Thursday, 18 June 2015

SPHPM researchers investigate the use of probiotics versus psyllium husk as a bowel preparation for prostate radiotherapy

Dr Dean McKenzie, as biostatistician from SPHPM, has co-authored a paper with researchers Daniel Hamilton, Jason Wasiak (SPHPM PhD Student) and Paul Fenton (from Epworth HealthCare) comparing the use of probiotics with psyllium husk as a bowel preparation for patients receiving radical radiotherapy for prostate cancer.

Prostate cancer is the most commonly diagnosed cancer in Australia, and the fourth leading cause of death in men.

Throughout radiotherapy, the prostate gland is susceptible to movement, leading to reductions in target coverage of radiotherapy which can lead to reduced tumour control.
Many variables such as bladder and bowel filling, respiration and leg rotation are implicated in internal prostate movement, however rectal distension is cited as the most important factor.

In light of these known facts, a bowel preparation resulting in stabilised rectal volume and therefore reduced prostate motion and deformation during radiotherapy treatment remains an area of clinical interest for clinicians and researchers alike. Increased knowledge and hopefully improved best practice has the potential for very positive impacts on patient outcomes and public health in general.

This retrospective pilot study analysed and compared a probiotic agent containing Lactobacillus acidophilus NCFM and Bifidobacterium lactis against a psyllium supplemented diet to establish the feasibility of probiotics as a bowel preparation for patients receiving radical radiotherapy for prostate cancer. The present pilot study compared the two types of bowel preparation, with five patients receiving each preparation. On treatment, cone beam computed tomography (CBCT) scans were compared with planning CTs to quantify inter-fractional variation in rectal volume and distension.

The results suggest that a probiotics-based bowel preparation that utilises Lactobacillus acidophilus and Bifidobacterium lactis may result in significantly increased rectal volume and CSA (cross-sectional) variation throughout treatment, in comparison with a psyllium-supplemented diet.

Consequently, these results have prompted the recommendation against the use of probiotics in isolation as a bowel preparation for radiotherapy in the treatment of prostate cancer until more evidence supporting its use becomes available.

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