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How Successful Is Radiation Therapy For Prostate Cancer

Why Are There Marks On My Skin

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

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.

How Prostate Cancer Staging And Risk Stratification Affect Treatment Options

Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

Prostate cancer staging

Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

Localized, meaning theres no indication that the cancer has spread beyond the prostate

Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue

Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate

Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

Prostate cancer risk assessment

How Is Prostate Cancer Classified

Tumors in the prostate range from slow-growing to fairly aggressive. Theyre referred to by a number, known as a Gleason score, which combines a pattern type and a stage . The resulting score is on a scale from two to 10, where lower scores indicate cells that are more similar to surrounding cells than higher ones scores below six respond well to 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.

Treatment By Stage Of Prostate Cancer

Radiation Treatment For Prostate Cancer Success Rate ...

Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you 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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The Best Method For Measuring Prostate Cancer Treatment Success

Measuring the Prostate Specific Antigen level is the most important, and most common test to measure success of treatment of prostate cancer.

Why? First, regardless of the treatment you receive, it is the test you will have each time you have a medical visit, and it is the test you and your doctor will use to determine if your cancer is controlled or not.

Second, if PSA levels become elevated after treatment, it will mean you need further tests and very likely further treatment. The tests and subsequent procedures following an elevated PSA level after treatment can significantly worsen the quality of your life. Before deciding on an initial treatment, you need to understand how well that treatment does at controlling the cancer. What is the chance that you will need further treatment? PSA progression rates provide a level playing field to compare the different treatments.

Initially, PSA is used as a cancer screening tool. But after treatment, PSA is used to monitor for the recurrence of cancer.

How Does Radiotherapy Work

Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy is high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body . Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.

Radiotherapy treats the whole prostate. It aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects that may cause you problems.

You may have radiotherapy to a wider area, including the nearby lymph nodes, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. If you do have radiotherapy to a wider area, you will be more likely to get side effects.

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Possible Side Effects Of Ebrt

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

What Types Of Radiotherapy Are There

Radiation therapy for prostate cancer: one patient’s story

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.

Intensity-modulated radiotherapy

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

Proton beam therapy

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Side Effects Of Surgery For Prostate Cancer

The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.

According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.

While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.

While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.

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.

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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.

Remission And The Chance Of Recurrence

Radiation Treatments for Prostate Cancer

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-only or biochemical recurrence.

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Radiation Therapy In Advanced Disease:

Some forms of radiation therapy, like external radiation therapy and radiopharmaceuticals, can help with advanced prostate cancer. One type of external radiation therapy is used along with hormone therapy to treat cancer that has spread outside the prostate to nearby tissue. In addition, radiopharmaceuticals are used to manage pain and symptoms of bone metastases. Scroll down to learn more about radiopharmaceuticals.

Staging Of Prostate Cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .

The stage of the cancer will determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

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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.

Radical Prostatectomy vs. Radiation: How to Compare the Results

Making a decision about prostate cancer treatment is not easy. When considering radiation therapy or radical prostatectomy, one of your top concerns is seeking reassurance that your cancer will be cured following treatment.

How Does Brachytherapy Work

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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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Will My Diet Affect My Treatment

Yes. Good nutrition is an important part of recovering from the side effects of radiation therapy. When you are eating well, you have the energy to do the activities you want to do, and your body is able to heal and fight infection. Most important, good nutrition can give you a sense of well-being.

Since eating when you don’t feel well can be difficult, consider working with a dietitian. They can help make sure that you are getting adequate nutrition during your radiation therapy.

Q: What Can Be Expected During Prostate Cancer Radiation Therapy

EBRT is similar to having a routine X-ray. Radiation is not seen, smelled or felt and side effects dont occur until 2 or 3 weeks into treatment. Prostate cancer radiation therapy is a local treatment so only the areas of the body where it is administered will experience side effects.

Most patients experience some or all of the following prostate cancer radiation therapy side effects:

  • Burning or tingling with urination
  • Difficulty starting urination or weak urinary stream
  • Hemorrhoids or rectal irritation with some blood
  • Increase in urination frequency and urgency
  • Infrequent, softer and smaller volume bowel movements
  • Occasional diarrhea

Depending on the severity of these side effects, patients will be given anti-diarrheal medications or a medication to decrease the frequency of urination. Most symptoms are short-lived and diminish after the prostate cancer radiation therapy ends. Otherwise, patients typically continue with their normal daily activities during treatment.

Patients are given detailed written instructions about the following:

Sperm production Prostate cancer radiation therapy affecting the testicles may lead to a temporary reduction in sperm count and, in some cases, lead to a permanent reduction in sperm count or sterility. Patients who are considering conceiving should seek medical advice regarding fertility and sperm banking.

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