Info on High Dose Radiation

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Regular Member

Date Joined Apr 2008
Total Posts : 364
   Posted 3/18/2010 7:29 AM (GMT -6)   
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Higher Radiation Dose Reduces "Biochemical Recurrence" of Prostate Cancer

Key Words

Prostate cancer, high-dose radiation, conformal radiotherapy. (Definitions of many terms related to cancer can be found in the Dictionary.)


After nearly nine years of follow-up, men with early-stage prostate cancer who received higher doses of radiation were less likely than men who received the conventional dose to have rising levels of prostate-specific antigen (PSA)—a phenomenon referred to as “biochemical recurrence” that may predict actual recurrence 15 years or more in the future. The benefit associated with a higher dose of radiation was most evident in men with a low risk of recurrence.


Journal of Clinical Oncology, published online ahead of print, February 1, 2010 (see the journal abstract).


Most cases of prostate cancer now diagnosed in the United States are detected at an early stage. One of the treatment options for men with early-stage prostate cancer is radiation to kill the tumor cells (radiotherapy).

Even after radiation treatment, however, prostate cancer can come back (recur). Several studies have shown that higher doses of radiation make recurrence less likely, although they increase the risk of some side effects, including intestinal problems and difficulty with erections and urination.

Studies of patients with advanced prostate cancer have suggested that “conformal” radiation therapy techniques might allow radiologists to safely deliver higher doses of radiation and, thus, cut down on recurrences. Conformal techniques produce tight three-dimensional radiation fields, leaving more of the normal tissue untouched. The tighter targeting is also thought to permit the safe delivery of greater amounts of radiation. Conformal radiation therapy may be delivered by high-energy x-rays (photon-beam radiation) or protons (proton-beam radiation).

The phase III trial described here was designed to test whether giving higher-than-conventional doses of radiation with conformal radiation techniques would improve prostate cancer control in patients with early-stage disease. Results after a median follow-up period of five years were published in 2005. In the current publication, researchers report results after median follow-up of nearly nine years.

The Study

Between January 1996 and December 1999, researchers at Loma Linda University Medical Center (California) and Massachusetts General Hospital (Boston) enrolled 393 patients with stage II prostate cancer that had not spread (metastasized) beyond the prostate gland. All of the patients were treated with both photon- and proton-beam conformal radiation techniques: 197 patients received a total dose of 70.2 Gy, which is the conventional amount, and 195 received a total dose of 79.2 Gy. The patients’ median age was 67 in the group receiving conventional doses and 66 in the group receiving high doses. Most of the patients were white.

While they were receiving radiation, patients underwent no other treatment (including hormone therapy) for their cancer. Researchers followed them for a median of 8.9 years, periodically testing the patients’ prostate-specific antigen (PSA) levels and examining their prostates. Biopsies were performed in some cases to test for local recurrence. Researchers asked the patients’ doctors about the severity and number of side effects.

Since the design of this trial in 1995, researchers have developed ways to categorize men according to the risk that their prostate cancer will recur. According to these categories, 227 (58%) of the men enrolled in the study had a low risk of recurrence, 144 (37%) had an intermediate risk, and 17 (4%) had a high risk.

The lead author of the study is Anthony L. Zietman, M.D., of Harvard Medical School and Massachusetts General Hospital.


Men treated with the higher radiation dose were more likely to be free from biochemical recurrence (measured by a rising PSA level) than men who received the conventional dose. Biochemical recurrence was seen in 32 percent of the men in the conventional-dose arm but only 17 percent of those in the high-dose arm. When the men were analyzed separately according to risk group, a statistically significant long-term advantage of higher-dose radiation therapy was seen only in patients with a low risk of recurrence, although there was some evidence of benefit for men of intermediate risk.

Few men reported serious side effects such as intestinal problems or difficulty with erections, and the numbers of men reporting such side effects were about the same in both the conventional and high-dose treatment groups.

Overall survival was similar in the two treatment groups.


Unlike some other studies of high-dose radiation for prostate cancer, which used photon radiation only, radiation in this study was delivered using both photon and proton beams. However, it was the dose of radiation that was compared and not the radiation source.

“The design of the current study does not allow one to draw any inference about the efficacy of proton [radiation] therapy vis-a-vis photon [radiation] therapy,” writes W. Robert Lee, M.D., of Duke University Medical Center, in an accompanying editorial.

The trial also did not show an improvement in overall survival with the higher dose of radiation. Longer follow-up times may be necessary to show an improvement in this outcome.

Finally, the trial was not designed to assess outcomes according to the participants’ predicted risk of recurrence. Therefore, the differences among risk groups will need to be confirmed in future studies.


The findings of this randomized clinical trial are consistent with a trend already well established in the United States toward the use of higher radiation doses in the treatment of early-stage prostate cancer, says Aradhana Kaushal, M.D., of NCI’s Radiation Oncology Branch.

However, in this study only patients at low risk of recurrence showed a statistically significant biochemical benefit from high-dose radiation therapy at this follow-up time, Dr. Kaushal notes. Moreover, for some patients with low-risk prostate cancer, active surveillance—closely monitoring a patient’s condition but holding off on treatment until symptoms appear or test results show that the cancer is changing—may be an equally viable option.

“Active surveillance needs to be on physicians’ minds when they counsel patients about potential treatment options,” says Dr. Kaushal. “It should definitely be at least one of the considerations in older men who have certain types of low-risk prostate cancer and other coexisting health problems thought this was interesting, a fairly significant difference in results

 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 3/18/2010 8:55 AM (GMT -6)   
Dr. Jeff Forman (whom used to be at Karmanos Cancer Inst.-also where DMC-Detroit Medical Center is and affilated with Wayne State Univeristy group), is a pioneer in using (in selected patients whom saw the choice offered), 2-machines separately and two rays used and published his own patients findings over a period of years, the ones whom got Neutron(Cylcotron machine)perhaps 10 sessions followed by Photon(IMRT machine) perhaps 24 sessions, thereafter had better survival and/or time to recurrance. Neutron ray is rarer than Proton as you have to have a huge Cyclotron machine available, maybe 3 total in the USA right now. Also you need a doc skilled at using this ray, which is more powerful and works little differently than Proton or Photon rays. Dr. Strum talks about these rays and how they work and comparison data in his book A Primer on Prostate Cancer, so it is interesting indeed as what is out there. If a patient is considering radiation as his first and primary overall treatment and has excluded brachy seeds for some reason, look closely at your radiation choices and in your case you may need or wish to get the more potent protocol or even highest doseage on IMRT (photon). Costs of these protocols is expensive and is something else to look at, if you have excellent insurance probably no problema mi amigo.
Alot of things for patients to consider even in salvage therapies, ask alot of questions that may help you.

Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 3/18/2010 7:58:48 AM (GMT-6)

New Member

Date Joined Oct 2009
Total Posts : 13
   Posted 3/18/2010 10:07 PM (GMT -6)   
Another form of high-dose radiotherapy is interstitial brachytherapy, which involves the introduction of high doses of radiation directly to the site of the cancers through a set of catheters introduced to the prostate through the perineum. I had this procedure done over the course of six days in early 2006, and after about 10 days, had absolutely no classic radiation symptoms. My PSA score came down very quickly and as of today, is below .1. Dr. Jeffrey Demanes, who is now at UCLA, is one of the leading practioners of this treatment, but I know there are other doctors and treatment centers in the U.S. offering this form of treatment.

57 Now
Age 54 at DX.  Gleason 6, PSA 4.2, a .78 rise in one year. 
Had High Dose rate brachytherapy at California Endocurie Therapy Center in Oakland, CA in February of '06.  Very successful - PSA came down quickly and steadily to current .08.  No problems.
Developed flow restriction in summer of '08 - had bladder neck resection in March of '09 - immediately incontinent, immediately in severe and constant pain, ultimately left job because I could not function because of pain and incontinence.
Started hyperbaric oxygen therapy (HBOT) three weeks ago - pain virtually gone, blood in urine down to "trace" levels, still pretty leaky.  HBOT has been a godsend with respect to reducing the pain! 
Considering sling procedure to get control of leakage. 

Regular Member

Date Joined Dec 2009
Total Posts : 214
   Posted 3/19/2010 6:55 AM (GMT -6)   
Thanks for an informative article.

Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
Next PSA May
Next doctor's visit in 6 months      

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