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How Many Radiation Treatments For Prostate Cancer

Possible Side Effects Of Radiation Treatment

Which is Better – Surgery vs. Radiation for Prostate Cancer?

There are possible side effects associated with radiation therapy. Some people may not experience any side effects. Others may experience mild or bothersome side effects.

Some side effects may only last a short period of time, and others may last longer or forever. Side effects may occur at the time of treatment or could develop months after treatment.

Most side effects are manageable by your radiation team and last only a short time. Before starting treatment, your doctor will discuss possible side effects and their duration.

Because we use advanced targeting technology, the probability of side effects is lower.

Possible side effects include:

Bowel Issues Because radiation treatment is so close to the rectum, it could cause irritation. This irritation could cause soreness, blood in your stool, or rectal leakage. Most of the time these issues are temporary, but in rare cases, normal bowel function does not return. Because patients use a rectal balloon during each treatment, the likelihood of rectal issues is lower.

Urinary Issues Radiation can cause irritation to the bladder. This can cause urinary frequency, urgency and a burning sensation. If these problems occur, they generally go away after time.

Keeping your activity level up will result in less fatigue and feeling better.

Keeping your activity level up will result in less fatigue and you will feel better overall.

Questions To Ask Your Doctor Nurse Or Radiographer

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?

Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

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Why Choose Valley For Prostate Cancer Radiation

  • Fewer side effects through precision: Your decision whether to treat prostate cancer vs. choose active surveillance will typically factor in the risks and benefits of treatment. With radiation therapy that is extremely precise, many of the risks and side effects of treatment are severely reduced, if not eliminated. Thats why Valley invests in the very latest radiation technologylike the ExacTrac Dynamic systemto provide patients with the highest level of precision, effectiveness and safety.
  • SpaceOAR hydrogel: As an additional level of safety, we use SpaceOAR hydrogel during treatment to separate the prostate from the rectum. This separation allows our team to protect the rectum from radiation, and through that, preserve normal bowel function. This also allows us to treat your prostate cancer with higher doses of radiation in a shorter period.
  • Team approach to treatment recommendations: Valleys Urologic Oncology Program brings together prostate cancer experts to discuss each case and come to a joint treatment recommendation. That means you will hear one opinion about how to address your cancer from radiation oncologists, urologic surgeons and medical oncologists. In that way, you can feel confident moving forward with treatment vs. watching and waitingor vice versa.

Cancer That Clearly Has Spread

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If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.

When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.

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Working During Radiation Therapy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

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Who Should Consider External Beam Radiation Therapy

In most cases, external beam radiation therapy is used for men with localized prostate cancer . The intent of EBRT in this case is to kill the tumor while sparing as much healthy tissue as possible. Sometimes it is used in more advanced cases. For example, it can be used along with hormone therapy, or used to relieve pain from bone metastases.

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When Is Radiation Therapy Given

Radiation therapy may be used:

  • for localised or locally advanced prostate cancer it has similar rates of success to surgery in controlling prostate cancer that has spread to the lymph nodes
  • if you are not well enough for surgery or are older
  • after a prostatectomy for locally advanced disease, if there are signs of cancer left behind or the cancer has returned where the prostate used to be
  • for prostate cancer that has spread to other parts of the body.

There are two main ways of delivering radiation therapy: from outside the body or inside the body . You may have one of these or a combination of both.

In intermediate and high-risk prostate cancer, radiation therapy is often combined with androgen deprivation therapy .

Possible Risks And Side Effects Of Brachytherapy

How Radiation Affects The Prostate | Mark Scholz, MD

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.

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Who Should Consider Taking Radiopharmaceuticals

Radiopharmaceuticals are given through a vein to men with metastatic prostate cancer that has spread widely to the bone. Strontium89 and Samarium-153 are radiopharmaceuticals given to reduce the pain caused by the bone cancer. Radium-223, or Xofigo®, is a radiopharmaceutical given to prolong life.

The side effects associated with radiopharmaceuticals are mainly the suppression, or lowering, of white blood cell and platelet levels in the blood. Your doctor will be able to assess whether your body can handle this side effect before you are given the treatment and will monitor your levels after you receive it. Your doctor, specialist nurse, or nuclear medicine practitioner will be able to give you more information about the treatment and possible side effects.

If your doctor has told you that your bone metastases have spread, you may be a candidate for a radiopharmaceutical. Speak with your oncology team to see if one of these treatments may be right for you.

Talk With Your Doctor About Side Effects And What To Expect

Your doctor can help you determine whether radiation therapy is right for you.

In addition, an oncologist a doctor specializing in cancer treatment can help you learn how to minimize your chance of developing side effects.

They can also refer you to local support groups where you can get in touch with other people who have undergone or are undergoing the same treatment.

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Three Methods To Provide External Beam Therapy

Image Guided Radiation Therapy Normal structures and tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT is radiation therapy guided by imaging equipment such as CT, ultrasound or stereoscopic X-rays that are taken in the treatment room just before the radiation is delivered. All patients first undergo a CT scan as part of the planning process. The digital information from the CT scan is then transmitted to the treatment console to allow the therapists to compare the earlier image with the images taken just prior to treatment. This allows for better targeting of the cancer while avoiding nearby healthy tissue. In some cases, a tiny piece of material called a fiducial marker may be implanted near or in the tumor to help localize the tumor during IGRT.

Intensity Modulated Radiation Therapy Intensity modulated radiation therapy is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit your tumor. With IMRT, the radiation beam can be broken up into many âbeamlets,â and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the exact amount of radiation that is received by normal tissues that are near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, increasing the chance of a cure.

What Should Patients Know About Msks Approach To Treating Prostate Cancer

About Your Stereotactic Hypofractionated Accelerated Radiation Therapy ...

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. 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. We will often obtain next-generation imaging and do genomic testing. 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 one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. 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. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

We 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.

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Good Prostate Cancer Care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

Prices And Where To Get It

The cost of a radical prostatectomy varies depending on insurance status and location of surgery.

Costs may include hospital fees, anesthesia fees, and surgeon fees. The average cost of hospital fees for prostatectomy in the United States is about $34,000. Anesthesiologist and surgeon fees average about $8,000. What out-of-pocket expenses the person being treated incurs will depend on their insurance.

The location of the procedure can be with a local surgeon, or the person being treated may travel to see a regional or national expert.

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Prostate Cancer: Radiation Therapy

Radiation therapy, also called X-ray therapy, uses high levels of radiation to kill prostate cancer cells or keep them from growing and dividing while minimizing damage to healthy cells.

Radiation can be given from a machine outside the body and directed at the prostate . Or a surgeon can place radioactive materials into the tumor . These radioactive materials can be temporary or permanent.

How Much Radiation Therapy Costs

Radiation therapy for prostate cancer: What to expect

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for information on organizations that may help.

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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.

Heres What You Should Know About This Treatment Option

Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.

But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.

Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.

“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.

There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.

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