22 November 2018
Over the years there has been much advancement in the planning and delivery of radiation therapy for prostate cancer. Radiotherapy is proven to be an effective, non-invasive method of treating prostate cancer but many men fear the potential side-effects which can result from radiation exposure (toxicity) to the surrounding organs and tissues, such as the rectum.
Professor Bahl says, “A number of recent improvements, such as intensity-modulated radiotherapy (IMRT) and the more recent addition of image guidance, allowing us to be more accurate in the delivery of the radiation to the prostate. Aside from the radiation delivery systems (known as a Linear Accelerator) there have also been advances in the software used to plan and execute the radiation therapy and the devices used to stabilise the patient to reduce organ movement.
The rectum mucosa is very sensitive to radiation injury. Its immediate proximity to the prostate makes the rectum the primary organ at risk (OAR) during prostate radiation therapy. Too much radiation exposure to the rectum can result in long-term side-effects such as abdominal pain, diarrhoea, incontinence, bleeding, and mucus discharge.
Oncologists and Urologists are always working together to provide patients with better treatment plans and reduced long-term complications. One new technology we’re implementing to combat these potential complications is an innovative, soft hydrogel spacer called SpaceOAR, which is clinically proven to lower radiation exposure to the surrounding organs and tissues.
When we started to implement SpaceOAR in our practise we were confident of the safety profile and positive impact to the patient, as the hydrogel is supported by over 72 clinical publications and a 222 patient randomised control trial. In the UK it has received positive guidance from NICE and so far, it has been implanted in around 30,000 men worldwide.”
Professor Persad says, “The hydrogel is relatively simple concept. We use a very fine needle (under anaesthetic) to inject the gel between the prostate and rectum. The procedure only takes a few minutes; the gel positions the rectum on average 1cm away from the prostate. This space moves the rectum out of the zone of high dose radiation and minimises the risk of bowel damage.
The clinical studies have shown that not only does the gel spare the bowel, it also has positive benefits in reducing urinary incontinence and erectile dysfunction (for men who were sexually potent prior to treatment), giving men their life back following treatment.”
Professor Bahl continued, “In the near future, hydrogel spacing will enable us to push our radiotherapy planning and delivery systems harder, eventually reducing the number of radiotherapy sessions from 20 to 5.
Today, the potential side-effects from radiation exposure are a major concern for men who are given the option of radiotherapy and can often negatively impact the decision to accept this treatment option. New technology such as radiotherapy delivery systems and SpaceOAR hydrogel are important, they give men the confidence that not only are we doing our best to treat the cancer, but also that we are protecting their long-term quality of life from bowel, urinary and erectile dysfunction.”