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External Beam Radiation Therapy For Prostate Cancer

Advantages And Disadvantages Of External Beam Radiotherapy For Early Prostate Cancer

External Beam Radiation Therapy for Prostate Cancer

You may want to think about the advantages and disadvantages of external beam radiotherapy when deciding about treatment.

Radiotherapy and radical prostatectomy are both treatments that may cure early prostate cancer. They are equally effective in treating the cancer.

To choose the treatment that is best for you, it can help to look at the different advantages and disadvantages of each one. You can then make your decision in partnership with your doctor.

What Is External Beam Radiation Therapy For Prostate Cancer

  • External beam radiation therapy for prostate cancer is treatment using radiation to kill cancer cells in your prostate. The prostate is a male sex gland that helps make semen. It wraps around your urethra and the bottom of your bladder. The urethra is a tube that carries urine from your bladder to the end of your penis. With prostate cancer, tumor cells turn to cancer, and divide without control or order. These cancer cells often grow, and spread to nearby areas of your body.
  • Radiation is a very strong beam of x-ray energy. External beam radiation therapy stops tumors from growing, and makes them smaller. Tumors may go away completely after this treatment. It may also stop the tumor from spreading to other parts of your body. This treatment can be used when cancer has spread to vesicles that carry semen and pelvic lymph nodes. It can be used with other treatments such as medicines, chemotherapy, and surgery to treat your cancer.

What Are The Side Effects Of External Beam Radiation Therapy

As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:

  • Skin irritation
  • Erectile dysfunction
  • Secondary malignancy

If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.

Recently, the FDA approved the use of Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.

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What Happens After Radiotherapy

After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:

  • check how your cancer has responded to treatment
  • help you deal with any side effects of treatment
  • give you a chance to raise any concerns or ask any questions.

Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have

follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.

PSA test

The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.

After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.

Treatment options after radiotherapy

Looking after yourself after radiotherapy

If Treatment Does Not Work

Figure 2 from Initial results for patient setup ...

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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How To Handle A Relapse After Treatment For Prostate Cancer

Am I going to die? This is the first question a patient usually asks me when a follow-up blood test reveals that his prostate-specific antigen level has risen after he has already undergone treatment for prostate cancer . The fear is understandable: When PSA levels rise to a certain threshold after prostate cancer treatment, the patient has suffered what is known technically as a biochemical recurrence, sometimes also referred to as a biochemical relapse or stage D1.5 disease. Whatever term is used, it means that prostate cancer remains within the prostate after radiation therapy, that it survived outside the excised area after radical prostatectomy, or that it has reappeared in metastatic form in other tissues and organs. In most cases the cancer remains at a microscopic level, and many years will pass before any physical evidence of it is detectable on a clinical exam or any abnormalities are seen on a bone scan or CT scan.

Thats usually of small comfort to the patient whose PSA has risen. Its emotionally traumatic to go through treatment for prostate cancer, thinking it is cured, and then learn that it might have come back. For many men, its as if theyre dealing with another diagnosis of cancer, except this time its much worse because there is less likelihood of getting cured. A mans confidence and sense of safety may be shattered, especially because the popular misconception is that when prostate cancer recurs, it is deadly.

If This Uncertainty Would Bother You So Much That It Would Affect Your Quality Of Life Surgery May Be A Better Option For You Phuoc Tran Md Phd

However, if youre okay with waiting for the PSA nadir, and if you dont mind getting treatment over the course of a few weeks instead of in one operation, then radiation may be ideal for you.

What are my options?

Conventional external-beam radiation therapy is given in little doses, a few minutes a day, five days a week, for seven or eight weeks. These small doses minimize the injury risk for the healthy tissue near the tumor. Scientists measure radiation in units called Gy . Most men get a minimum total dose of 75.6 Gy, but could get as much as 81 Gy this works out to 2 Gy or less per day.

The treatment itself is painless just like getting an x-ray at the dentists office. But one big challenge with getting repeated treatments is making sure youre always in the exact same position, so the radiation can hit the target the way its supposed to. Thus, you will be custom-fitted with your own pelvic immobilization device, which will not only keep you from fidgeting, but will make sure youre not slightly higher and to the right on the table one day, and slightly lower and to the left the next.

When you get fitted for your device, you will have a CT scan, so doctors can get a 3D look at your prostate. Then, when you get the radiation, you wont just get it from one side, but from multiple directions, and each beam of radiation will be individually shaped to target the cancer and a 5- to 10-millimeter margin of healthy tissue around the prostate.

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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy

Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.

How Is External Beam Radiation Therapy Given

External-Beam Radiation Treatment for Prostate Cancer
  • You will need to wear a hospital gown for the treatment, and you may need to have a full bladder. This will help push away the tissues around your prostate so that the radiation beam can point directly at your tumor. You are taken to a room where the treatment will be given. Caregivers will have you lie down on a special table that can be moved to different positions. The table is moved into the treatment area. A CT scan or ultrasound may be used to mark the location and shape of your tumor. This helps caregivers set and point the beam right at the tumor. A machine is used to make the x-ray beam. A low energy or high energy beam may be used.
  • Dye may be given so that caregivers can see your prostate gland clearly. When you are in the right position, pillows or supports will be used to hold you in place. You will be asked to lie still during the treatment. Your treatment will last for a short time, and should not be painful. After the treatment, you may be able to go home. Treatments are done every day, and you may need them for up to eight weeks. A wide energy beam may be used to treat the whole prostate gland. It can also be used when there is a high risk for cancer to spread to nearby areas in your body.

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What Is External Beam Therapy And How Is It Used

External beam therapy , also called external radiation therapy, is a method for delivering a beam or several beams of high-energy x-rays to a patient’s tumor. Beams are generated outside the patient and are targeted at the tumor site. These high energy x-rays can deposit their dose to the area of the tumor to destroy the cancer cells and, with careful treatment planning, spare the surrounding normal tissues. No radioactive sources are placed inside the patient’s body.

External beam therapy is used to treat the following diseases as well as many others:

Why is this procedure performed?

External beam therapy is most commonly used to treat cancer. Often, the goal is to eliminate a tumor or prevent a tumor from returning. The procedure may also be performed before or after surgery to remove a cancerous tumor, to reduce the tumor size before surgery, or to prevent the tumor from coming back after surgery.

EBT may also be used as a palliative treatment in patients with advanced stage cancer or cancer that has metastasized. In this case, the goal of therapy is to reduce a patient’s symptoms rather than cure the cancer.

What To Expect After Radiation Treatment For Prostate Cancer

What to Expect After Radiation Treatment for Prostate Cancer? Many patients wonder what to expect after receiving radiation treatment for prostate cancer. It is the most widely used method of treatment regardless of the cancers stage. Radiation therapy can be followed by a radical prostatectomy, which removes the prostate gland and nearby lymph nodes.

Prostatecancer is the most diagnosed solid tumor type among men. In the early stages ofprostate cancer, indolent cases without major symptoms will receive activesurveillance and watchful waiting to observe how the disease progresses. If thecancer spreads outside of the prostate gland, other treatment options areconsidered, the first of which being radiation.

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Stereotactic Body Radiation Therapy

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.

The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

Frequent Urination Burning With Urination And Difficulty Urinating

New Prostate Cancer Guideline Offers Shortened Radiation Time

These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.

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Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

  • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
  • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
  • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
  • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

How Does Your Doctor Plan Your Radiation Treatment

Radiation is planned and given by a team of trained health care providers. The radiation oncologist is a doctor who treats cancer with radiation and oversees the care of each patient getting radiation. Working closely with the radiation oncologist, the radiation therapist gives the daily radiation treatment and positions patients for each treatment. Other professionals include the medical physicist and dosimetrist who plan and calculate the doses of radiation.

Before starting radiation therapy, your radiation oncologist will examine you, review your medical history and test results, and pinpoint the exact area to be treated. This planning session is called simulation. You might hear this referred to as the sim. Youll be asked to lie still on a table while the radiation therapist uses imaging scans to define your treatment field . These are the exact places on your body where the radiation beams will be aimed.

The simulation is very important and may take some time. It’s used to plan exactly where the treatment will be on or in your body. The radiation can then be delivered as directly as possible to the tumor while affecting normal, healthy tissues as little as possible.

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Are There Side Effects Of The Combination Approach

There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects, both of which are common with any radiation treatment given to the prostate. But at MSK, we routinely use sophisticated planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications.

In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation that the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and after a few months dissolves on its own within the body, causing no harm or long-term effects.

Questions To Ask Your Doctor Nurse Or Radiographer

External Beam Radiation Therapy for Prostate Cancer

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of radiotherapy will I have?
  • How many sessions will I need?
  • What other treatment options do I have?
  • What are the possible side effects and how long will they last?
  • What treatments are available to manage the possible side effects from radiotherapy?
  • Will I have hormone therapy and will this carry on after radiotherapy?
  • How and when will I know if radiotherapy has worked?
  • If the radiotherapy doesnt work, which other treatments can I have?
  • Who should I contact if I have any questions?
  • What support is there to help manage long-term side effects?

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Will Radiation Therapy Make Me Tired

Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.

If your doctor thinks you should limit your activity, they will discuss it with you.

To minimize fatigue while you are receiving radiation treatment:

  • Be sure to get enough rest.
  • Eat well-balanced, nutritious meals.
  • Pace your activities and plan frequent rest periods.

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