Frequently asked questions
Prostate disease and possible therapy solutions could be difficult to understand as the medical terminology, many times, is technical and require previous knowledge in the field. We hope this short glossary of explanations will help to facilitate the communication with your physician.
List of words and radiotherapy expressions
Brachytherapy (sometimes called internal radiation) is a procedure that involves placing radioactive material inside target organ.
Brachytherapy allows doctors to deliver higher doses of radiation to more specific areas of the body, compared with the conventional form of external beam radiation .
Brachytherapy may cause fewer side effects than does external beam radiation, and the overall treatment time is usually shorter with brachytherapy.
Chemotherapy is not a standard treatment for early prostate cancer. Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn´t working. Research has also shown that it may work in combination with hormone therapy.
Difficulties to empty the bladder, weak urinary tract or need to urinate very often can be an indication of age-related prostate congestion. Prostatic hyperplasia is the most common disease among elderly men and every second man over 50 is affected, but only half of them suffer from the prostate enlargement. Approximately 30% will need active treatment sometime.
External Radiation Therapy (RT)
Therapies using irradiation from cobalt sources or beams generated by a linear- or proton accelerator. The most common therapy is external beam therapy delivered every weekday during a period of six to eight weeks with a linac. Beams are delivered from different angles into the prostate so the healthy tissue gets as little irradiation as possible. The concentration of the beams at the tumour will destroy a little of the cancerous tissue each day while healthy tissue will be able to recover before the next day´s treatment is given.
Standard fractionated RT treatment is divided into fractions over a period of time which is usually six weeks. Hypofractionated radiation therapy, when the fractions are delivered during one-week time, has been winning terrain as tools have been developed to localise the target position in real time
Hormone treatment is mainly used for patients with proliferated prostate cancer. The intention is to knock out the male hormone testosterone that almost all prostate tumours need to grow. The aim is to shrink the cancer and slow its growth so that the patient’s life is prolonged and the quality of life is expected to rise.
Hypofractionation is a treatment plan of a short period of time, typically five days. This may be used when the target is very precisely defined and can be followed in real time. The dose is then increased to compensate for the shortage of treatment time.
Organs of the bodies are moving a little all the time. Breathing is changing the breast volume very visible but you do not see movement of the prostate although it may move with several centimetres over a relatively short period. Ultrasound and Magnetic Resonance Imaging(MRI) are the most common tools to locate the prostate before the treatment start but this does not guarantee that the position of the prostate is at the same place at the days of treatment. Ray Pilot solves this problem as the receiver follows the prostate movement all the time showing the real-time position of the organ. This is tracked without any imaging devise so radiation in reduced to zero.
Intensity-modulated radiation therapy (IMRT)
IMRT an advanced mode of high-precision radiotherapy to a malignant tumor or specific areas within the tumor. IMRT conform more precisely to the 3D-shape of the tumor by modulating the intensity of the radiation beam. IMRT may deliver higher focused radiation doses within the tumor while minimizing the dose to surrounding normal critical structures.
Internal radiation therapy
Internal radiation therapy is a treatment in which a source of radiation is put inside the patient´s body. The radiation source can be solid or liquid.
Internal radiation therapy with a liquid source is called systemic therapy. Internal radiation therapy with a solid source as seeds, ribbons, or capsules is called brachytherapy.
Linac or linear accelerator
A linear accelerator shortened linac produce a reliable, flexible and accurate radiation beam used to treat both benign and malignant disease. The beam consists of accelerated charged elemental particles (electrons, protons, ions). The particles are accelerated to high energies by an alternating voltage produced by electrodes along the acceleration tube.
A linac can also be named External Beam Radiation Therapy (EBRT)
Palliative vs Curative
Curative means that the disease is cured and nothing remains. Palliative is to alleviate symptoms from an incurable disease.
- PSA Test
In the western World, elderly men are normally surveyed with a PSA test, which may give an indication for enlarged prostate. This is a simple blood sample that shows if the Prostate-Specific Antigen (PSA) produced by the cells of the prostate gland has increased. This value elevates with age and if the PSA-value is higher than the recommended value for the patients age, further examination may be recommended. Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cut-off for concern about the risk of prostate cancer. As the prostate cancer is slow growing the decision is often wait and see.
- Rectal examination
A physician makes a rectal examination, which means palpating the prostate and investigating any enlargement or physical change. The patient´s symptoms are evaluated with a Scoreett test which contains 7 questions where each question can yield between 0 and 5 points. If the total score is above 8 further examination are normally performed.
- Ultrasound and Biopsy
When PSA test and the rectal examination has shown indications of prostate cancer a biopsy may be taken of the prostate. A biopsy is a tissue sample that is taken from the prostate with a needle inserted into the prostate. It is done with local anaesthesia. An ultrasound test is also normally performed to see if the prostate is enlarged. Ultrasound is a fully non-invasive instrument that transmits waves that are reflected back to the sensor giving an image of the organs inside the body.
Invasive procedure with open or keyhole surgery under anaesthesia. Both the prostate and seminal vesicles are normally removed to prevent the cancerous tumour from spreading. Number of days in the hospital depends on methods used. The recovery time depends on the operating technique used and it is common with a sick leave of approximately four weeks. Urinary leakage is common but is remedied with drip protection. There is also a risk of becoming impotent after surgery. If the doctor can preserve the nerve threads that pass the prostate gland the chance of retaining that ability increases
A linac delivers an X-rays in daily small doses called fractions with rest periods between, so healthy cells can recover before the next dose is given the day after. Each fraction is measured and expressed in Grey (Gy). Fractions are normally delivered over a period of six weeks. Hypofractionation is a treatment plan of a short period of time, typically five days. This may be used when the target is very precisely defined and can be followed in real time. The dose is also increased to compensate for the shortage of treatment time.
RayPilot HypoCath procedure
The RayPilot HypoCath’s transmitter is positioned at the prostate with an easy urinary catheter procedure. The transmitter stays in place during the whole treatment period, which may be five days to six weeks depending on the clinic´s therapy programme. When the sessions are over the catheter can easily be removed. Nothing remains in the body. The catheter does not hinder any social life or limitations on driving etc.