Prostate cancer is one of the most common forms of cancer affecting men. The most recent EU-wide figures (for 2020) showed it accounted for 23 per cent of cancer diagnoses in men, while data for the UK between 2017 and 2019 put the figure at 28 per cent.

There are some significant demographic variations. For instance, the disease is most likely to affect men in their late 70s, while there are also racial differences, with black men at the greatest risk and Asian men at higher risk than their white counterparts.

New Discovery Highlights Genetic Risk

A further discovery has highlighted how some men may be at a particularly high risk for genetic reasons. The Institute for Cancer Research in London has found that men with mutations in the BRCA1 or BRCA2 genes are at an elevated risk of getting the disease.

This led to the institute calling for changes in UK prostate screening guidelines to ensure that all men aged over 40 with these mutations are given regular screening to increase the chances of an early diagnosis.

The findings were presented at the annual congress of the European Society for Medical Oncology. It marks a shift from the previous findings from the same institute, which had already identified mutations in the BRCA2 gene as a sign of increased risk, with sufficient evidence now available to add mutations in the BRCA1 gene to the high-risk category.

Treating Prostate Cancer

As with any type of cancer, an earlier diagnosis can make treatment easier. However, whether the diagnosis is early or late, radiotherapy will commonly be used.

While earlier detection typically broadens treatment options and improves outcomes, radiotherapy remains a principal treatment for prostate cancer across different stages.

Our private radiotherapy centre can offer different methods of delivering this, in accordance with each patient’s circumstances.

Because prostate cancer is so common, there is a lot of knowledge and treatment about how to tackle it. However, as can be seen above, research is ongoing on a large scale and more is being learned all the time. This means that new means of treating the disease emerge frequently, whether entirely new or a fine-tuning of existing methods.

In the case of radiotherapy, the latter applies, as radiotherapy as a treatment for prostate cancer has a long history. It may be used on its own, or in combination with other treatments such as surgery to remove the tumour or even the whole prostate, as well as chemotherapy.

There are two main methods of treating prostate cancer through radiotherapy, which are external beam radiotherapy and brachytherapy.

External Beam Therapy

In the first case, this involves beams of radiation being aimed at the affected area using a machine to direct them. The most precise form of external beam radiotherapy is known as stereotactic radiotherapy, which seeks to target very specific, small areas. That is something that can be done when the cancer is very localised, such as after an early diagnosis.

The benefit of stereotactic radiotherapy is that it can concentrate the radiation very closely on a small area to target the cancer effectively while minimising exposure for the surrounding tissue.

For this reason, less concentrated radiotherapy may be more likely to be used in the event of secondary cancer occurring, which spreads beyond the prostate into surrounding areas and therefore warrants the delivery of a wider dose of radiation across a less restricted area.

The Use Of Brachytherapy

The other main treatment method is Brachytherapy. This involves placing a small seed of radioactive material under the skin in or near the affected area, where it will deliver radiotherapy. This means it is delivering this constantly rather than in specific sessions at one of our radiotherapy centres.

In the case of brachytherapy, multiple ‘seeds’ of material, around the size of a grain of rice, are used, with the number varying according to the size of the tumour.

If it proves possible to use radiotherapy alone without resort to surgery, this can produce better outcomes for the patient. Common problems for those who undergo surgery include losing the ability to get and sustain erections and urinary leakage.

Side Effects Of Radiotherapy

As with radiotherapy for any form of cancer, there are side effects to consider. These commonly include tiredness and fatigue, skin soreness, a loss of appetite, bowel and urinary issues, and sexual side-effects (including erectile dysfunction).

The minimisation of exposure for healthy tissue near affected areas, reducing symptoms, is one of the benefits of stereotactic radiotherapy.

However, the right kind of radiotherapy treatment, along with other treatments, will depend on the circumstances of each patient. What we will always do is ensure that you get the best treatment for your own situation.

Learn more about our advanced radiotherapy treatments for prostate cancer on the Amethyst Group website.

The value of radiotherapy treatment for cancer has grown exponentially over the years. When it was first used in the early 20^th century, its effects were merely palliative and while that is still a use for it today, there is now so much more that can be achieved, with some patients making a full recovery and being able to live cancer-free.

Advances have come from three sources. Firstly, this came through a better understanding of radiation itself. Secondly, through the development of ever more sophisticated devices, which have been able to deliver doses of radiotherapy with greater precision both in terms of the amount of radiation given and the accuracy of it.

A third area of advancement has been the use of studies to establish how particular uses of radiotherapy in certain situations may be effective in bringing about better patient outcomes.

The impact of this aspect may be more incremental than the other two, and some discoveries relate only to specific circumstances, but each such advance will benefit many patients.

The latter case may be particularly useful when treating secondary cancer, as by its very nature it is often unpredictable; once a cancer spreads beyond its area of origin, the treatment will need to be tailored according to where else in the body the cancer starts to manifest itself.

A Pelvic Relapse Breakthrough

A recent example of research that can advance treatment for secondary cancer was presented at the recent annual meeting of the American Society for Radiation Oncology (ASTRO).

It relates to the use of radiotherapy in the wake of surgery for bladder cancer and its effect in preventing the recurrence of muscle-invasive secondary cancer in the pelvic region.

The Phase III  Bladder Adjuvant RadioTherapy (BART) study, which was carried out at hospitals across India, found that the use of adjuvant radiotherapy for patients who had undergone surgery to remove their bladder had greatly reduced instances of postoperative secondary cancer in the pelvis.

This was achieved with acceptable toxicity and no unexpected safety signals for patients.

In the study, the group undergoing the adjuvant radiotherapy only experienced muscle-invasive secondary cancer in eight per cent of cases, compared with 26 per cent for a control group without the therapy.

The Significance Of The Findings

Speaking about the findings, principal investigator for the trial Dr Vedang Murthy, a professor of oncology based at the Tata Memorial Hospital in Mumbai, said: “This is one of the first studies and the largest randomised trial to show that post-operative radiation therapy can meaningfully reduce pelvic relapses in bladder cancer.”

Noting that “pelvic relapse can be devastating for patients – extremely painful and almost impossible to treat,” he added: “Our research shows that modern radiation therapy offers a safe way to prevent many of these recurrences and improve patients’ quality of life.”

The significance of this particular piece of research is twofold. Firstly, this is one of the more predictable forms of secondary cancer. In the US, around a third of patients with bladder cancer suffer secondary cancer due to tumours growing beyond the lining of the bladder into the muscle wall and invading the muscles of the surrounding area.

That means this research is not likely to be a ‘niche’ discovery that will only benefit a few patients, but become a common treatment that will help as many as a third of bladder cancer sufferers.

Multiple Ways Of Using Radiotherapy

A second important fact to note is the role of adjuvant radiotherapy. Some patients might imagine radiotherapy is either to attack the primary cancer that they were first diagnosed with, or to fight a secondary cancer after it has developed.

However, this use of radiotherapy is a prime example of a third method of use, acting as an effective preventative measure against recurrent secondary cancer.

Discoveries of this kind help radiation oncologists to offer a wider range of treatments to patients at various stages of their patient journey, improving the prospects of better outcomes.

Other Radiotherapy Advances For Secondary Cancer

This research was far from the only new research presented to the ASTRO meeting about the effectiveness of treatments in helping to fight secondary cancer.

For example, a trial by the University of California in Los Angeles revealed that a combination of stereotactic radiotherapy for limited metastatic prostate cancer could be made more effective when combined with a radiopharmaceutical, a drug that adds radiation to a ligand, a molecule that attaches itself to cancer proteins throughout the body.

The use of radiotherapy will continue to become more precisely calibrated, either on its own or in combination with other treatments. We may be able to bring the latest techniques and technology to bear on your condition, providing the best treatment available to you to seek an optimal outcome.

Learn more about our advanced radiotherapy treatments for secondary cancers on the Amethyst Group website.

A cancer diagnosis is a major event in the life of any patient and the response needs to involve both medical and personal support, with an important combination of the two coming through each patient being provided with plenty of information and understanding about their treatment options.

Most patients will have limited knowledge of cancer at the outset, particularly if the particular kind with which they have been diagnosed is among the less common types, but it is also important to be aware of how situations can change.

In particular, there is the distinction between primary and secondary cancer, which has major implications both for the prognosis and the kind of treatment options that may be most suitable. This can include changes to the way that radiotherapy treatment may be given.

Secondary Cancer Explained

Every cancer starts off as a primary cancer, with the disease arising in a particular part of the body. Common examples include the brain, lungs, breast, colon, prostate and skin.

Secondary cancer is what occurs when the primary cancer spreads beyond the area where it has started into other parts of the body, a process known as metastasis. This happens when cancer cells break away and spread through the blood or lymphatic system.

Occasionally, a form of cancer known as cancer of unknown primary can occur, where a diagnosis of secondary cancer has taken place and it is not clear where it started as a primary cancer.

This may occur because the original cancer was very small, while the secondary cancer has grown quickly. Occasionally, the immune system successfully attacks the primary cancer while the secondary one starts to spread.

Late diagnosis is not the reason for a cancer of unknown primary, as in most cases, the location of origin can still be easily identified, since the cancer is very prominent there. For instance, a malignant brain tumour will still be present even after metastasis.

Causes Of Metastasis

How metastasis occurs is still a matter of debate and a topic of much research. For instance, a recent paper produced by the University of Texas MD Anderson Cancer Centre has indicated a possible link between the consumption of added sugars in soft drinks and fruit juices and metastasis from colorectal cancer.

If this finding is corroborated by further research, this may help reduce such instances by making the abstinence from such drinks an imperative for those diagnosed with primary colorectal cancers.

However, this link, if proven, may have little or no relevance to other cancers. Medical science is still a very long way from being able to prevent metastasis.

Radiotherapy Options

Secondary cancer often means new treatment approaches are required, not least when it comes to radiotherapy.

For some primary cancers, radiotherapy can be very precisely directed, a technique known as stereotactic radiotherapy. This will use very precise beams of intense radiation to target specific locations, such as a tumour, while minimising exposure to surrounding tissue.

However, in the case of secondary cancer, a different form of radiotherapy may be required.

It is not simply a case of undergoing full-body radiotherapy, as if the best approach would be to treat the entire anatomy. Metastatic cancer does not suddenly affect the entire body, but spreads from one part to another.

For example, metastatic breast cancer may migrate to the bones, with treatment being given to the affected area.

If the metastasis takes the cancer to areas close to or touching sensitive organs or the brain, stereotactic radiotherapy may be used. In other instances, internal radiotherapy may be given. This is where the radioactive material is put in an implant that is inserted into the body close to the affected area.

The aim of such treatment is fundamentally the same as with primary cancer, aiming to shrink tumours and prevent the cancer spreading by using radiation to disrupt the DNA of cancer cells, which damages their ability to reproduce and multiply.

Internal radiotherapy may be used, particularly for conditions like metastatic bone pain and metastases to the liver. While it’s not a common treatment for all types of metastasis, its use is growing for specific applications.

What To Expect

In the most favourable cases, this can ultimately lead to a patient winning their battle against cancer and ultimately becoming cancer-free. When this is not the case, it can still extend life and, in palliative care settings, reduce discomfort.

If you have been unhappy with your treatment so far and are seeking private radiotherapy, the progression of cancer from primary to secondary will pose new challenges. However, we can offer a combination of leading expertise, the most advanced technology and a personalised approach to care that will ensure the treatment is tailored to your needs.

Not only will this be undertaken with the aim of providing the best patient outcomes, but to ensure that you are involved, informed and feel confident you are getting the best care at every stage in the process.

At Amethyst Radiotherapy, we plan metastatic care with a multidisciplinary team and deliver SBRT/SRS, VMAT/IMRT and image-guided radiotherapy to target secondary lesions precisely while sparing healthy tissue.

Learn more about our advanced radiotherapy for metastatic cancer on the Amethyst Group website.