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External Radiation For Prostate Cancer

University Of Michigan Radiation Oncologist And Pcf

Radiation therapy for prostate cancer: What to expect

If you are about to undergo external-beam radiation for prostate cancer, you may find that the treatments themselves are easy. Preparing for the daily treatments, however, may take some getting used to but you can do it!

Here with some tips is University of Michigan radiation oncologist and Prostate Cancer Foundation -funded investigator, Daniel Spratt, M.D. The most important thing you can do, Spratt advises, is to familiarize yourself with the anatomy of the pelvis your doctor may have literature with an illustration that will help. If not, heres one that will give you a better understanding of where the prostate is, and the important anatomy nearby.

Seeing the big picture literally will help make it clear why your doctor is asking you to come to your treatments with a comfortably full bladder and an empty rectum, Spratt says. Having a full bladder is going to move the intestines upward and away from the radiation, and having a rectum about the same size every time the way we planned it before your treatment helps us be very precise, to make sure were giving all that dose to the prostate and not hitting the rectum, or that were avoiding the rectum but also missing some of the prostate. It allows us to use very tight margins, treating every bit of the cancer but not harming the normal tissue. Every program has a slightly different protocol, but the main thing is to keep things generally about the same every time.

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Treating Advanced Prostate Cancer

If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • hormone treatment
  • chemotherapy

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Can Surgery And Radiation Be Used Together

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

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Side Effects Of Radiation Therapy

Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.

With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.

This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.

What Is External Radiotherapy

External Beam Radiation Therapy For Prostate Cancer

External radiotherapy is a technique used to treat localised prostate cancer i.e., that has spread outside the organ or locally advanced cancers that only affect the area adjacent to the prostate.

In some cases, the therapy is also beneficial in controlling the cancers progression and relieving symptoms. It can also be used to treat cancer metastases if symptomatic or few in number.

Radiotherapy seeks to destroy cancerous cells without causing major damage to healthy tissue. It uses ionising radiation in the aim of permanently eliminating the cancer and preventing it from growing or spreading to other parts of the body.

Though healthy cells are affected, they have the power to recover their integrity and function more quickly.

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Combined Prostate Implantation And Ebrt

Current data suggest that the clinical outcomes of patients treated with external beam radiotherapy and those of patients treated with permanent prostate brachytherapy are comparable if properly selection criteria are used .

An ongoing Radiation Therapy Oncology Group trial should clarify the difference between the 2 forms of therapy. Although permanent brachytherapy is widely accepted for patients with low risk of extracapsular disease, its role in other patients is less clear.

A well-performed prostate implant is perhaps the most conformal type of radiation treatment available. To this end, brachytherapy has been used more frequently for boost purposes in patients with more advanced disease . Prospective data demonstrating an improved outcome in comparison with EBRT alone are scant however, the logic of combined treatment is irrefutable.

Using brachytherapy alone is reasonable if one wishes to treat only the prostate and immediate periglandular tissue. However, if the patient is believed to be at increased risk for extracapsular disease, brachytherapy may not adequately address all sites of potential disease. In this instance, many clinicians consider supplementing the brachytherapy dose with a shortened course of EBRT.

When implantation is followed by EBRT, the brachytherapy doses with I-125, Pd-103, and Cs-131 are reduced to 108 Gy, 90 Gy, and 90 Gy, respectively. When EBRT follows permanent prostate implantation, the dose usually is limited to 45 Gy per 5 weeks.

If Treatment Does Not Work

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 some 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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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.

Side Effects Of External Radiotherapy

External Beam Radiation Therapy is a non-invasive treatment option for prostate cancer

You might have a few side effects with palliative radiotherapy. The effects vary, depending on which part of your body is treated.

You have more side effects if you have radiotherapy to the prostate to try to control your cancer. This includes loose or watery poo and passing urine more often.

  • Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021

  • Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and othersAnnals of Oncology, 2020. Vol 31, Issue 9. Pages 1119-1134

  • Cancer: Principles and practice of oncology VT De Vita, TS Lawrence and SA RosenbergLippincott, Williams and Wilkins, 2019

  • External beam radiotherapy for patients presenting with hormone sensitive, low volume metastatic prostate cancer at the time of diagnosisNHS England, 2021

  • Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer : a randomised controlled phase 3 trialC Parker and others

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Why Are There Marks On My Skin

Your radiation therapist will make small marks resembling freckles on your skin along the treatment area. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area.

Donât 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: What Are The Options

For much of the past, external radiation therapy was available in primarily one form:External Beam Therapy . During EBT, a machine called a linear accelerator delivers high energy beams of radiation towards the targeted place on the body, called the treatment field. The treatment field is identified before EBT is started by using imaging such as magnetic resonance imaging or computed tomography to identify the precise location of the prostate tumor. EBT is usually administered during brief sessions five days a week over the course of five to eight weeks.

More recently, newer methods of delivering external radiation have become available, allowing for better localization of radiation towards the prostate while sparing the surrounding normal or healthy tissue, including bladder and rectum.

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Side Effects Of Ebrt For Prostate Cancer

Many of the possible side effects of radiation therapy for prostate cancer involve the bladder and bowelthe prostate is very close to both. Although the goal is to target only the prostate with radiation, sometimes small amounts may cause problems to nearby areas of the body.

Some of the potential side effects from EBRT include:

  • Bowel problems, including diarrhea, leakage or rectal bleeding
  • Urinary symptoms, such as a need to urinate more frequently, incontinence or a burning sensation during urination
  • Lymphedema

Intensity Modulated Radiation Therapy

Prostate Radical Prostatectomy surgical operation

IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.

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What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

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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External Radiation For Prostate Cancer

Definitive Radiation Therapy External-Beam Treatment

Traditional radiation techniques encompass the entire prostate and, for those at high risk of the disease spreading, the pelvic lymph nodes. A recent study suggests that treating the lymph nodes may be beneficial in patients at risk for harboring lymph node metastases.

Conformal External-Beam Therapy

This type of therapy creates three-dimensional representations of target structures and designs a high radiation dose that conforms to the target shape. The anatomic information used to define the target is generally derived from CT images obtained while the patient is placed in the precise treatment position.

Early results using conformal therapy showed an improvement in survival rates. Also, conformal therapy has permitted the use of doses far above traditional levels without significant increases in serious side effects.

Intensity-Modulated Radiotherapy

This type of treatment for prostate cancer has only recently been introduced. IMRT is a refinement of conformal external-beam therapy, employing a highly non-uniform beam to create greater conformal dose distributions. Although it is likely IMRT will have an increased benefit in the treatment of non-prostate cancers , there is emerging evidence that prostate cancer therapy is also an appropriate site for IMRT treatment.

High-Dose-Date Devices

External Beam Radiation Treatment

with or without High Dose Radiation interstitial therapy

Radical Prostatectomy

Radiation Therapy

What Are The Side Effects Of External Beam Radiation Therapy

External-Beam Radiation Treatment 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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Image Guided Radiation Therapy

In this type of radiation therapy, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue.

In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.

Calypso is another form of IGRT where the prostate can be tracked during the treatment.


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