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.

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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.

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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.

Interview with Dr Kateřina Dědečková on the possibilities of treatment of hematologic diseases with proton radiotherapy.

According to the latest recommendations of the International Lymphoma Radiation Oncology Group (ILROG), radiotherapy is also suitable for some patients diagnosed with leukaemia. Which patients specifically?

ILROG is very active in raising awareness on the benefits of radiation in the treatment of hematological malignancies, i.e. blood tumours. Over the past few years, ILROG has issued recommendations for the use of radiation in most haematologic cancers such as lymphomas, leukemias, myelosarcomas, myeloma, and others. For leukemias, in particular patients with central nervous system (CNS) involvement, it is now recommended to use radiation more frequently and to a greater extent.

Why is it now advisable to irradiate the central nervous system (CNS) also in patients with leukemia?

The CNS (brain and spinal cord) is separated from the bloodstream by a safety barrier, called blood–brain barrier (BBB), which prevents materials from the blood from entering the brain. Thus, some molecules, including drugs, reach the CNS with limited or no effect. For this reason, in some cases, the CNS may be a source of disease recurrence because part of the cells escapes the effect of chemotherapy or biological therapy, leading to a re-spread of cancer cells in the body.

What benefits do patients have from using proton radiotherapy?

Due to the limited possibilities of systemic treatment, irradiation of the entire CNS area is advantageous. This consists in irradiation of the brain, spinal cord, spaces where cerebrospinal fluid (CSF) circulates, craniospinal axis. The aim is also to get to the hard-to-reach leukaemia cells, as well as those that are no longer sensitive to chemotherapy or biological therapy.

Patients who benefit the most from proton radiotherapy are the ones who, despite intensive systemic treatment, have

• a positive finding of leukemic cells in the cerebrospinal fluid;
• a positive cerebrospinal fluid at the time of diagnosis;
• leukemic lesions in the brain or spinal cord.

Also, patients who are at risk of involvement of the central nervous system future.

Therefore, according to the new recommendations, these patients should preferably be irradiated in the whole area of ​​the craniospinal axis.

Is radiotherapy commonly indicated in these patients or is it a new recommendation?

Previously, because of the high toxicity, it was preferable to irradiate only the skull area. However, thanks to the use of proton radiotherapy instead of classical radiation, it is possible to reduce the adverse effects of treatment that previously impaired quality of life, such as nausea, vomiting, fatigue, swallowing pain, and aphthae in the oral cavity. Therefore, radiotherapy has not been commonly used in these patients and, if so, less extensive exposure has been used, mainly because of concerns about toxicity associated with older exposure techniques, as I have mentioned. Irradiation of the CNS as a risk area has been found to improve the outlook for cure in risk patients. According to the new ILROG recommendation, groups of patients have already been identified who will benefit from the inclusion of craniospinal axis irradiation in their treatment plan.

How does the treatment work?

The patient is placed in supine position with their arms along the body, while the head is fixed with a special thermoplastic mask. A CT scan is done over the entire irradiation range, i.e. the entire head and spine to the coccyx. These CT images then show the areas that are the target of radiation and also the areas that we want to protect from radiation, called organs at risk (OAR). Then, the doctors and physicists collaborate to carefully calculate the irradiation plan. This plan is then checked multiple times, as well as directly in the gantry to confirm its accuracy. Then, the actual treatment begins. Leukaemia is typically treated in 9 to 12 fractions (sessions), applied to the entire craniospinal axis. In some patients, we also irradiate apparent tumor deposits, up to a total of 15-18 fractions. Irradiation takes place every weekday and may be associated with mild swallowing difficulties, fatigue and a decrease in the number of blood cells.

Is there a difference if a patient is irradiated with photon or proton techniques?

Yes, the difference is that when using proton RT, the patient is less exposed to radiation. There is less irradiation to the organs in front of the tumour, minimal irradiation to lungs, heart, oesophagus, intestinal loops, kidneys, liver, bladder, which significantly reduces the possibility of late toxicity of these organs, and the patient also better tolerates irradiation of craniospinal axis.

Do you have any recent experience with this form of treatment? If so, how did the patients tolerate the treatment?

At the Proton Therapy Center in Prague we already have experience with this irradiation technique for hematological malignancies. In some of these patients, RT was the last treatment option and even here we managed to successfully destroy CNS tumor cells. From our point of view this is a very promising method of treatment, but a longer follow-up of patients and evaluation of a larger group of patients will be required.

Dr Kateřina Dědečková

In 1998-2001 Dr Dědečková worked at the radiotherapy department of the District Hospital in Jičín. Then, from 2001 to 20017, she worked at the Institute of Radiation Oncology of the University Hospital Na Bulovce. In 2009 Dr Dědečková gained specialised competence in the field of radiation oncology. Since 2012, she has been working as a radiation oncologist at the Proton Therapy Center in Prague. Since 2019, Dr Dědečková also leads the interdisciplinary Center of Excellence for Proton Radiotherapy of Malignant Lymphomas at the Proton Center in Prague.

Dr Dědečková specializes in radiation treatment of malignant lymphomas and other hematological tumours, urological tumours and head and neck tumours. She has participated in international clinical trials with independent quality control of radiotherapy (GHSG, ESTRO Equal, QARC) in the treatment of malignant lymphomas and head and neck tumours. Dr Dědečková is a member of the Council of the International Lymphoma Radiation Oncology Group (ILROG) and a member of the Lymphoma Sub-Committee of the Particle Therapy Co-Operative Group (PTCOG). Dr Dědečková publishes professional medical press and lectures at congresses, both domestically and internationally. Dr Dědečková is co-author of the “Diagnostic and Treatment Guidelines in Patients with Malignant Lymphoma” of the Lymphoma Cooperative Group (chapter on lymphoma radiotherapy). Dr Dědečková deals with new techniques of lymphoma radiotherapy, such as proton radiotherapy of mediastinal lymphomas using the pencil beam scanning technique in maximum inhalation.

Every year on 14th February millions of people celebrate Valentine’s day showing their compassion and love for the special people in their lives. When you think of how to express your love on this special day, you may think of flowers, fancy dinners, chocolate, and greeting cards, but this day might be harder to celebrate for those battling cancer. However, it is more important than ever to show your love and support during this time. Here are some ideas that may be a little more low key, but still have a big impact.

❤ Write a love note or poem – express your feelings in writing and let them know how much they mean to you.

❤ Plan an at-home movie night complete with take-away and their favourite snacks.

❤ Buy your loved one a journal so they can write down their emotions and challenges. You can also start your own journal and together write about daily topics or achievements.

❤ Help complete tasks on their to-do list. Cancer can be exhausting and your loved one may need help crossing off some items.

❤ Have a spa night – candles, lotion, face masks, essential oil and a Zen playlist will help set the atmosphere.

❤ Spend quality time with your loved one without any distractions such as electronics, live in the present.

❤ Plan a game night – try a new board game, play charades or have a small tournament with all your favourite games.

❤ Have your own private book club – is there a book you both wanted to read? Get two copies and spend the evening reading and discussing the book.

❤ Cook their favourite meal or recreate their favourite restaurant – sometimes going out can be exhausting so bring the experience to your home.

Are there any ideas that you think we should add to our list? Let us know in the comments ⬇