Radiotherapy > Prostate Cancer
Don't bury your head in the sand!
The Centre for Radiotherapy and Medical Genetics will help you to beat prostate cancer.
For the treatment of prostate cancer patients, we work closely with our colleagues at the certified Prostate Cancer Centre at Stuttgart Diakonie Clinic and the resident urologists. In the interdisciplinary tumour team at the Prostate Cancer Centre, the urologists work together with pathologists, radiologists and radiotherapists to find the best therapy concept for you. Of course, the current national and international guidelines apply.
In the event of a diagnosis of a local prostate carcinoma (=prostate cancer), there are, in principle, two treatment possibilities available to the patient: operation or radiotherapy.
Radiotherapy instead of an OP
Undesirable side effects are rare in both methods, but are quite different if they arise:
While permanent urinary incontinence and impotence can sometimes become a problem after an operation, these side effects occur far more rarely, and usually only temporarily, in radiotherapy. Instead, radiotherapy may occasionally lead to diarrhea and, in some cases, bowel or bladder inflammation.
Radiotherapy can be done on an outpatient basis and does not carry the risks associated with surgery. However, the treatment extends over a longer period of time: usually five days per week for about seven to eight weeks. During this time, it is important to avoid very gassy and spicy foods.
Even after the operative removal of the prostate, additional postoperative radiotherapy must be carried out in some cases in order to completely kill remaining tumour cells. Also, even the recurrence of a prostate carcinoma can often be treated well by radiotherapy.
We give radiotherapy to all prostate patients using the modern VMAT technique: Here, the radiation source rotates once or twice around the patient. This latest intensity-modulated radiotherapy technique not only helps to adjust the dosage even more precisely to the target volume and thus to better protect risk areas, such as bladder and rectum; It also reduces the total amount of radiotherapy time to only one to three minutes per day.
In order to keep the bladder and small intestine from the irradiation area, it is necessary to have a well-filled bladder for receiving the radiotherapy. For this purpose, the patient should drink approx. 700 to 1,000 ml from about an hour before his radiotherapy appointment. Each patient will receive an information leaflet at the first consultation in our outpatient clinic.
The optimal bladder and intestine filling as well as the correct position of the prostate in the irradiation field are regularly controlled by means of a 'ConeBeam-CT' directly on the radiotherapy device (IGRT: image-guided radiotherapy). If necessary, patient repositioning can be fully automated in millimetres.
In order to be able to take into account the slight daily change in the position of the prostate as a result of fluctuating intestinal and bladder filling when planning radiotherapy, we perform three CT examinations on three consecutive days before the radiation therapy begins and record the contours of the prostate, bladder and rectum in each individual CT scan.
On this basis, a target volume is then prepared and the dose distribution is optimised in such a way that the tumour can be safely targetted every day (Tübinger concept).
From the beginning of 2015, prostate patients have also been given radiotherapy with the FFF technique (flattening filter-free): This technique significantly decreases the amount of scattered and leaky radiation, so that the radiation exposure outside the directly irradiated body area can be significantly reduced once again.
As the first radiotherapy in Stuttgart and the surrounding area, we offer an additional treatment method: it consists of injecting a gel-filled spacer (SpaceOAR ™ gel) between the rectum and the prostate. This keeps the rectum away from the high dose area, therefore helping to avoid side effects in the rectum.
(Mariados et al., Int J Radiat Oncol Biol Phys., 2015 Aug. 1, 92 (5): 971-7; Pinkawa et al., Radiother Oncol, 2011 Sep; 100 (3): 436-41).
The gel is injected into the perineal area before the start of radiotherapy by a very experienced urologist working at o our prostate centre, under ultrasound control. It remains in the same place throughout the several weeks of radiotherapy, and is thereafter slowly decomposed by the body.
(For more information about SpaceOAR click here).
We would be happy to advise you as to whether this treatment is appropriate in your particular case, and exactly how this treatment is carried out.