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Common Question

How come I don’t feel sick even though my doctor told me I have prostate cancer.

This is among the most common questions from my patients.  In order to “feel” cancer, it has to have spread extensively to the nerves which surround the prostate or spread into the bone in other parts of the body.  When either of these events occur, it is too late to completely cure you of your prostate cancer.  Your best chance of being completely cured of prostate cancer is to treat it when it is small and before it causes symptoms.  This seems strange to many people since they are treated when they feel perfectly healthy.  This is part of the reason you should have a discussion with your primary physician during routine appointments.

Common Question

What is Proton Therapy?

Using proton therapy for prostate cancer is controversial in the field of radiation oncology because the prostate is relatively deep inside the patient which diminishes or eliminates any potential benefit.  Proton therapy for prostate cancer usually results in a plan which is slightly less conformal that IMRT and it usually costs 3 times the cost of IMRT.  Protons have a some disadvantages over IMRT including a poor penumbra (the sharpness of the lateral field edges) and significant uncertainty of the path length of the proton (which requires a significant overshoot of the target to ensure adequate dose).   The benefit of protons is not controversial for pediatric cancers because many pediatric tumors are ideally located to exploit the benefits of protons (they are more superficial).  I was on faculty at the MD Anderson’s Proton Therapy Center in Houston, Texas and can discuss all potential benefits and disadvantages with interested patients.  A good discussion about protons for prostate cancer can be found at http://jco.ascopubs.org/content/25/24/3565.full.

Common Question

What is IMRT and Calypso?

There are several basic principles in prostate radiation therapy:  delivery technique and targeting.  Delivery technique is analogous to the weapon used in warfare.  IMRT or intensity modulated radiation therapy is the general term for the technique used for treatment delivery.

It allows us to deliver the radiation only to the area we want to treat.  Targeting is analogous to the scope on the weapon.  At GGCC, we used a combination of Calypso with a mini targeting CT scan (CBCT) on a daily basis.