The evolution of radiation treatment options for Prostate Cancer

From Dr. Holly Campbell, BSc, MD, FRCPC

As a radiation oncologist, I am never bored.  I have the privilege of working with a great team of smart and motivated people and the privilege of meeting many interesting patients and their families. 

There are constant and rapid advances in radiation treatment planning, the technology available and treatment delivery.  I see constant evolution of technology in imaging patients’ tumors, image guidance for accurate treatment delivery, improvements in treatment delivery and improvements in quality of life after treatment.

Five years ago, we were treating localized prostate cancer with up to 39 daily treatments of radiation.  With the development of our new stereotactic body radiation therapy (SBRT) program, eligible patients have the option of receiving radiation over five treatment days.

It is very exciting that we now have the ability to offer SBRT at Horizon’s Saint John Regional Hospital.  We are the first oncology centre in Atlantic Canada to offer this treatment and we are helping our colleagues in Halifax develop their program. 

Not long ago we used X-ray images of pelvic bones to target the prostate. This evolved into using daily small CT scans through the pelvis and now, in addition to daily CT scans, we can use gold markers called fiducial markers implanted in the prostate to accurately target the prostate throughout treatment and to stop treatment if there is any movement of the patient or prostate.

SBRT is like shrink wrapping an ablative dose of radiation to the prostate, while limiting the dose to the surrounding rectum and bladder. 

We do this using advanced imaging in conjunction with diagnostic MRI and using gold markers in the prostate to ensure accurate targeting of the prostate.  In preparation for SBRT, a patient has three gold markers inserted into their prostate so we can track the exact position of the prostate throughout treatment. 

We also insert Space OAR hydrogel to move the rectum away from the prostate.  Space OAR hydrogel is a made up of two liquids that when combined create a temporary soft gel material mostly made of water. It is inserted in the small space between the back of the prostate and the anterior rectum to temporarily move the rectum away from the prostate to reduce the radiation dose to the front wall of the rectum and reduce radiation side effects.

Prostate cancer is a very common problem.  According to Canadian Cancer Statistics, it is estimated 23,300 men were diagnosed with prostate cancer in Canada in 2020, or 64 new diagnosis of prostate cancer per day.  This represents 20 per cent of all new cancer diagnoses in men. 

It is very exciting to be able to safely and accurately reduce the number of radiation treatments for eligible men with localized prostate cancer while providing the same survival as surgery, reducing long term side effects and requiring less visits for the patient and the health care system.

Throughout my career it has been truly incredible and rewarding to see the treatment options for cancer evolve and improve the lives of so many people.

If you are diagnosed with prostate cancer, it is important to see both a urologist and a radiation oncologist to discuss your treatment options.

Dr. Holly Campbell, BSc, MD, FRCPC, has been a radiation oncologist, and head of the Brachytherapy Program, at Horizon’s Saint John Regional Hospital since 2009. She is also an assistant professor at Dalhousie University. Born and raised in Saint John, NB, Dr. Campbell attended University of New Brunswick for her Bachelor of Science, and attended Dalhousie Medical School in Halifax, NS. She completed a fellowship in Brachytherapy at the University of British Columbia. Dr. Campbell practiced medicine as a radiation oncologist in Ontario for eight years before returning home to Saint John.

To learn more about this exciting treatment now available at Horizon’s Saint John Regional Hospital, watch our video!