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THE STAGING GUIDE VIDEO SERIES | TRANSCRIPTION:

Hi, I’m Dr. Scholz.  Let’s talk about prostate cancer.

In today’s video we’re going to cover intensity modulated radiation therapy (IMRT).

IMRT first came on the scene around 2004 and for the first time radiation therapy—beam radiation therapy—surpassed surgery as the preferred type of treatment.  Prior to that we had something called 3D conformal and it was somewhat effective, but unfortunately frequent side-effects (rectal burns, urinary problems) were really unacceptable. IMRT changed that with these very focused pencil beams that are so precise that the surrounding sensitive area of the body were able to be spared from the dangers of radiation.  So now for over a decade IMRT has become the standard type of beam radiation. When men undergo IMRT they’ll visit a specialized facility daily (Monday through Friday) for a 30 or 40 minute visit, undergo a treatment with invisible radiation (just like getting a chest x-ray), and go home. Historically, this process is continued for a total of about nine weeks, and that has recently changed.  Recent studies show that the same effectiveness can be accomplished by giving bigger doses more quickly and it appears that five weeks is just as effective without adding adding any side-effects. So IMRT requires, as of 2018, about five weeks of visits to the doctor.

Right now we are in the middle of a series talking about intermediate risk prostate cancer or what we call Teal at the Prostate Cancer Research Institute, and we divided into Low, Basic, and High Teal. When you are talking about Basic and High-Teal you’re often times considering adding something to the IMRT, perhaps a seed implant and certainly possibly hormone therapy, usually for a short period of time such as 4-6 months.  The seed implant is almost mandated in High-Teal; it is probably not necessary with Basic-Teal, and when we talk about Low-Teal we’re talking about usually doing something like active surveillance.

The side-effects from IMRT, like all the other treatment options, include erectile dysfunction depending on a man’s age and pre-existing function.  The incidence of erectile dysfunction may vary between 30% of men and 75-80% of men. The second very common problem is urinary problems and these things occur frequently for a month or two after treatment and they usually go away, but maybe 10% of men will be left with ongoing urinary frequency, urgency, waking up at night, burning pain when they urinate. In that 10% of men that could drag on for one or two years.  The third thing we used to worry about a lot was rectal burns, and that became much less frequent as technology improved. Now more recently with an injectable hydrogel spacer called SpaceOAR most men can completely eliminate the risk of rectal inflammation or damage. So the main concerns: Erectile dysfunction and possibly difficulties with urination.

So in summary, IMRT might be considered sort of the standard basic treatment for Teal, and it is scaled up with additional treatments like seeds or hormones depending on the seriousness of the disease in the Teal category, but the treatment has become quite standardized and there are a number of qualified practitioners around the country.  Often times men can go through the treatment with little or no side-effects, although some men of course will have problems. So IMRT is an excellent option.  All the options for Teal need to be considered in the context of all your other choices and there of course will be factors such as how the prostate is, how elderly the patient is, how much there are issues with pre-existing urinary side-effects.  All of these things are factored in, but IMRT is in general going to result in high cure rates for the Teal category with an acceptably low-risk of side-effects.

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