GU Cancers 2019 | Prostate cancer radiotherapy: maximizing quality of life

I have two main interests and the first one is just what you had said, which is trying to reduce the quality and reduce the effects of prostate cancer treatment to really maximize quality of life.

So in the radiation world there are a couple of ways that we can do that and the easiest sort of most straightforward way to think about it is to be more focal with the therapy. There’s a big push for ultra-hypofractionation or stereotactic radiation and the idea there is we’re giving very tightly focused, high-dose radiation techniques that can oblate the tumor with minimal side effects because we’re not hitting a lot of the normal tissues. So that’s certainly I think an ongoing area and actually some great trials have come out of the U.K. for that and we have some trials here through RTOG and NRG as well.

The other area though is sort of what can we do to do radiation in a way that is still damaging to the tumor cells but protective of the normal tissues. And so there we are starting to develop some agents through some research programs that we have at Duke, they’re drugs that actually will do both. They will sensitize tumor and protect normal tissues. So we’re excited about that and we’ve got some preliminary publication from animal work and actually starting to put it into human trials as well.

Improving quality of life is a big part of that. One of the other things that I’m actually really interested in is survivorship care, so as we transition patients from active cancer treatment into a survivorship and for bladder cancer or for prostate cancer, which is what I do in my clinical care, that’s a really big transition. Patients are used to coming in every day for treatment, some of them, particularly the bladder cancer patients, are getting chemotherapy with the radiation and can be quite ill. So transition out into where it’s just a monitoring program, and a monitoring program that doesn’t interfere with the rest of their life and is cost-effective, it is very important. So that I think is an area where we still have a lot to grow and we’re working on how to develop programs for that.

And then the last step, which we talked a little bit about in the previous question, was the idea of how do we apply radiation? There are places in which we should not be using it. There’s been a general trend to try to avoid treatment in patients who can go to active surveillance instead. How do we apply radiation appropriately for patients who may have very high risk disease or nodal positive disease or metastatic disease? And so that’s I think again where we’re going to see the trends and treatments shifting in terms of being able to really apply radiation more selectively and individually, depending on the patient and their cancer.