How Successful Is Radiation Treatment For Prostate Cancer

Side Effects Of External Beam Radiation Therapy

How Radiation Affects The Prostate | Mark Scholz, MD

Each type of external beam radiation therapy causes similar side effects. Some are temporary or self-resolving, but others may be long-lasting or permanent. In some instances, erectile dysfunction may start to occur several months after your treatment is complete.

Short-term side effects may include:

Urinary symptoms such as urgency, needing to urinate often at night, and a weaker urine stream
Loose bowel movements
Redness or bruising at the radiation site

Long-term side effects may include:

Erectile dysfunction, including difficulty getting and maintaining an erection hard enough for penetration
Urinary dysfunction, including incontinence
Rectal inflammation

You may be able to reduce your risk of some long-term side effects before beginning therapy. Before starting radiation, talk to your doctor about using a hydrogel spacer during treatments. This technique reduces exposure of healthy rectal tissue to radiation.

Your surgeon will insert hydrogel in the space between the prostate and rectum, increasing the distance between the rectum and the radiation beam. This technique may help you to avoid proctitis.

Erectile dysfunction affects most prostate cancer patients who have radiation, at least temporarily. When the nerves are left intact, this side effect usually improves.

Talk to your doctor about vessel-sparing radiation, which may preserve erectile function more effectively than some other forms, including standard external beam radiation.

Advantages And Disadvantages Of Radiation Therapy

The advantages of radiation therapy include:

death of a large proportion of cancer cells within the entire tumor
death of microscopic disease at the periphery of the tumor that would not be visible to the naked eye
ability to shrink tumors
relative safety for the patient
synergy with systemic therapy
organ preservation (e.g. not removing a breast, larynx, or part of the gastrointestinal tract, which would have significant negative impact on a patients quality of life
possible stimulation of an immune response against the tumor

The disadvantages of radiation therapy include:

damage to surrounding tissues , depending on how close the area of interest is located to the tumor
inability to kill tumor cells that cannot be seen on imaging scans and are therefore not always included on the 3D models of radiation planning
inability to kill the all cancer cells in tumors
inability to relieve mass effect in certain parts of the body , thereby requiring surgery
poor killing of cancer cells in areas that do not have a good supply of oxygen
increased incidence in wound complication and poor healing
inconvenience of radiation therapy

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Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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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.

Entrance And Exit Dose Defined

External Beam Radiation Therapy for Prostate Cancer

Entrance dose: The dose of radiation that inadvertently makes contact with normal cells before it reaches the cancerous tissue.

Exit dose: Imagine the radiation hitting the tumor, but then continuing on beyond it, taking out normal cells in its path.

The primary difference between proton therapy and Cyberknife is that protons do not have an exit dose, says Dr. Cavanaugh. Both modalities deliver entrance and target dose.

Many insurers have been unimpressed with the differences in outcomes with proton therapy and have declined to pay.

For many patients I prefer HDR brachytherapy to both proton and Cyberknife therapy. HDR stands for high dose rate.

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Diarrhea Flatulence Or Painful Defecation

These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

How Well It Works

For men with localized prostate cancer, radiation works about as well as surgery to treat the cancer. With either treatment, the chance of the cancer spreading is low. One study looked at men who had localized prostate cancer and found that the risk of dying was very low . The study found that the risk of dying was about the same, no matter which treatment the men chose.footnote 1

For men with advanced prostate cancer that has grown beyond the prostate but not into lymph nodes or bones, external-beam radiation combined with hormone therapy can work better than surgery. This treatment will often control cancer growth and give men many disease-free years.footnote 2

Radiation therapy also works well to treat pain when prostate cancer has spread to the bone.footnote 3

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Da Vinci Robotic Prostatectomy/robotic

Surgery is performed by a trained and skilled surgeon through the use of a computer-enhanced robotic surgical system positioned near the operating table. The Da Vinci Robotic surgical system is made up of three major components, which include a vision system with high magnification and resolution, robotic arms and instruments, and a console to provide the surgeon with a view of the operative field and control the instruments.

Questions To Ask Your Doctor Radiographer Or Nurse

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

Which type of radiotherapy is suitable for me and why?
Will I have any other treatments while Im having radiotherapy?
How long will the pain relief last? What other treatments are available to help with my pain?
Will I get any side effects and if so, how can I manage them?
Are there any safety guidelines I should follow during and after treatment?
Who should I contact if I have any questions at any point during my treatment? How do I contact them?
Will having this treatment mean I cant have other types of treatment later on for example, chemotherapy?

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When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

Survival Rates With External Beam Radiation Therapy In Newly Diagnosed Elderly Metastatic Prostate Cancer Patients

This article was originally published here

Prostate. 2021 Oct 11. doi: 10.1002/pros.24249. Online ahead of print.

ABSTRACT

BACKGROUND: The survival benefit of primary external beam radiation therapy has never been formally tested in elderly men who were newly diagnosed with metastatic prostate cancer . We hypothesized that elderly patients may not benefit of EBRT to the extent as younger newly diagnosed mPCa patients, due to shorter life expectancy.

METHODS: We relied on Surveillance, Epidemiology and End Results to identify elderly newly diagnosed mPCa patients, aged > 75 years. Kaplan-Meier, univariable and multivariable Cox regression models, as well as Competing Risks Regression models tested the effect of EBRT versus no EBRT on overall mortality and cancer-specific mortality .

RESULTS: Of 6556 patients, 1105 received EBRT . M1b stage was predominant in both EBRT and no EBRT groups, followed by M1c and M1a . Median overall survival was 23 months for EBRT and 23 months for no EBRT . Similarly, median cancer-specific survival was 29 months for EBRT versus 30 months for no EBRT . After additional multivariable adjustment, EBRT was not associated with lower OM or lower CSM in the entire cohort, as well as after stratification for M1b and M1c substages.

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Treating With Radiation Alone

The meaning was clear. Oakleys cancer was still in an early stage, and Yeh believed he could treat it successfully with radiation alone. That belief was backed up by data. In early stages, radiation can be an alternative to surgery, with a similar cure rate, he said. The overall survival rate is very similar.

Part of that success is due to the evolution of the older, more traditional external beam machines, such as the linear accelerator, which are noninvasive and deliver radiation aimed at a specific part of the body. Although the basic technology has existed since the 1950s, the last two decades have witnessed major improvements.

Oakley received several weeks of daily intensity modulated radiation therapy . In use since the 1990s, IMRT adapts the strength of the radiation beam to match the precise contours of a tumor and minimize the damage to surrounding tissue. The IMRT is guided by computed tomography imaging, which maps those contours and pinpoints the cancer.

Questions To Ask Your Doctor Nurse Or Radiographer

Prostate Cancer Treatment Specialist Sydney

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?

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What Types Of Hormone Therapy Are Used For Prostate Cancer

Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:

reducing androgen production by the testicles
blocking the action of androgens throughout the body
block androgen production throughout the body

Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.

Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:

Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:

Treatments that block the production of androgens throughout the body include:

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

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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.

How Is Radiation Therapy Used To Treat Cancer In Dogs

To protect normal cells, veterinarians carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal. tissue as possible while they aim the radiation at the site of the cancer. There are two approaches for using radiation therapy in dogs curative and palliative.