Can healthy tissue be protected during prostate cancer radiation therapy?

Researchers at Upstate are studying a new system designed to reduce the amount of radiation a man‘s healthy tissue is exposed to during radiation therapy to treat prostate cancer.

Radiation therapy uses high-energy X-rays to kill cancer cells, but even though advanced techniques make the radiation more focused, there is still a risk of damaging normal tissue. The prostate gland sits like a donut in front of the rectum and beneath the bladder, with the urethra going through the gland.

The new system, called SpaceOAR, uses an injectable gel to add space between the prostate and the rectum, to protect the normal healthy tissue of the rectum. When the gel is injected, three markers are placed into the prostate. The markers show up on X-ray, so even if the prostate moves, the radiation therapy can be targeted properly. Men undergo 43 to 45 sessions, each lasting 10 to 15 minutes.

Men involved in the study will get intensity modulated radiotherapy with image guidance and have the option of being treated with Helical Tomotherapy or Varian‘s RapidArc technology.

“Radiation to the prostate is very effective. There is a lot of information that shows even long term the likelihood of eliminating the cancer is quite similar for many patients whether they chose to have surgery or radiation therapy. That being said, there is some difference with the side effect profile, and our goal is to use the most advanced technology to further reduce the risk of side effects,”said Jeffrey Bogart MD, a professor of radiation oncology and urology who leads Upstate‘s Department of Radiation Oncology and directs the prostate cancer program.

The study is for men with early stage prostate cancer that is confined to the prostate gland, who are considering radiation therapy. To learn more about the study, call 315-464-5262 or email project coordinator Dena Martin at [email protected]

Upstate is one of 20 hospitals in the United States participating in the SpaceOAR study.

Immunotherapy option for some men with prostate cancer

A new method of treating prostate cancer using a patient‘s own white blood cells is available at Upstate. Provenge may extend a man‘s life by several months.

“It‘s a modest improvement in terms of survival for the patients,” said Bernard Poiesz MD, chief of Upstate‘s Hematology and Oncology division and the Regional Oncology Center. Provenge does not shrink tumors or reduce levels of a man‘s prostate-specific antigen, PSA. Rather, the immunotherapy is designed to harness the body‘s immune cells to attack the prostate cancer cells.

The Food and Drug Administration approved Provenge in 2010, but it was only available in a handful of hospitals. Now Upstate offers the therapy. Poiesz said the first patient is doing well.

“The actual collection of the peripheral blood dendritic cells is done at the Red Cross,” he said. The cells are shipped to Dendreon, a biotechnology company in New Jersey, where the patient‘s personal dose is manufactured and shipped to Upstate, where the patient is infused.

Poiesz said the first step is obtaining approval by the patient‘s insurance company. Because Provenge is FDA approved, most insurance plans cover it, but because it costs about $90,000 for three doses, patient copay amounts can be considerable. Then, Dendreon must agree that the patient is suitable for immunotherapy.

Patients who are likely to see the most benefit from Provenge are men whose prostate cancer has spread beyond the prostate gland but whose symptoms are minimal. Their immune system must be functioning. They have to be on hormone therapy, with rising PSA levels, and they cannot be taking narcotics for pain relief.

Poiesz said this approach is promising and that future research will look at the value of giving Provenge to men soon after diagnosis, or pairing it with other immune system modulators.

“This is fairly time-consuming research. It‘s not easy to get quick answers,” he said.