, enabling the cancerous tissues to be destroyed with high levels of radiation without causing damage to near healthy tissue and vital organs.

Proton therapy is considered more accurate than other types of radiation therapy, and also non-surgical and noninvasive with minimal side effects. What’s more, the treatment requires little to no recovery time, nor does the radiation have an impact on the patient’s energy levels in comparison to other cancer treatment options. Those who choose proton therapy experience fewer complications than those who choose other types of treatment such as surgery or conventional x-ray radiation.

Proton Therapy vs. Conventional Radiation Therapy

Unlike proton therapy, conventional radiation treatments use x-rays to deliver radiation to the cancerous tumour. Unfortunately, these x-rays cause damage not only to the cancerous tissue, but also the surrounding healthy tissue. Proton therapy uses positively charged subatomic particles called protons. Unlike conventional radiation therapy, the clinician can use the proton beam to target the cancer cells in the body specifically, allowing for a more successful and far less damaging procedure.

Proton Therapy Shown to Enhance Quality of Life

According to an American national survey, those who received proton therapy to treat prostate cancer reported experiencing a better quality of life involving urinary and bowel function during and after their proton therapy treatments, in contrast to patients who received x-ray radiation treatments. More than 70% of prostate cancer patients who received proton therapy additionally noted that the treatment had no impact on their quality of life overall.

Proton Therapy Success Stories

It’s one thing to hear about the success rate of proton therapy treatment for those with prostate cancer in comparison to conventional treatments. It’s another thing to hear the success stories straight from those who have survived and continue to survive today. To learn more about the experiences of others who underwent proton therapy in Prague, click here.

Proton Therapy has the Potential to Reduce the Risk of Long-Term Medical Problems Associated with Anal and Rectal Cancer Treatments

Proton beam Therapy (PBT) is increasingly used for the treatment of paediatric, central nervous system, skull base, and head and neck tumours. Today, there are over 75 particle therapy facilities in operation worldwide, with more in development. Whether proton therapy can play an important role as well in the treatment of anal and rectal cancer is under active investigation.

Anal and rectal cancers are surrounded by radio-sensitive organs, limiting the treatment options available to medical practitioners responsible for treating these forms of cancer. Proton radiotherapy has the potential to remove these limitations, and could be used to treat certain rectal and anal cancers with greater efficacy than conventional radiotherapy.

In a study published by medical researchers at the Harvard Medical School, the potential use of proton therapy was shown to reduce toxicities associated with treatment, increase patient compliance with treatment, minimise treatment interruptions and enables for the possibility of dose escalation (also known as hypofractionation).

The authors observe that currently, “… the maximal efficacy of radiation plans for primary and recurrent anorectal cancer is constrained by delivery techniques and modalities which must consider feasibility challenges and toxicity secondary to exposure of organs at risk.”

Given the minimal difference in biological effect between both protons and x-ray radiotherapy modalities, protons have drawn interest as a way of sparing adjacent organs at risk from unnecessary radiation, while delivering “tumoricidal” doses, and increasing the therapeutic effect of treatment.

Researchers are highly optimistic about proton therapy as an effective treatment for anal and rectal cancers (especially as intensity-modulated proton therapy and pencil-beam scanning techniques become more prevalent). Additionally, decreased doses to bone marrow and bowel may “improve tolerance of multi-modal treatment” and allow for dose escalation, in turn improving clinical and patient-reported outcomes.

In summary, proton therapy has the potential to more effectively treat anal and rectal cancers. Proton therapy can result in less short- and long-term side effects, and due to its precision, allows for dose escalation (hypofractionation), thereby increasing the chance of completely eliminating the disease.

To find out if proton therapy is appropriate for you or a loved one, please do not hesitate to contact us.

Sources:

Colaco RJ, Nichols RC, Huh S, et al. Protons offer reduced bone marrow, small bowel, and urinary bladder exposure for patients receiving neoadjuvant radiotherapy for resectable rectal cancer. J Gastrointest Oncol 2014;5:3-8.

Raldow AC, Hong TS. Will There Be a Clinically Significant Role for Protons in Patients With Gastrointestinal Malignancies? Semin Radiat Oncol 2018;28:125-30.

Verma V, Lin SH, Simone CB, et al. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: A systematic review. J Gastrointest Oncol 2016;7:644-64.

Vaios EJ, Wo JY. Proton beam radiotherapy for anal and rectal cancers. J Gastrointest Oncol. 2020;11(1):176‐186. doi:10.21037/jgo.2019.04.03

Wolff HA, Wagner DM, Conradi LC, et al. Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: A planning study with clinical implications. Radiother Oncol 2012;102:30-7.