Dear Doctors: I am dealing with prostate cancer. I have a Gleason score of 8, which I understand makes me high-risk. I am undergoing hormone therapy, and brachytherapy is pending. Any wisdom you can share about this or advances in prostate cancer treatment would be greatly appreciated.
Dear Reader: We’re sorry to hear about your diagnosis. The prostate is a walnut-sized gland in men that sits in front of the rectum and just below the bladder. As men grow older, their risk of developing prostate cancer increases.
Once a cancer diagnosis has been made, additional tests are used to assess how the cancer cells are behaving in the body. This is known as staging. One of these is a numerical measure known as the Gleason grading system. It is determined by examining the cancer cells under a microscope, and it reflects how likely a cancer is to spread beyond its initial site. A lower Gleason score indicates the cancer is growing slowly and has not yet become aggressive. A Gleason score of 8 indicates the presence of what is known as a high-grade cancer. That reflects an increased risk that an existing cancer may begin to spread.
Your medical team is addressing this with brachytherapy. That’s a treatment in which a radioactive material is implanted within the prostate gland. This allows the energy from the radiation to remain localized, killing the cancer cells and minimizing damage to surrounding healthy tissues. In high-dose brachytherapy, which is often done in multiple sessions, a high-energy radiation source is put in place for just a few minutes and then removed. Low-dose brachytherapy involves the permanent placement of low-energy radioactive seeds, which are about the size and shape of grains of rice. Both forms of brachytherapy have been shown to be helpful in slowing or preventing the spread of a localized cancer.
A new treatment for patients with a certain type of metastatic prostate cancer has recently received Food and Drug Administration approval. Known as Pluvicto, it’s a radiopharmaceutical. That’s a drug that uses radiation to fight disease at the cellular level. In this case, the drug is administered by injection or infusion. As it travels throughout the body, the drug seeks out cells with a specific biomarker, which identifies them as being cancer cells. The drug then emits a microscopic amount of radiation. It’s enough to kill or damage the cancer cell but does minimal harm to the surrounding healthy tissues. The treatment consists of six doses, set six weeks apart.
There has also been encouraging news about another type of radiotherapy, known as metastasis-directed therapy, or MDT. This treatment uses recent advances in imaging technology to precisely train intense beams of radiation on tumors from multiple directions. This makes it possible to intensify the therapeutic dose of radiation, and at the same time spare healthy tissue. A study into the therapy, which included more than four years of follow-up, found the therapy improved outcomes in many of the participants.
If your cancer has begun to spread, you might ask your medical team to explore if any of these therapies might be appropriate for you.
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