Quality of life for men with prostate cancer is improving, thanks to faster treatment with fewer side effects.
About 4000 New Zealanders are diagnosed each year with cancer of the prostate, a small gland located deep inside the groin. This is more likely to develop as men get older and is highly treatable when diagnosed early.
New technology is now offering an alternative to surgery for those who have early-stage, localised disease. In this country, radiation oncologist Giuseppe Sasso has pioneered the advanced therapy – which is known as stereotactic ablative radiotherapy (SABR) or stereotactic body radiotherapy (SBRT) – and has been involved in an international trial, PACE.
So far, the PACE research has been giving encouraging results.
“Our trial was incredibly successful and, when it ended, we decided to carry on offering the treatment because it’s been so well-received by patients and we’re so impressed with the outcomes,” says Sasso.
While males can lead a healthy life without a prostate, unwelcome side effects of surgery may include impotence and urinary incontinence. The PACE studies have shown that the risk of both is significantly reduced if SABR is given instead.
Since it is targeted and intense, SABR is a more convenient option than traditional external beam radiotherapy. Rather than a course of 20 treatments over four weeks, SABR requires only five treatments and there are efforts underway to reduce that further.
“That’s a lot less impact on lifestyle for patients,” says Sasso. “And the cancer control rates are also looking incredibly good.”
The results of the PACE trial showed that five-year survival rates with SABR were 95.8% and with conventional radiotherapy they were 94.6%.
“Being able to sit down with a patient and tell him that SABR will highly likely eradicate his disease effectively in five treatments and also reduce his chances of incontinence and impotence, is extremely positive,” says Sasso.
While conventional equipment can be adapted to deliver this new therapy, at Auckland Radiation Oncology, Sasso has been working with what he describes as “the Ferrari” of radiation treatments.
Equipped with the latest robotic technology, Cyberknife is fully mobile and highly accurate so it treats the cancer while minimising damage to the surrounding area, avoiding the bladder, urethra and rectum as much as possible.
The prostate moves when a patient breathes but Cyberknife is able to adjust for that movement, thanks to tiny gold markers inserted into the gland. The equipment tracks these as it delivers many thousands of mini beams of radiation.
While SABR is an effective option for those with a localised and non-aggressive form of the disease, Sasso says it can also form part of the treatment plan for cancers that have begun to spread and be used alongside drugs and hormone therapy.
Even for more advanced disease, the prospects are improving. Scientists are working on identifying the genetic fingerprints of cancer cells so they can provide tailor-made therapies.
Aside from age, a man’s risk of prostate cancer is increased if he has a family history, especially the BRCA1 and BRCA2 gene mutations, which are linked to breast and ovarian cancer.
There is also an association with high testosterone. And in the US, researchers from Stanford University have identified 22 pesticides they say are consistently linked with the incidence of prostate cancer, including 2,4-D, a herbicide used in New Zealand for weed control.
Symptoms of prostate cancer include the frequent and sudden need to urinate, particularly at night, along with difficulty and discomfort urinating, blood in urine and semen, unexplained pain in the lower back or hips and unexpected weight loss.
Urinary symptoms can also be caused by an enlarged prostate, which is common in older men and benign, so it is important to get checked. Initially this involves a blood test that looks for a protein called prostate-specific antigen. If levels of these are raised, further tests will be required.
Improved testing means the number of Kiwi men being diagnosed is increasing, but the good news is that improvements in treatments mean the death rate is dropping.
“We’re obtaining survivals that are incredible,” says Sasso. “With oligometastasis [cancer that has spread from the original tumour to a limited number of other areas in the body] patients are now living a long life.”
