Brought to you by:

Dr Looi Wen Shen
Dr Wong Ru Xin
Dr Shaun Ho

Please WhatsApp +65 9297 5542 or email frontdesk@proton.sg to contact us for more information or for an appointment with Proton Therapy SG.

Do I need to treat my prostate cancer?

Patients with very low-risk or low-risk prostate cancer may undergo a period of active surveillance by their doctors, which is akin to close monitoring. However, patients with intermediate-risk prostate cancer or high-risk prostate cancer are generally advised to undergo treatment if their overall health status is good. Surgery, radiotherapy, and now proton therapy are available in Singapore.

Should I choose surgery or radiotherapy for prostate cancer treatment?

It can be difficult to choose your prostate cancer treatment. The main difference is in the side effect profile. After the prostate is removed during surgery, the bladder has to be joined back to the urethra near the base of the penis. As a consequence, urinary incontinence is a complication that can some times be permanent. The main side effect of radiotherapy is injury to the bottom of the bladder and the front portion of the rectum, which can cause bleeding the future. Fortunately, there have been advances in both surgery and radiotherapy that have led to improvements in the side effect profile of both!

Your chance of beating cancer is the same with either prostate cancer treatment

The most important thing for the patient to note is that the overall disease control and survival with either surgery or radiotherapy is very similar for prostate cancer treatment.

What types of radiotherapy are available for prostate cancer treatment?

Most radiotherapy centres offer volumetric modulated arc therapy (VMAT) or intensity modulated radiation therapy (IMRT) for prostate cancer treatment. Some centres offer stereotactic body radiation therapy (SBRT). Select centres such as Proton Therapy SG of the Singapore Institute of Advanced Medicine (SAM), located at biopolis, offer proton therapy.

Conventional radiotherapy- VMAT and IMRT

VMAT and IMRT are improvements over 3-dimensional conformal radiation therapy, which is now rarely used for for curative treatment of prostate cancer. Although the prostate cancer be targeted with high-dose radiotherapy, this comes at the expense of a low dose bath to the rest of the organs- see figure below. The courses with this type of radiation usually last for 4 to 8 weeks.

Proton Therapy for prostate cancer.
Top: Proton therapy spares the bowel in this patient.
Bottom: VMAT radiotherapy is associated with a low-dose both to the patient’s bowel and bones.

Stereotactic body radiation therapy (SBRT)

SBRT for the prostate is similar to VMAT/IMRT. However, it harnesses technological advancements that allow for more precision in delivery prostate cancer treatment. Therefore, the treatment is more ‘targeted’. One big advantage is being able to deliver the full dose in just 5 sessions.

However, it still suffers from the same drawback as VMAT/IMRT in that a splash of dose to the entire are is required because of the nature of x-rays passing in and out of the body.

Proton therapy with intensity modulated proton therapy (IMPT)

Proton therapy using IMPT via pencil beam scanning is a radiotherapy technique for prostate cancer treatment that is available in Proton Therapy SG. By using particles called protons that do not need to traverse the body like x-rays, there is less dose for the patient.

How about SBRT with protons- stereotactic body proton therapy (SBPT)?

Recently, a few international groups have reported on using ultrahypofractionated proton therapy for prostate cancer treatment. This means that patients were treated with 5 fractions or fewer. This helps very much for the convenience of patients. So far, the results indicate that this technique is safe and comparable to longer courses of proton therapy.

What if my prostate cancer has spread (metastatic prostate cancer)?

Surgery to remove the prostate is rarely undertaken for prostate cancer that has spread to other areas of the body (metastatic prostate cancer). However, radiotherapy to the prostate is increasingly being used for metastatic prostate cancer treatment as it has been shown to prolong survival or reduce complications in certain groups of patients. Radiotherapy in the form of SBRT can also be used for metastatic sites.

Speak to our proton fellowship-trained radiation oncologists to find out more!

Please WhatsApp +65 9297 5542 or email frontdesk@proton.sg to contact us for more information.