Future Prostate Treatments in the Upright Position
Historically a large proportion of prostate cancer has been treated with daily external beam radiation with the patient lying down flat on a hard table bed, in most cases with a full bladder.
However studies are starting to explore whether this is truly the optimal position as it is increasingly being recognized that when we lie down, our organs move or change shape and often into a less natural position than when we stand or are seated upright, so why are we still doing it in this position?
In a small study, 15 volunteers were scanned lying flat with a full bladder and in the upright position some with a full and some with an empty bladder.
What this study showed us:
In the upright position:
Position and shape of the prostate is not impacted by changes in bladder fill;
Seminal vesicles (a pair of glands often included in prostate radiation therapy) are pushed down by the bladder, meaning they are closer to the prostate and so included in the treatment area which is needed for many people;
Normal breathing motion does not affect the prostate position.
Patients expressed a strong preference for the upright orientation based on how comfortable and stable they felt, as well as how easy it was to navigate getting in and out of the upright seat.
What this means for treatment
Less organ movement including the seminal vesicles when upright, could mean more accurate targeting of treatment since smaller safety margins could be applied and less radiation exposure to surrounding healthy tissue.
If we are less dependent on a full bladder during treatment the time spent in the cancer centre each day could be greatly reduced, patient comfort will increase and there will be less need for repeat daily scans meaning less unnecessary dose exposure.
Other Research
Centre Léon Bérard (CLB) in Lyon in France, a comprehensive cancer centre that is dedicated solely to cancer care, research and education, have been assessing upright positioning and immobilization accuracy based on optical images, the setup time and comfort for participants in pelvic positioning and repositioning.
They found that the accuracy of repositioning participants into the upright treatment position each day varied by less than 1 millimeter and whilst staying in that position for 20 minutes 80% of people moved by less than 1 millimetre and 90% moved by less than 3 millimeters. This suggests that the position is stable and comfortable so that when people are having their treatment, which can take up to 20 minutes, their prostate is likely going to remain exactly where the treatment is being targeted.
If you would like to explore the research a little more please click on the links below: