Reirradiation of the Prostate May Become Feasible Treatment Option

As radiation to the prostate becomes more focused and localized, James B. Yu, MD, MHS, FASTRO, believes that re-irradiation is going to become more common. Currently, patients who receive radiation aren’t able to receive surgery afterward, whereas those who receive surgery first have the option to do radiation afterward. Due to this, some patients opt to receive surgery first because it guarantees that they will get a second shot at alleviating their prostate cancer.

Yu, professor in the Department of Radiation Oncology and Applied Sciences, leader of the Genitourinary Radiation Oncology Program at Dartmouth Hitchcock Medical Center, and radiation oncology editorial advisory board member of the Journal ONCOLOGY®, told CancerNetwork® that as radiation oncologists get better at targeting specific parts of the prostate, patients will be able to receive radiation a second time after enough time passes and the tumor is discrete enough.

Additionally, chemoradiation for bladder cancer is another topic of interest in the radiation oncology field, especially as some of the larger studies mature and release more data.

Transcript:

Reirradiation for prostate cancer is a fascinating area. One of the things that urologists say when they talk about surgery for prostate cancer is [that] if you get surgery, there’s the option to salvage with radiation should the surgery fail, but if you [receive] radiation first, you can’t subsequently get surgery… Some men are persuaded to get surgery because they want 2 shots at a cure, as opposed to, theoretically, 1 shot with radiation. As we get better with targeting parts of the prostate, or pieces or cancers inside the prostate, we can now talk about, “Well, you can get radiation again in the future if enough time has passed [and] if the tumor is discrete enough.” That is very interesting for patients to consider. I’ve done salvage radiosurgery after an initial round of radiation, and patients do great. Admittedly, I’m conservative about urethral dose and rectal dose, but patients do well with prostate radiation. In the future, it’s going to become increasingly mainstream, because these patients are very common to have a local failure. There’s just so many patients with prostate cancer that even if a [small] percent have local failure, you’re going to get a lot of patients. That’s an area of continued research around the country.

The field is also very interested in bladder chemoradiation, especially with a lot of the big studies maturing in bladder cancer and [its] increasing awareness of bladder-preserving chemoradiation and how good the quality of life can be with your intact bladder. As immunotherapy and other targeted therapies come to the fore with bladder cancer, focal therapy with radiation is going to be even more important.