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Formerly the only possibility to treat prostatic cancer were operations. Now the oncologic performance of these operative methods had been equalized or surpassed by radiation treatments: For at least 15 years post treatment the curative effect of radiation is as good as that of any operation; and as soon as the carcinoma shows some spread, operations must be supplanted anyway by a follow-on radiation treatment. The remaining problem of the operative methods is: they could not get rid of side effects and complications. A mortality of 2% endangering elderly patients. 17% of the cases becoming incontinent, especially under pressure. The impotence rate between 20 and 100%. Many radiotherapists consider operations for prostatic cancer as obsolete today.
So called expectative therapy without interventions combined with systemic therapies (with chemotherapeutics or antihormonal drugs) may be indicated for very old patients to avoid the side effects of operations. The repeated punctures necessary to control that method are highly inconvenient. And whenever a curative intended treatment is consequently delayed or avoided, the probability of cancer progress is much higher, for example statistically (within a defined time interval) 33 metastases without curative therapy compared to only three within the same time after definitive treatment.
The Rinecker Proton Therapy Center (RPTC) as only institution in Europe (out of 60 Proton-Radiation-Centers worldwide) has realized the peak of the current technical development. It has treated more than 3.000 patients, 1.000 of them presenting with prostatic carcinoma. Contrary to all other radiation methods it is possible, with the use of protons in its fully developed scanning-method, to reduce stray-radiation into healthy surrounding tissue to between 1/3 and 1/5 of the radiation values of x-ray methods. Because with all x-ray methods, the stray-radiation hitting healthy tissue is several times the curative radiation into the tumor! Proton radiation however does not stress the patients anymore. We are able to offer with this technique and our experience, following international scientific developments, an optimal treatment for prostatic patients.
RPTC With a new computer system the targeting of the radiation is by now controlled with an algorithm using the so called Monte Carlo Method. This controls the proton radiation on a millimeter scale even more exactly following the local tissue configuration.
RPTC All prostate carcinoma patients at the RPTC are checked for distant metastases with the help of nuclear magnetic resonance systems, in order not to oversee metastases anywhere. This method is supplanted by Positron Emission Tomography (PET-CT) which is even more reliable in the search for tumors.
RPTC Prostate therapy today is often not complete, because metastases in the higher lymph node locations within the belly are not treated. X-ray methods are problematic in this area because the insufficiently concentrated X-ray radiation cannot avoid damage to intestine nearby. The three dimensional control of protons however permits the treatment of demonstrated or statistically probable malignant lymph node areas while sparing the intestine. It may be expected that the sometimes occurring failure even of treatment of early prostate cancer with other methods may be avoided that way. An important advantage compared with older treatment methods.
RPTC All this developments together allow us to treat early cases without metastatic spread within only 5 irradiations, reducing the treatment time (from 40 days elsewhere and 21 days in our institution up to now) down to only 5 single treatments. Within a week the radiation is completed – the patient has (in this early stadium) a curative chance of 90 %. One week diagnostics, one week radiation, no stress, no significant side effects. And the optimal curative chance.
RPTC Avoiding intermittent recovery phases for the cancer (by reducing the treatment from 40 to 5 sessions) improves the efficiency of the therapeutic radiation to twice its value – and permits halfing it. This reduction of the given dosis fulfills the wish of those patients, who insist upon the legally required minimization of the dosis (StrlSchV §§ 6, 80, 81, 83) in Germany as it can be achieved with proton scanning. In early cases of the prostate cancer we recommend the 5-days-therapy with only 37,5 Gray compared to conventional x-rays with nearly 80 Gray.