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External Beam Radiation Treatment For Prostate Cancer

What Happens After Radiotherapy

External Beam Radiation Therapy for Prostate Cancer

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

Possible Risks And Side Effects Of Brachytherapy

Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

To learn more, see the Radiation Therapy section of our website.

What Is A Radiation Oncologist

If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the persons overall health and well-being through the process.

With advanced cancer, a patient may also be referred to a medical oncologist. This specialized doctor uses medicines such as chemotherapy and hormone therapy to treat cancers. Its common for several medical specialists to work together on a treatment plantheyre known as a cancer care team.

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External Beam Radiation Therapy

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

Types Of External Beam Radiation For Prostate Cancer

Figure 2 from Initial results for patient setup ...

3-D Conformal Radiation Therapy is one of the advanced procedures used to deliver radiation to the prostate. It involves the use of a body immobilization device to enhance the precision of the treatment. For the radiation therapist it gets simpler to target radiation on an immobile patient because there is no risk of patient movement. This minimizes damage to the surrounding healthy cells and maximum destruction can be caused to the targeted area. The second treatment option is Proton Beam Radiation Therapy which is quite similar to the procedure of 3D-CRT. The use of proton beams allows for improved precision and results in maximum energy being deposited into the cancerous tissue.

Another treatment version available today is Intensity Modulated Radiation Therapy that goes one step beyond 3D-CRT. In this case the intensity of the external beam is modulated in such a way that smaller beams of radiation are delivered from different positions at small intervals. The number of beams becomes higher, but each beam is thinner and more precise to hit the targeted cells, and spare the healthy cells. IMRT is gradually gaining an increased acceptance as an effective delivery mechanism for radiotherapy for prostate cancer.

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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.

Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

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Why Might Hormone Therapy Be Given Before Or After Ebrt

Prostate cancer grows in response to the male hormone testosterone. Hormone treatment works by reducing the amount of testosterone in your body and as a result slows down the growth of the cancer or shrinks it. However, hormone treatment does not cure prostate cancer.

Some men may be given hormone treatment for prostate cancer for several months before radiotherapy treatment with the aim of shrinking the cancer so that radiotherapy has a higher/better chance of working.

For men who have high-risk prostate cancer hormone therapy may be continued after radiotherapy. In this case radiotherapy usually starts after 3 6 months of hormone therapy and only when the PSA level is less than 1. Hormone therapy is continued for up to 2-3 years as it has been shown to reduce recurrence rates and improve survival.

What Side Effects Will I Have

External-Beam Radiation Treatment for Prostate Cancer

During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation. Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice a loss of hair or decreased perspiration within the treated area.

These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. If skin changes appear outside the treated area, inform your doctor or primary nurse.

Long-term side effects, which can last up to a year or longer after treatment, may include a slight darkening of the skin, enlarged pores, increased or decreased sensitivity of the skin, and a thickening of tissue or skin.

Another possible side effect is erectile dysfunction and urinary symptoms such as frequency, bleeding, or, rarely, incontinence. Keep these side effects in mind when considering your treatment options. If you have any concerns, don’t hesitate to talk to your doctor about them.

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Bowel And Bladder Problems

You may have bowel or bladder changes because of radiotherapy. For example, blood vessels in your bowel and bladder can become more fragile. This may cause blood in your urine or from the back passage . If you notice any bleeding, always tell your doctor so they can check it out.

Let them know about any bowel or bladder symptoms you have. They can give you advice and may do some tests. You may also find it helpful to contact the Bladder and Bowel Community for support.

What To Wear For Your Treatments

Wear clothes that are comfortable and made of soft fabric, such as fleece or cotton. Choose clothes that are easy to take off, since you may need to expose the treatment area or change into a hospital gown. Do not wear clothes that are tight, such as close-fitting collars or waistbands, near your treatment area. Also, do not wear jewelry, adhesive bandages, or powder in the treatment area.

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Why Are There Marks On My Skin

Small marks resembling freckles will be made on your skin along the treatment area by the radiation therapist. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area. Do not try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.

External Radiation Therapy Machines Linear Accelerator Is The Most Commonly Used Machine For Giving External Radiation Therapy It Delivers High

New Prostate Cancer Guideline Offers Shortened Radiation Time

CyberKnife is a small compact linear accelerator mounted on a robotic arm that moves around the person to give radiation from many different directions. It also has several x-ray cameras . Computers track a persons position and movement. If a person moves slightly, the robotic system can adjust by repositioning the linear accelerator before the beam of radiation is delivered. CyberKnife is particularly useful for treating tumours of the lung because of movement during breathing. It is most used for treating tumours of the brain, lung, prostate and spine. CyberKnife uses larger doses of radiation for each treatment than a LINAC so fewer treatment sessions are needed. Each session may take 30 to 90 minutes. Not every cancer treatment centre has a CyberKnife.

Gamma Knife is designed to give external radiation therapy to the brain. It delivers about 200 thin beams of high-energy radiation at a tumour. The highest dose of radiation is delivered at the point where the beams cross . It is usually given in a single session and used to treat primary brain tumours or brain metastases. The technique is sometimes called Gamma Knife radiosurgery.

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What Are The Advantages And Disadvantages Of External Beam Radiotherapy

What may be important for one person might not be so important for someone else. If youre offered external beam radiotherapy, speak to your doctor, nurse or radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.

Advantages of external beam radiotherapy

  • If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
  • Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
  • Radiotherapy can be an option even if youre not fit or well enough for surgery.
  • Radiotherapy is painless .
  • The treatment itself only lasts around 10 minutes, including the time it takes to get you into position. But youll probably need to be at the hospital for up to an hour each day to prepare for your treatment. You dont need to stay in hospital overnight.

Disadvantages of external beam radiotherapy

I was able to continue working throughout my treatment, although I got tired quickly. I had some side effects but nothing I couldnt cope with. A personal experience

What Are The Different Types Of Internal Radiation Therapy

Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside. However, the similarities mostly end there. Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer. Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Read on to find the details of each.

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Why Might Ebrt Be Suggested

EBRT can be used in the following ways:

  • As the primary/main treatment when the cancer is localised, contained within the prostate and has not spread to other parts of the body -this is called radical radiotherapy
  • For men with low, intermediate and high-risk prostate cancer.
  • As a treatment, after a period of active surveillance. If there are signs of the cancer growing or progressing, then EBRT may be one of the treatment options offered to you
  • For men who are expected to live for at least 10 years
  • After radical prostatectomy if there are high-risk features or if there are signs of the cancer growing again
  • For men who are fit enough to have treatment and do not have other significant medical conditions that may impact on survival and life expectancy
  • In combination with hormone therapy for treatment of cancers that have spread out-with the prostate capsule or affected other organs nearby such as the seminal vesicle. Hormone treatment can be used on a short term basis or long term basis
  • Smaller doses of EBRT can also be used very effectively to treat bone pain in cases of cancer spread to the bones.

What Are The Side Effects Of External Beam Radiation Therapy

External Beam Radiation Therapy for Prostate Cancer

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 Should Patients Know About Msks Approach To Treating Prostate Cancer

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease and to the individual person. There is no one specific therapy that is best for everyone.

Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are the only center in the world to do MRI-based treatment planning. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. This allows us to make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

For more advanced disease, we have ongoing studies in which we combine novel hormonal therapy agents with radiation to achieve better results. Even the way we follow our patients after treatment is unique, with carefully sequenced MRI checks that give us opportunities to monitor patients extremely closely.

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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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