How Effective Is Modern Radiation Treatment Of Prostate Cancer
Radiation therapy can give more radiation dose directly to the prostate than to surrounding healthy tissues, given the improvements in technology and imaging techniques. Physicians use various imaging techniques to see the prostate and surrounding tissues in three dimensions, so that the radiation beams can be tailored more precisely to the individual patients unique needs. Physicians can estimate and minimize the dose of radiation that will be received near the rectum, small bowel, bladder and hips during the course of radiation treatment to reduce the risk of side effects and complications. The goal is to safely provide a higher dose of radiation than even five years ago, which helps to improve the chances of cure. For similar stage and prostate cancer types, radiation therapy is as effective as surgery but with a different treatment process and different side effects.
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Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.
If I Choose Radiation Therapy Will Surgical Treatment Still Be An Option
If radiation therapy is used as the primary treatment, and the treatment is not successful, surgery or repeat radiation therapy are not considered to be desirable treatments due to the high risk of serious complications. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you may have the same risk of cancer recurring if surgery is performed. If surgery is performed after radiation, or additional radiation is recommended, the physician performing the re-treatment should have a high level of experience. There are experimental clinical studies being evaluated for use of very localized re-irradiation for this group of patients. Some patients for which radiation is not effective are treated by systemic therapy or by close surveillance.
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What The Research Shows About Radiation Vs Surgery
The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.
The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year mark for radiation therapy, surgery or active surveillance.
If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 100,000 prostate cancer patients over a 15-year period.
As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.
The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.
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Higher Dose Radiation Raises Cure Rate
In the 2006 study conducted on nearly 5,000 radiation patients treated in nine academic U.S. radiation oncology departments standard doses for external beam radiation of the prostate were at or below 60 Gy.
Yet since then, radiation doses are often at or well above 70 Gy, due to the high-dose delivery systems in newer 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy , and Imaged Guided Radiation Therapy . Studies have shown that a higher dose of radiation significantly improves chances of the cancer not returning.
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A Large Role For Radiation Therapy
People diagnosed with localized prostate cancerthat is, disease that hasnt spread outside the prostate regionhave many potential treatment options, depending on the stage and grade . Some may have surgery alone. Others may only have radiation therapy.
And some may have a combination of the two. This often happens when theres concern that surgery hadnt removed all the tumor tissue. Or, if someones prostate-specific antigen levels start to rise months or years after surgery, radiation therapy may be recommended even if imaging hasnt been able to identify tumor growth.
Hypofractionated radiation therapy is already an accepted treatment option for some people undergoing radiation therapy alone to treat prostate cancer. But whether this type of radiation therapy is appropriate for use after surgery has been unclear.
When radiation is used after surgery, its delivered to a larger area of the body, including sensitive areas in the bladder and rectum, Dr. Buyyounouski explained. This raises the possibility that the higher doses used in hypofractionation may cause long-term side effects that could outweigh the benefit of two fewer weeks of treatment for these patients.
And a lot of people do have some urinary complications after surgery, said Dr. Citrin. So even a small increase in urinary or bowel symptoms that persist after treatment with one regimen versus the other could be quite impactful in terms of quality of life.
What Happens To The Prostate After Radiation
The entire prostate gland is radiated when we treat the cancer. The prostate normally produces some of the fluid in the ejaculation. Radiation therapy has the side effect of damaging the glands in the prostate, so a lot less fluid is produced. The ejaculation may be dry or nearly dry. In addition, you will probably be sterile after radiation, but this is not 100% guaranteed and should not be relied upon as a form of birth control. You can still usually have erections because the nerves and blood vessels that go to the penis are not as damaged as the prostate gland.
The prostate gland will end up having a lot of scar tissue. It will shrink in size to about half its original weight within a couple years after finishing radiation. The urethra passes through the canter of the prostate gland like the hole of a doughnut. Sometimes this passage can widen, other times it can shrink after radiation. In summary, the prostate gland is heavily damaged from radiation and does not work normally afterwards.
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Confirming What Weve Practiced For Years
- What was the grade of the cancer?
- Was it at the edge of the removed prostate gland?
- Was it in the attached seminal vesicles or extending beyond the capsule?
- Was there cancer in any removed lymph nodes?
- What is the trend of serum PSA since surgery?
- How old is the patient, what are his other medical issues, and what are his goals?
Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
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Treatment Options: When Cancer Returns After Radiation
After prostate cancer is treated, patients usually undergo a blood test called PSA. PSA stands for Prostate Specific Antigen and is a simple blood test that gives a number. After treatment, that number should be low. If it starts to increase, that can be a signal of cancer coming back, also known as cancer recurrence.
Often doctors will watch a series of PSA values to identify the trend. If the PSA number continues to increase, this is called biochemical failure, and your doctors will investigate the cause. Sometimes doctors will order scans to see if there is cancer recurrence locally , or distantly . Treatment is different depending on where the cancer is found.
If there is high suspicion for local recurrence, your doctors may encourage a prostate biopsy to see if there is tumor identified under the microscope. If so, there are several local treatment options including cryotherapy and prostatectomy. Some patients may choose observation.
Brachytherapy Option
What about using brachytherapy on the prostate? This has not been as popular given the concern about risk of toxicity for patients who have used external beam radiation previously
More follow up is needed and the complete results will be reported with longer follow up, but this study shows that salvage brachytherapy may be another option in the treatment of recurrent prostate cancer after radiation therapy.
How Can I Choose From Among The Options
In addition to talking with family and friends, you will need a team of physicians to help advise you. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:
- your primary care physician as well as a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy.
Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .
If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.
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When Is Brachytherapy Alone The Right Choice
For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease then it would be very appropriate to do active surveillance and hold off on treatment.
How Long Will My Follow
You will have follow-up appointments for some time after your treatment. Exactly how long will depend on your cancer, any side effects of treatment and the services in your area. You will usually have appointments for several years.
After your follow-up appointments finish, you may continue to have PSA tests. Speak to your GP if you have any problems or concerns they can refer you back to the hospital. Make sure you remind them about your prostate cancer, especially if its been a while since you had treatment or a PSA test.
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Chemotherapy Drugs For Prostate Cancer
- Docetaxel
- Mitoxantrone
- Estramustine
The drugs listed above are only a sample of what is available and is used to illustrate a truth. Because of the range and variety of drugs used in both these treatments the impact on sexual function can range from sever to insignificant.
Hormone replacement therapy for prostate cancer, for example, can often impact sex drive rather that create erectile dysfunction. It is important to work with your physician to explore all available treatment options. How to keep a healthy erection?
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During Your Radiation Treatments
When its time for your treatment, your radiation therapists will bring you to the treatment room and help you onto the treatment table. Youll be positioned exactly how you were during your simulation. Your radiation therapists will do everything they can to make sure youre comfortable during your treatment. Then, theyll leave the room and start your treatment.
Breathe normally during your treatment, but dont move. Your radiation therapists will be able to see you on a monitor and hear you through an intercom during your whole treatment. Tell them if youre uncomfortable or need help.
Neither you nor your clothes will be radioactive during or after treatment. Its safe for you to be around other people.
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During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
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Hormone Therapy Helps Some Prostate Cancer Survivors Live Longer
A study published in the New England Journal of Medicine in January 2017 indicates that men whose prostates are removed to treat prostate cancer are likely to survive longer if they take drugs to block the male hormone testosterone in addition to undergoing radiation therapy.
Unfortunately, its not that simple.
Rx Drugs For Advanced Pc Can Be Effective
Surgery and radiation are usually first-line treatments for localized prostate cancer requiring action, says Przemyslaw Twardowski, M.D., medical oncologist and director of clinical research in the department of urology and urologic oncology at Saint Johns Health Center in Santa Monica, CA. But if doctors have determined that your cancer is advanced, meaning that its spread beyond the prostate gland, then medications, sometimes used in combination with other treatments, may be the more effective approach.
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Short Term Side Effects
Patients who receive any type of radiation therapy to treat their prostate cancer can have side effects. Short term side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment