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1. Summary and website contents.
(Contents of webpage 7 updated on 19th May 2006,
webpage 8 on 4th October 2007 and
webpage 14 on 30th July 2010)

Patients deserve and need access to accurate, timely and understandable information on their health service.
(Patient empowerment and public participation - UK General Practioners Committeee Report 2001)

This website is for men with prostate cancer and their families who want to know more about its treatment with external beam radiotherapy (EBRT). Although there is an increasing number of treatment options for prostate cancer, external beam radiotherapy will remain a mainstay therapy for sometime to come and this website is intended to give patients information about possible improvements to this method of treatment so that when they discuss their case with their consultant, they can actively engage in a dialogue about the options open to them. The site is biased towards the UK NHS service but the discussion has general applicability. It is recommended that a visitor to this site be reasonably familiar with the general terminology of prostate cancer and there is a web page of links which lists books and websites where this can be obtained. However, important terms are defined either as they are introduced or in a series of pop-up windows that can be accessed by a left click of the mouse button. The internet encylopedia Wikipedia has a very good article for general information on prostate cancer -

It is difficult to read a lot of text on a screen and so there is an option (17) on the menu to display and print the main website contents in a single Adobe Acrobat pdf file that can then be browsed through at leisure.

The contents of the site are regularly expanded or updated as new publications appear.

Prostate cancer consultation Prostate cancer is one of the biggest killers of men today and, in a recent submission to the UK House of Commons Public Accounts Committee (April 2005), Sir Nigel Crisp (NHS CEO) and Professor Michael Richards (National Cancer Director) acknowledged that progress with treating the disease was lagging behind that of other forms of cancer. Changing this situation requires action mainly from the medical profession but patients can and should play a part in this too. The "NHS Expert Patient Programme" is an NHS initiative concerned with empowering patients. Empowerment arises from patients educating themselves to become sufficiently expert in their disease so that they may actively participate in a dialogue with their medical carers about their treatment and also to enable them to apply pressure in whatever ways are appropriate to improve the quality of the service that they receive.

This website arises out of my own experience as a prostate cancer patient and it focuses on the primary treatment of prostate cancer by external beam radiotherapy (EBRT). Of the 30,000 or so men diagnosed in the UK each year with prostate cancer, about 6,000 are treated with EBRT and a similar number undergo surgery. For those treated by EBRT, the overall probability of remaining disease free over a ten year period is only around 50% and this website focuses on possible improvements that could be made to this form of treatment to improve this situation.

Although there is no 'standard' treatment for prostate cancer with EBRT, a common treatment regime has emerged over time that is based on giving a total dose of radiation of 70 Gray delivered in daily 2 Gray doses or fractions. There is good evidence that significant improvements on this treatment can be made: by combining EBRT with hormone therapies; by increasing the total dose above the 'standard' 70 Gray; and, more radically, by increasing the daily dose fraction above the 'standard' 2 Gray - this is called hypofractionation. These issues are discussed on separate web pages and are primarily aimed at patients. Medical practitioners and researchers may find the content of value too. There are new review papers that cover the content in more detail - web pages 10, 11 and 12.

The website pages are accessed from the navigation menu on the left hand side of each web page. The web pages are numbered so that they can be referenced from one another.

Before discussing possible improvements in treatment, there is a discussion in web page 2 on what constitutes 'standard' radiotherapy treatment and the patient parameters that make external beam radiotherapy a suitable option.

The issues that are discussed are
(1) the interaction between hormone therapies and radiotherapy - web page 3.
(2) escalating the overall dose above the 'standard' 70Gy level - web page 4.
(3) increasing the daily fraction above the 'standard' 2Gy level - web page 5.
(4) the side-effects from external beam radiotherapy - web page 6
(5) the behaviour of PSA measurements after radiotherapy including PSA bounce - web page 7.

There is also a checklist (web page 8) that is intended as a guide to the sort of questions that a patient might ask of his consultant. In my experience, most consultants are quite prepared to discuss these questions and, indeed, will modify details of the treatment if they think the changes are clinically reasonable. If you don't ask, you may not 'get'! The primary treatment you receive for prostate cancer is the best chance you have of overcoming the disease and so it is vital that you make sure that this is as effective as possible. There is no room for reticence here.

On web page 9, there is a Microsoft Excel spreadsheet that can be run or downloaded to estimate the long-term disease free survival probability for a range of radiotherapy scenarios including EBRT, permanent seed brachytherapy and combinations of the two. This 'calculator' is based on work described in the REVIEW 2 (web page 11).

It should be noted that it is not the aim of this website to provide general information on prostate cancer. There are thousands of internet sites and books on prostate cancer and it is assumed that anyone using this site will be familiar with the general terminology of prostate cancer and its treatment. A list of books and links to websites that can provide this general information is given in web page 13.

On web page 14, I include some details of my own prostate cancer history which is still an ongoing story.

Also, the relative merits of external beam radiotherapy as compared to, say, low dose rate brachytherapy and surgery are not discussed. It is assumed that a patient has already opted - for whatever reason - to accept external beam radiotherapy. I am not even necessarily advocating EBRT because there is no clear winner in choosing a treatment therapy for prostate cancer. They all have their pros and cons and the reasons to choose one rather than another is a difficult decision that may have many factors in it including personal preferences. On the other hand, EBRT is a mainstay form of therapy and, at its best, it offers treatment outcomes that are comparable with other forms of treatment. The prospects are that EBRT can be improved significantly with developments such as: intensity modulated radiotherapy (IMRT); hypofractionation; tracking and targeting of the prostate gland during treatment; and synergy with drug therapies.

Finally, I should stress that the opinions in this site are my own. I am a patient rather than a medical practitioner but I have spent a lifetime in multi-disciplinary research and many of the types of problems associated with EBRT occur in other fields with which I am familiar.