Who Might Benefit From Radiation Therapy
Your doctor might recommend radiation therapy in several situations.
It can be the first treatment for cancer that hasnât spread outside your prostate gland and is âlow grade.â The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are â and, in general, the more likely your cancer is slow-growing.
Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.
If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldnât remove all of the cancer or if the cancer comes back in the area of your prostate.
If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.
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
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
What Are The Different Types Of External Beam Radiation Therapy
Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a CT scan to map your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.
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What Happens On Treatment Days
If you get external radiation therapy, youâll need to get regular sessions during a period of about 5 to 8 weeks.
For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure youâre positioned well, theyâll leave the room and start the radiation treatment.
Theyâll watch you closely during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Try to stay still and relaxed during treatment. Let the therapist know if you have any problems or you feel uncomfortable.
Theyâll be in and out of the room to reposition the machine and change your position. The treatment machine wonât touch you, and youâll feel nothing during the treatment. Once the treatment is done, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that youâre being positioned accurately during your treatments.
Port films donât provide diagnostic information, so radiation therapists canât learn about your progress from them. But these films do help the therapists make sure theyâre delivering radiation to the precise area that needs treatment.
Next Steps & Resources:
- Learn more about our featured clinical experts:
- Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Healths John Theurer Cancer Center and associate professor of Oncology at the Hackensack Meridian School of Medicine.
- Prashant Desai, M.D., medical director of radiation oncology at Hackensack Meridian Ocean Medical Center.
- Priti Patel, M.D., medical director of radiation oncology at Hackensack Meridian Riverview Medical Center.
- US News & World Report has recognized Hackensack Meridian John Theurer Cancer Center as the best cancer center in New Jersey. To schedule a visit or a second opinion call 551-996-5855.
- We also offer cancer services across Hackensack Meridian Health at several convenient locations near you. To schedule a visit or a second opinion call1-844-HMH-WELL.
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What Is 3d Conformal Radiation Therapy
Itâs a procedure that uses a computer to make a three-dimensional picture of your tumor. It helps your treatment team deliver the highest possible dose of radiation to the tumor while minimizing the damage to normal tissue.
3D conformal radiation therapy uses CT-based treatment combined with three-dimensional images of a prostate tumor. CT is short for computed tomography, which uses X-rays to produce detailed pictures inside the body.
So far, this technique has worked well for localized tumors such as prostate cancer limited to the prostate gland.
What Types Of Radiotherapy Are There
There are two common types of external beam radiotherapy:
- intensity-modulated radiotherapy
- 3-dimensional conformal radiotherapy .
You may also hear about image guided radiotherapy . This is part of all radiotherapy treatments. Taking images of the prostate before each treatment allows your radiographer to make small changes to the area that is going to be treated, in case the prostate has moved slightly since your last treatment session. This makes sure the surrounding healthy tissue gets as little radiation as possible. It also makes sure the whole prostate is treated.
This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location, size and shape of your prostate. The radiotherapy machine gives beams of radiation that match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects.
The strength of the radiation can be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate without causing too much damage to surrounding tissue.
3D conformal radiotherapy
As with IMRT, the radiation beams are mapped to the size, shape and position of the prostate. But the strength of the radiation cant be controlled in 3D-CRT, so all areas are treated with the same dose.
Other types of radiotherapy
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Dealing With Feelings Of Sadness
If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.
Talk to your GP, as counselling or medication even for a short time may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council may also run a counselling program in your area.
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Note The Time Of Your Procedure
A staff member from the Admitting Office will call you after 2:00 pm the day before your procedure. If your procedure is scheduled for a Monday, theyll call you on the Friday before.
The staff member will tell you what time to arrive at the hospital for your procedure. Theyll also remind you where to go. If you dont get a call by 7:00 pm, call .
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Focal Ablative Salvage Therapy
More recently, there is a growing body of research on focal salvage therapy to target just the identified tumor. This approach is called Focal Ablative Salvage Therapy, or FAST. Thanks to mpMRI and MRI targeted biopsy, the tumors location, extent, aggressiveness and genomics can be identified. Ablating just the tumor offers the dual advantage of cancer control plus low side effect risks. As with whole-gland primary treatment, the same three ablation methods can be used.
As of this writing, the most recent data was presented at the 2022 annual meeting of the American Urological Association by Dr. Deepika Reddy . The statistics were drawn from 288 consecutive cases of radiation recurrence that were treated with either focal HIFU or focal cryo . According to Dr. Reddys presentation, 265 patients had pertinent follow-up records for analysis. Patients had either stage T2 or T3 disease, and Grade Group 2, 3 or > 3.
Treatment was deemed successful based on failure-free survival and retreatment-free survival . The numbers are very encouraging, with 77% success rates for both FFS and RFS at 6 years post-FAST. About 7% of patients had adverse events following ablation, most of which were urinary infections. These patients avoided the surgical trauma of salvage prostatectomy, the increased cancer risk of salvage radiation, and the likely side effects of both.
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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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.
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
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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What Happens Before The Procedure
A transrectal ultrasound is done to provide the radiation oncologist with specific details about your case. Newer techniques using a CAT scan or MRI may be used to guide the proper placement of the implants. This information is used to custom-design the treatment plan for you. Another option is for the ultrasound and treatment plan to be done at the same time as the radioactive seeds are implanted.
How Does Brachytherapy Work
Brachytherapy involves implanting small, permanent radioactive seeds or temporary needles into the cancerous prostate.
After you are identified as a good candidate for brachytherapy, an ultrasound is used to guide the placement of needles into the prostate. Depending on whether you and your doctor have chosen permanent/low-dose brachytherapy or temporary/high-dose brachytherapy, these needles are then used to either put in permanent seeds or temporary radiation sources.
Placement of seeds is a minimally invasive procedure and does not require incisions. Men undergoing the procedure can return to full activity in less than a week. This is done as an outpatient procedure before you begin treatment.
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Why Measuring Survival Is Less Important Than Measuring Psa
Using survival as the measure for a successful prostate cancer treatment does not tell you whether the cancer is gone. Only PSA level can tell you that. If you fail the initial treatment, you can live with prostate cancer for many years. For example, one treatment can have a prostate cancer control rate of 80%, but because patients can live with their cancer for a long time, the survival rate may be 90%. It is very important to know the likelihood of requiring additional treatment and also the effects of additional treatment. Failure of the primary prostate cancer treatment will have a large impact on the quality of life.
The measurement used by the Foundation, Percent PSA Progression Free, is an estimate, prior to treatment, of a particular treatment failure rate, and the likelihood of not requiring additional treatment. Survival measurement does not provide this important information. Please understand this important point. If the survival rate of competing treatments are equal, this does not mean the cancer control rate, long term side effects, or the quality of life are equal.
Are You A Candidate
Whether your doctor recommends radiation depends on various factors, including your age, health, and personal preferences. The type of radiation is often dictated by your risk group and whether the cancer is localized or has spread.
Sometimes hormone therapy is given before radiation or along with it. ADT reduces levels of male hormones, called androgens, which can slow or even stop the cancers growth. Studies have found this one-two punch leads to higher survival rates than radiation alone among men with localized prostate cancer and a Gleason score of 7 or higher.
If you opt for surgery, your doctor may suggest radiation afterward, called adjuvant radiation therapy. “You have surgery to remove cancer, and then radiation to eliminate any remaining tumor deposits to keep cancer from returning,” says Dr. Anthony DAmico, a radiation oncologist with Harvards Dana-Farber Cancer Institute. Cancer that has grown beyond the prostate also may require post-surgery radiation.
After youve had radiation, youll have a prostate-specific antigen test every three to six months for five years and then annually after that to check for recurrence of the cancer. “If your PSA ever rises above 2, then imaging tests are done, and if needed, additional radiation or other appropriate treatment is given,” says Dr. DAmico.
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What Is Brachytherapy For Prostate Cancer
In high-dose brachytherapy , a single radioactive source is temporarily placed in the prostate using catheters. Typically, the catheters are inserted in the morning in the operating room under general anesthesia, then a CT scan is obtained for treatment planning, and the 5 to 15 minute treatment takes place in the afternoon. A combination of a long-acting local anesthetic and other medications keep the patient comfortable until treatment delivery. The catheters are removed at the end of the treatment. Patients go home that day and are not radioactive.
The time and position of the radioactive source is carefully controlled to maximize the radiation dose to the prostate and minimize the dose to the urethra, rectum, and bladder.
HDR brachytherapy alone can be used to treat low-risk patients, and can be used as a boost for higher-risk patients receiving external beam radiotherapy. In select patients, HDR brachytherapy can be used to treat failures from LDR brachytherapy or external beam radiotherapy.
Siteman is the first and only medical center in the region to perform HDR brachytherapy for prostate cancer. More than 200 patients have received the treatment since our program opened in 2014.
What You Need To Know About The Prostate How Do They Treat Prostate Cancer With Radiation
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .