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There are many ways to have radiation therapy but they all work in a similar way. Carefully controlled high-energy X-rays destroy or damage cancer cells. This stops them growing or spreading.

Radiation therapy is usually delivered in daily intervals called ‘fractions’. This allows time between treatments for the healthy cells to repair and the cancer cells to die off.

At GenesisCare, we’re always pushing the boundaries of technology to develop better radiation therapy treatments. Targeting the cancer cells in tumors without damaging the surrounding healthy tissue.

Most men going through prostate radiation therapy will also go through hormonal therapy leading up to, during, and sometimes for a time after radiation therapy. This improves the outcome of prostate radiation therapy by enhancing local control, and by potentially reducing relapse. Your treatment team will discuss and prescribe hormone therapy where required. They will also monitor you whilst on the treatment, supporting you to manage potential side effects.

Chemotherapy is medication that treats your cancer. It kills cancer cells, preventing them from dividing and spreading further.

Traditional or standard chemotherapy works by disrupting the cell cycle. Each time a new cell forms it goes through a series of phases to become mature. Traditional chemotherapy drugs target the different phases of the cell cycle. By disrupting or stopping a particular phase, a cancerous cell can no longer mature and divide and ultimately dies.

Chemotherapy is generally used to kill cancer cells in advanced prostate cancer cases when the cancer has spread outside the prostate gland. In this instance, the aim of chemotherapy is to shrink the tumor and slow its growth; it is not used to cure the cancer. By doing this, it may help to prolong the survival of advanced prostate cancer patients.6

Chemotherapy is generally given intravenously at a GenesisCare clinic as a day procedure. The number of sessions will be based on the latest scientific research and personalized to your specific cancer.

The side effects of chemotherapy may include fatigue, hair loss, weight loss, nausea, vomiting, loss of appetite, changes in nails, low energy and changes in blood counts increasing the risk of infection or bleeding and numbness or tingling in the hands or feet.

Theranostics is a treatment that combines diagnostic imaging with radiation treatment; identifying if target receptors are present on cancer cells, and then delivering precision radiation treatment to target these receptors.

Theranostics can be used to treat cancers that have spread (metastasised), or where cancer is advanced and/or has not responded to other treatments.

While in the future theranostics may be used for different cancers, to date most experience and success has been in metastatic prostate cancer and neuroendocrine tumors.

Theranostics uses PET scan imaging to see if specific targets, known as tumor receptors, are present on tumor cells.

If these targets are present and visible on the scan, a radioactive drug is used to treat the tumors. The drug is given as an injection and selectively targets the tumor cells while avoiding healthy areas. Most of the radioactive drug that doesn’t reach the target is quickly passed out of the body.

It’s important to note that at this time, treatment for neuroendocrine cancer is approved by the FDA and treatment for prostate cancer is expected to get approval soon.

Brachytherapy involves placing small radioactive seeds to release radiation directly into a tumor. This limits radiation to surrounding tissues, which is critical for patients with prostate cancer. GenesisCare offers both low-dose brachytherapy (continuously delivered over several days or weeks) and high-dose brachytherapy (performed in one session).

There are many ways to have radiation therapy but they all work in a similar way. Carefully controlled high-energy X-rays destroy or damage cancer cells. This stops them growing or spreading.

Radiation therapy is usually delivered in daily intervals called ‘fractions’. This allows time between treatments for the healthy cells to repair and the cancer cells to die off.

At GenesisCare, we’re always pushing the boundaries of technology to develop better radiation therapy treatments. Targeting the cancer cells in tumors without damaging the surrounding healthy tissue.

Stereotactic Body Radiotherapy (SBRT) is a less invasive radiation treatment for men diagnosed with prostate cancer. SBRT has a shorter treatment schedule and limits potential damage to surrounding organs while lessening side effects through its sub-millimeter accuracy. SBRT is often used as an alternative to surgery. Additionally, SBRT has shown to be highly effective for late-stage cancers, allowing patients who were previously considered incurable to be offered long-term and curative outcomes.

Surface-Guided Radiation Therapy (SGRT) uses sophisticated 3D camera accuracy to help correctly position you for treatment without the need for permanent tattoos. SGRT delivers highly accurate doses of radiation while monitoring the unintended movements you make during treatment. With SGRT, the radiation delivery pauses until you are back in the correct position.

HDR brachytherapy is given by placing temporary needles or rods into the prostate under anesthetic, and then delivering internal radiation, avoiding dose to the surrounding tissues.

LDR brachytherapy is often used to treat prostate cancer. It involves permanently placing brachytherapy seeds in, or near, the tumor. The seeds continually release low-dose radiation over several months.

PSMA PET is most effective and precise for localizing metastatic prostate cancer. GenesisCare is one of the only medical centers in the U.S. offering FDA approved PSMA PET to deliver the best possible life outcomes. With PSMA PET scans, we use targeted imaging to detect areas of suspected metastasis  for initial therapy and suspected recurrence based on an elevated serum prostate-specific antigen (PSA) level.

At GenesisCare, we are finding new ways to care for your patients. We are one of the first medical centers in the US offering FDA approved PSMA PET to deliver the best possible life outcomes. With the release of the PSMA PET scans, we can enhance the way to test for metastatic prostate cancer by using targeted imaging to detect areas of suspected metastasis for initial therapy and suspected recurrence based on an elevated serum prostate-specific antigen (PSA) level.*

Find a PSMA PET GenesisCare center,** close to you:

21020 State Road 7, Ste 100
Boca Raton, FL 33428
Tel: (561) 883-8656

4571 Colonial Blvd, Ste 100
Fort Myers, FL 33966
Tel: (239) 322-5200

2161 Kingsley Ave, Ste 100
Orange Park, FL 32073
Tel: (904) 276-2303

7751 Baymeadows Rd E, Ste 102
Jacksonville, FL 32256
Tel: (904) 562-4400

6957 West Plano Pkwy, Ste 1300
Plano, TX 75093
Tel: (469) 364-7880

12606 Greenville Ave, Ste 185
Dallas, TX 75243
Tel: (469) 364-7880

2526 S Pinnacle Hills Pkwy
Rogers, AR 72758
Tel: (479) 271-8900

301 N 32nd Street
Muskogee, OK 74401
Tel: (918) 683-2000

11100 Hefner Pointe Dr, Ste A
Oklahoma City, OK 73120
Tel: (405) 839-7340

111 Harrison Ave, Ste 104
Oklahoma City, OK 73104
Tel: (405) 272-5090

*Based on FDA approved clinical indications
** PSMA supply subject to availability per location

***PSMA PET is available at select GenesisCare sites that provide PET imaging.

IMRT delivery enables high doses of radiation to be precisely delivered to the tumor while protecting normal tissues, resulting in fewer side effects.

This form of IMRT involves a quicker treatment delivery process resulting in each treatment being significantly shorter.

IGRT uses X-rays and scans before, and during your treatment. It is used to check your position before the treatment machine is turned on. The scans show the exact shape, size, and location of the tumor. We can then make tiny adjustments to precisely target the tumor.

Barrigel is a natural, biodegradable material that stays in place for 6 to 9 months and is then naturally broken down by the body over time. It is inserted into the tissue planes between the prostate and the rectum, pushing the rectal wall away from the prostate, helping to protect healthy tissue and reduce unwanted radiation doses to the front rectal wall.

The spacer procedure is usually performed under a light general anesthetic, although occasionally performed under sedation. An ultrasound probe is inserted into the rectum to ‘visualize’ the prostate, bladder, rectum, and the area surrounding these organs. Thin needles are used to insert the markers into the prostate through the area of skin between the scrotum and anus called the perineum. Using a separate needle, the Barrigel spacer is injected into the space between the rectum and the prostate to increase this area. The gel is sculpted to fit so each insertion is individualized. The procedure takes between 15-30 minutes.

SpaceOAR hydrogel is a water-based soft gel implant that is injected before you start your radiation therapy. SpaceOAR hydrogel stays in place for around three months. After that, it’s naturally absorbed by the body.

The spacer procedure is usually performed under a light general anesthetic, although occasionally performed under sedation. An ultrasound probe is inserted into the rectum to ‘visualize’ the prostate, bladder, rectum, and the area surrounding these organs. Thin needles are used to insert the markers into the prostate through the area of skin between the scrotum and anus called the perineum. Using a separate needle, the SpaceOAR hydrogel spacer is injected into the space between the rectum and the prostate to increase this area. The gel is sculpted to fit so each insertion is individualized. The procedure takes between 15-30 minutes.

Access to spacing is generally in our offices and in partner ambulatory surgery centers. It will likely be a day procedure done under a light general anesthetic, although occasionally performed under sedation. You will need to spend a few hours in hospital until the anesthetic has worn off. Generally, you will not need to stay in hospital overnight and will go home afterwards.

Side effects are generally mild, and many people do not experience any. However, following insertion of the spacer, some people may experience procedure-related side effects, such as injection site pain and possible bruising at the injection site in the perineum. You may experience a mild to moderate sensation of rectal filling that may make you feel as if you need to empty your bowel. Very occasionally, some people may experience cramping pain in the rectum or possible urinary symptoms. It is important to let your doctor know if you do experience any side effects.

In a randomized clinical trial, at a median three-year follow-up, SpaceOAR Hydrogel patients experienced reduced side-effects from prostate cancer radiation, including:

• 67% maintained sexual potency ^3*** 
  • A reduction in erectile disfunction (for men potent at baseline) ³
• 73% relative reduction in rectal v701* 
  • A reduction in bowel dysfunction¹
•  66% fewer clinically significant declines in urinary QOL^2** 
  • A reduction in urinary incontinence²
• 0% Late Grade 2 or higher rectal toxicity ² 
  • A reduction in rectal toxicity from radiation exposure_¹ 
• An overall improvement in quality of life, compared to patients who did not receive the implant.¹

References:

_{1 Mariados, N. et al. 2015. Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. International Journal of Radiation Oncology biology physics. 92(5), pp. 971 – 977.}

_{2 Hamstra, D. et al. 2017. Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial Hamstra, Daniel A et al International Journal of Radiation Oncology. Practical Radiation Oncology. 97(5), pp. 976 – 985.}

_{3 Hamstra, D. et al. 2018. Sexual quality of life following prostate intensity modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial. Practical Radiation Oncology. 8(1), pp. 7 – 15.}

_{* average reduction when comparing pre and post-spacer treatment plans.}

_{** defined as 2x the minimally important difference compared to control patients.}

_{*** compared to 38% in the control group; of men who had erections sufficient for intercourse at baseline; median 3 years}

Only men have a prostate gland. The prostate is a small, rubbery gland about the size of a ping-pong ball, located deep inside the pelvis at the base of the bladder. It is important for reproduction, because it supplies part of the seminal fluid (semen), which mixes with sperm from the testes. Seminal fluid helps the sperm to travel and survive.

Prostate cancer is the most common male cancer in America. In the United States, 1 in 8 men will be diagnosed with prostate cancer in his lifetime. Early diagnosis and treatment can mean a positive outcome for many.

The exact cause of prostate cancer is not known. However, some factors are known to increase the risk. Prostate cancer is rare before the age of 40, and the risk increases after the age of 50.

Risk factors can also include:

• Diet and lifestyle
• A strong family history of prostate cancer
• Genetic factors, which are also associated with breast cancer and ovarian cancer in women (BRCA mutations)

Prostate cancer is usually slow-growing and does not spread beyond the prostate gland before the time of diagnosis. Early detection is key to deciding which men require active treatment for a more active tumor that is classed as higher-grade.

Prostate cancer happens when abnormal cells in the prostate multiply, causing a tumor. In men diagnosed with early or localized prostate cancer due to an elevated PSA blood test result, the majority have no symptoms. This is because early prostate cancer often starts in the outer edge of the prostate, away from the urethra, and not does not cause any symptoms.

These cancerous cells sometimes grow throughout the prostate and through the capsule surrounding the prostate. There may be spread to the adjacent seminal gland, and they can spread to other areas including bone and lymph nodes. This is known as advanced or secondary prostate cancer.

Advanced prostate cancer symptoms can include:

• The frequent or sudden feeling to urinate
• Difficulty and/or discomfort when urinating
• Discovering blood in semen or urine
• Pressure or pain in the rectum
• Pain or stiffness in the lower back, upper thighs, or hips.

Some symptoms of advanced prostate cancer can be symptoms of other common conditions, for example benign prostatic hyperplasia (BPH) – a non-cancerous enlargement of the prostate causing some of the above symptoms. It is therefore important to seek medical advice for any symptoms you are experiencing.

If prostate cancer is found before it has spread, there are a broader range of treatments available, with greater expectation that treatment will achieve a curative outcome. Depending on the type and stage of cancer, you may be offered one, or a combination of treatments including surgery, radiation therapy and hormone therapy.