MRIdian radiotherapy for prostate cancer
The latest game-changing treatment for prostate cancer
We provide specialist cancer care that focuses on innovating the latest, evidence-based treatments from around the world. We are proud to be the first healthcare provider in the UK to introduce the MRIdian MR linac. This smart radiation technology combines high-resolution magnetic resonance imaging (MRI) techniques with extremely precise radiotherapy beams that can treat tumours more accurately than conventional radiotherapy. This type of radiotherapy is called MRI-guided radiotherapy.
The MRIdian is considered ground-breaking because it is able to turn on the radiation beam only when the tumour is positioned precisely in the treatment window and turn off the beam in an instant if the tumour moves even by a fraction – helping to protect normal tissue from unnecessary radiation exposure. No other radiotherapy technology in the UK is currently able to achieve this.
Benefits of the MRIdian for prostate cancer
The MRIdian provides a type of radiotherapy called stereotactic ablative radiotherapy (SABR), which is often used for prostate cancer. However, unlike conventional SABR, MRIdian has the advantage that it can see and adjust for every movement during treatment.
The MRIdian shows the exact position and shape of your tumour while your treatment is happening, and if your tumour temporarily moves slightly out of position, such as if gas moves through your bowel and rectum, your treatment will automatically pause. This helps to protect your healthy tissues from damage.
With conventional radiotherapy, you may need up to 37 treatments. But with MRIdian, the radiation is much more focused and you’ll only need five treatments. This type of radiotherapy is sometimes called stereotactic ablative radiotherapy (SABR) and is often used for prostate cancer, although not all patient’s prostate cancers are suitable to be treated this way.
The exceptional accuracy of the MRIdian means that the radiation beam is less likely to damage surrounding healthy tissue than with conventional radiotherapy. If healthy tissue is damaged, side effects may occur which can be short term or longer lasting.
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Radiotherapy for prostate cancer treatment
Radiotherapy is often preferred over surgery for prostate cancer as a less invasive treatment option and provides similar rates of cure. Having radiotherapy on the MRIdian may be suitable for you if your prostate is not too large and your urinary symptoms are not particularly troublesome. As each treatment can take over an hour, you must be comfortable lying within the MRIdian while holding your urine in for that length of time.
You may also be able to have radiotherapy on the MRIdian if you’ve already had radiotherapy to your prostate. You can find out more prostate re-irradiation here.
Your consultant will discuss your prostate cancer diagnosis, treatments to date and overall health with a multidisciplinary team of oncologists (doctors who specialise in cancer) and urologists (surgeons who specialise in urology conditions, including prostate cancer) to decide if this treatment is right for you. By working together, they’ll create a personalised treatment plan that may include radiotherapy, surgery and/or drug treatments. If they recommend that MRIdian is the best option for you, your oncologist will explain the treatment in detail to you and provide you with written information about what to expect, as well as give you plenty of opportunity to ask questions.
The MRIdian is just one of a number of treatment options that GenesisCare offer for prostate cancer. Having your treatment at GenesisCare also means access to integrated cancer care, such as psychological support and wellbeing services, which have been shown to reduce the burden of cancer and improve your quality of life outcomes after treatment.
This is our commitment to offer world-class care to every patient with cancer.
What are the side effects of prostate radiotherapy with the MRIdian?
Both surgery and radiotherapy carry risks of damage to the surrounding organs including incontinence, impotence and diarrhoea. The precision of MRIdian radiotherapy means you can expect these side effects to be reduced. A study from VU University Medical Centre in Amsterdam showed a low occurrence of bowel and urinary side effects in patient-reported and clinician-reported outcomes (1).
With MRIdian, side effects are fewer and less severe than with conventional radiotherapy. However, you may still experience some of the following side effects.
- Bruynzeel A, Tetar S, Oei S, Senan S, Haasbeek C, Spoelstra F et al. A Prospective Single-Arm Phase 2 Study of Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy for Prostate Cancer: Early Toxicity Results. International Journal of Radiation Oncology Biology Physics. 2019;105(5):1086-1094.
You may experience these during your treatment course, but they’ll usually disappear within three to four weeks:
- Discomfort on passing urine
- Needing to pass urine urgently
- Loose and frequent bowel movements
- Feeling tired
These may last years and include difficulty getting or maintaining an erection. In addition, you may rarely experience:
- Narrowing of the urethra, the tube that carries urine out of your body, making it difficult to pass urine
- Persistent bleeding from your back passage
It’s important that you attend your follow-up appointments so we can identify and treat any problems as soon as possible. Your consultants and radiographers can also provide advice about things you can try to help, and no question is too small if you have any queries or concerns.
We know that living with cancer can be challenging. That’s why you’ll also be offered support through life-changing therapies, such as exercise medicine, psychological support and wellbeing therapies. These are provided to all patients at no extra cost to you or your insurer, to help you manage the side effects of treatment and symptoms of cancer.
What does MRIdian treatment involve?
Here is an outline of what to expect after your initial consultation and before, during and after your treatment. There are four stages to the process: your planning appointment, planning, treatment and follow-up. Before your first appointment, your care team will call you to explain any preparation instructions in advance of your appointments and to answer any questions.
The appointment will last for two to three hours and will involve a magnetic resonance imaging (MRI) scan on the MRIdian and a computerised tomography (CT) scan.
It will involve the following steps:
- Your radiographer will explain the process to you and ask you to fill in a safety questionnaire
- You’ll be asked to change into a gown and remove any metal objects such as jewellery, hearing aids, glasses or dentures
- In the treatment room, you’ll lie on a couch where you’ll be placed in position. The radiographer will make some temporary markings on your skin
- Soft pads – called coils – will be placed over your pelvis; these help us to produce high-quality MRI images
- Before your scan, we’ll fit you with earphones so you can listen to music rather than the noise of the scanner. During the scan, which will last for around 20 to 30 minutes, you’ll be able to speak to us through an intercom
- You’ll go to a different room for your CT scan. This scan is much quicker, lasting around five to ten minutes. You’ll be placed in the same position as for your MRI scan
- After your scans, you can go home
Over the next week, your consultant and care team will work together to create a MRIdian radiotherapy plan that is specific to you. We use advanced computer technology to do this.
Each day your treatment team will ask you to drink some water so that your bladder feels approximately half full. We’ll also carry out many of the same steps at treatment as we did at planning, such as removing accessories and changing clothes. Your treatment will take 45-60 minutes and you will not be allowed to empty your bladder during this time. We will talk to you regularly throughout your treatment and you can talk to us through an intercom.
Before each treatment session, you’ll have a new MRI scan which will be compared with your planning scans. Any movements of your tumour and internal organs will be taken into account and your treatment plan will be carefully adjusted and optimised to account for these changes. Sometimes you may feel the couch that you are lying on move slightly; this is just the treatment team placing you in the perfect position for your treatment.
You can go straight home after each treatment session. You’ll be given contact details for your care team so you can call if you’re worried about anything.
Here’s what will happen after your treatment course has finished.
You’ll be referred back to your own doctor, together with all the information they need to plan any further treatment you may require.
Seven to ten days later: a member of your MRIdian care team will call to see how you are feeling and answer any questions you may have.
Four to six weeks later: you’ll attend a review with your GenesisCare consultant.
In the longer term, we’ll continue to follow up on your recovery and wellbeing through appointments, phone calls and emails with your MRIdian care team.
Our GenesisCare centre in Oxford is rated ‘Good’ by the Care Quality Commission (CQC)
Our team of experts
Dr Nicola Dallas
Special clinical interest in urological cancers, head and neck and thyroid cancer.
Dr Prantik Das
Special clinical interest in urological cancers, bladder, stomach, neuroendocrine and lung.
Dr Philip Camilleri
Milton Keynes, Oxford
Special clinical interest in urological cancers.
Dr Carla Perna
London, Guildford, Oxford
Special clinical interest in urological cancers and brochytherapy.