Fighting Prostate Cancer for a *Second* Time? Read This

prostate cancer ribbons


“This technology has opened up a whole new world for recurrence patients.”

You think you’ve won your battle. You’re told you’ve beat the cancer. But then comes some sobering news: “It’s back.” Learning you have prostate cancer is devastating no matter your history with the disease, but hearing that it returned after treatment can feel like a betrayal.  

The recurrence of this intimate cancer is more common than many people realize. And it can happen even if you’ve successfully treated the cancer the first time around, whether through radiation or a prostatectomy (a surgery that removes your prostate entirely).

For high-risk patients, the probability of receiving a second prostate cancer diagnosis is 85 percent; in medium-risk patients, it’s 50 percent; and in low-risk patients, there’s a 33 percent chance, according to a Harvard study. (Doctors generally label prostate cancer as high-, medium-, or low-risk by assessing a combination of factors.)

“If the patient chooses to have surgery as their primary treatment, there’s still a possibility some residual microscopic cells get left behind,” says Michael Greenberg, MD, a radiation oncologist at Jefferson Health. After the prostate is removed, tiny cancerous cells can be left in the tissue outside of the area where the prostate was removed. You can also get a recurrence if you underwent radiation during your first battle. “There’s always a risk: It’s never a zero percent chance of recurrence,” says Dr. Greenberg.

Since prostate cancer treatment often comes with harsh side effects, if you or a loved one has been re-diagnosed, you’ll likely have to make some tough decisions about how to move forward. Fortunately, there are many treatment options that can help you beat and treat prostate cancer as you put up your dukes a second time around.

We spoke with two renowned cancer doctors about a technological advancement in radiation therapy for recurrence patients: the MRIdian MRI-guided radiation therapy system. MRIdian is a form of radiation therapy that offers lots of benefits over more traditional forms of recurrence treatment. (Of course, always consult with your doctor about the plan that’s best for you.)

Find out how MRIdian is helping recurrence patients recover faster and with fewer side effects, compared to other treatments offered in the past, below.

Traditional treatment options for prostate cancer recurrence 

For patients who initially had radiation, doctors used to recommend removing both the prostate and the bladder after a recurrence, Dr. Greenberg tells us. “The problem was that the prostate after radiation was kind of scarred, and it was hard to remove it without damage to the bladder,” says Dr. Greenberg. “It was a very morbid operation and patients would basically have to use a catheter for the rest of their life.”

And for those who had prostate surgery? “Normally, if a patient had surgery, we would add radiation after, but it wasn’t the kind of radiation that we use now,” says Dr. Greenberg. “We used bigger fields that included the whole prostate bed and it took almost eight weeks of treatment.”

MRIdian’s MRI imaging allows each patient’s treatment to be personalized

MRIdian offers a game-changing treatment solution for people who had radiation or surgery for their initial treatment. “We really didn’t use radiation a lot before for re-treatment because it was really hard to target the particular area and spare all the normal tissues,” says Dr. Greenberg. Now, thanks to the MRI imaging on the MRIdian, doctors can see the area they’re treating, which helps ensure they’re targeting the right area with radiation. “This technology has opened up a whole new world of treatment for recurrence patients,” he says.

At the start of every treatment, MRIdian takes a new MRI image of the patient’s prostate area, or the area called the prostate bed (if the prostate was removed). The MRI allows the doctor to clearly see nearby organs like the bladder and rectum, which helps the doctor adapt and personalize the treatment plan if something has changed from the previous treatment. “MRI really gives us the best quality of imaging, especially in the pelvis,” says Dr. Greenberg. “It lets us see exactly what we’re treating, and also lets us see what we want to stay away from.”

mridian xray machine view ray
MRIdian MRI-Guided Radiation Therapy System. Courtesy of ViewRay.

How does MRIdian work to track the cancer and protect healthy tissue?

On MRIdian, the MRI controls the beam. During treatment, MRI images of the prostate area are taken eight times per second and MRIdian tracks critical anatomy to ensure that it stays in the correct position during treatment. If any part of the area being treated with radiation shifts out of position because the bladder fills or gas bubbles up, MRIdian reacts faster than human reaction time and automatically shuts off the beam. This prevents otherwise healthy tissues from getting hit by radiation. “Since we know the nearby areas can move, that adds another layer of protection against overdosing [the wrong areas],” says Amar Kishan, MD, associate professor, and chief of the genitourinary oncology service at UCLA.

With MRIdian, doctors are able to reduce the area they treat from up to 10 millimeters down to three, because of the MRIdian’s precision imaging capabilities and its ability to only target the treatment region. This reduces the chance that healthy tissues and organs will be exposed to radiation. “It’s high-value real estate — every millimeter in this area matters,” added Dr. Kishan, Because the area is so close to other organs, like the bowel, bladder, and rectum, doctors have to be careful not to overdose the healthy tissue with radiation.

Does MRIdian’s radiation technology impact side effects?

A clinical trial at UCLA, led by Dr. Kishan, treated recurrence patients after surgery using traditional CT-guided radiation systems, compared to MRIdian, MR-guided radiation systems with real-time tissue tracking and automated beam control. In the six months after the treatment, Dr. Kishan’s team assessed the side effects the men experienced. “What we found was there were significantly less side effects in the men who were treated with the MRIdian,” says Dr. Kishan. That’s, in large part, due to the system’s precise imaging capabilities and smaller treatment margins. “You can be much more precise with the radiation and reduce the safety margins that have been traditionally used. And when you reduce the safety margins, you reduce side effects.”

Doctors are currently conducting two clinical trials* using MRIdian to treat men with cancer recurrence in fewer visits to reduce the disruption to their lives and allow them to return to a normal schedule faster. Patients can complete treatment in just five visits with the MRIdian, instead of the traditional longer course treatment with many more visits. “If we were treating somebody without the MRIdian, we would have to treat them for about seven weeks of treatment,” says Dr. Greenberg. “But right now with MRIdian, we only need five treatments.”

For a list of hospitals currently using MRIdian, please click here

*For more information on the two clinical trials underway, please click here and here

The information provided on this site isn’t intended as medical advice and shouldn’t replace professional medical treatment. Consult your doctor with any serious health concerns.