Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
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A PSA test every 3 to 6 months
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A DRE at least once every year
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Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
Hdr In Conjunction With External Beam
When first used for prostate cancer, HDR brachytherapy was predominantly implemented to boost the prostate as an adjunct to pelvic EBRT. This was considered particularly advantageous when first being used given the contemporary EBRT doses of 66-70 Gy that were considered standard at the time. Several single-institution experiences reported on the safety and efficacy of such treatment, and a prospective, randomized trial published by Hoskin et al6 demonstrated superior biochemical control in patients receiving HDR brachytherapy boost treatment relative to those patients treated with EBRT alone.
Biological analyses of responses to changes in HDR dosing/fractionation suggested a high sensitivity of prostate cancer cells to increasing fractional doses. That is, prostate cancer has a low alpha-beta ratio, and biologically equivalent dose , it was found, could be dramatically increased through relatively small increases in HDR fraction size. In fact, evidence of dose response in terms of enhanced biochemical control was demonstrated across a range of HDR fractionation regimens increasing progressively from as low as 550 cGy x 3 fractions up to 1150 cGy x 2 fractions.7 More recently, HDR boost regimens given in a single fraction of 1500 cGy 8,9 has gained favor and is the recommended dosing in the most recent open Radiation Therapy Oncology Group protocol to allow HDR brachytherapy as a boost.
Problems With Your Bowels And Back Passage
Your bowel movements might be looser or more frequent than before your treatment. You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help.
You might find that you need to avoid high fibre foods as it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Inflammation of the back passage is another possible long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Talk to your doctor or specialist nurse if you have any of these side effects. They will be able to refer you to a specialist team that can help you to find ways of controlling the effects.
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When Can Hdr Brachytherapy Be Used
HDR brachytherapy is primarily used to enhance external prostate cancer radiotherapy, but it is also used as the monotherapy for prostate cancer.
HDR brachytherapy can be used as monotherapy for local low-risk prostate cancers. When it comes to medium-high-risk and high-risk cancers as well as locally advanced prostate cancers, the combination of external radiotherapy and HDR therapy appears to be particularly effective, while the recurrence of cancer in the prostate gland is considerably less likely and the probable appearance of metastases is smaller compared with mere external radiotherapy or surgery.
Even though the radiation dose level in HDR brachytherapy is very high, the external healthy tissues, such as the bladder or the rectum, will be spared from adversely high doses of radiation, as it is possible to deliver the high radiation dose directly to the prostate area only. Consequently, it is possible to minimise the adverse effects. This also explains why there is hardly any reason for active follow-up for low-risk prostate cancer.
HDR brachytherapy may also be combined with other treatments for metastatic prostate cancer.
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.
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Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
Treatment For A Rising Psa After Brachytherapy
A PSA test measures prostate-specific antigen levels in the blood. Benign enlargement of the prostate, inflammation of the prostate, and prostate cancer can all cause a high PSA.
PSA levels sometimes rise after brachytherapy. However, your doctor wont recommend further cancer treatment based on this test alone. Theyll look for a rising trend in PSA over time and consider other factors, such as imaging tests, before recommending further treatment.
Even if your doctor cant see cancer cells with imaging, they may recommend you undergo treatment again based on a risk-benefit analysis. The benefit of catching all the cancer may outweigh the risk of additional treatment.
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Less Common Side Effects Of Brachytherapy
There are some other side effects that may happen after treatment, but they arent as common.
Fistula
There is not much research about fistulas caused by brachytherapy, but we know they can happen. Any symptoms will depend on where the fistula is, but could include:
- vaginal discharge that smells badly
Its important to tell your healthcare team about any symptoms, as they can check for a fistula and offer you treatment.
Second cancer
There is limited research to suggest that having brachytherapy increases the risk of developing another cancer. This is sometimes called second cancer.
We know that this will be worrying, so it is best to speak with your healthcare team to understand more about this risk and find out any symptoms to look out for. Remember that you will be in the care of your healthcare team for follow up, so they will make sure you are well and can check out any problems.
Who To Tell About Side Effects
It is important to tell your healthcare team know about your symptoms and how you are feeling. This could be your team at the hospital or your GP. They will be able to assess you and possible refer you for specialist support.
If you are struggling with side effects between appointments, it is important to call the hospital or 111 and let them know.
– Jasmine, who with us
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Treatment Vs Side Effects
Prostate cancer treatment side effects can vary greatly from little to none, or create lifetime issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.
Treatment or the combination of treatments in advanced cases can lead to a wide range of side effects. Prostate cancer treatment side effects include erectile dysfunction, incontinence, urinary issues, diarrhea, hot flashes, weight gain, loss of muscle, vomiting and hair loss. There are short term prostate cancer treatment side effects that subside over time, as well as long term side effects that can last for years. Question your Doctor about the side effects of the treatment you have selected. Make an informed decision.
Prostate cancer treatment side effects can vary greatly from little to none, or create lifetime issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.
Will I Need To See My Doctor After My Imrt Treatment Is Over
Once your IMRT is finished, it is important for you to have regular visits with your doctor to check how well your treatment is working and to deal with any side effects that you may have. Your doctor will want to see you every three to four months for two to three years. Your doctor will schedule your appointments and order any tests you need to make sure you have the best follow-up care possible. Dont be afraid to ask about any tests or treatments that your doctor orders. Use these appointments to learn about the things you need to do to take good care of yourself following your prostate cancer treatment. .
Helping Yourself After Your IMRT Treatments.
- When do you need to see your doctor or health care team?
- How can you reach your doctor or health care team?
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Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
Low Levels Of Vitamin B12
You might have low vitamin B12 after radiotherapy to the pelvis . This is called a vitamin B12 deficiency.
Radiotherapy can stop your digestive system from taking in vitamin B12 from the food you eat. This is called malabsorption. This means you can have a B12 deficiency even if you eat a balanced diet.
A B12 deficiency can be a cause of anaemia. This can lead to weakness, diarrhoea, numbness and tingling.
Its important that you go to your doctor if youre experiencing these symptoms so that they can help you.
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What Side Effects May Occur As A Result Of Brachytherapy
Side effects of brachytherapy can include swelling, bruising, bleeding, or pain and discomfort at the spot where the radiation was delivered. Brachytherapy used for gynecologic cancers or prostate cancer can lead to short-term urinary symptoms, including incontinence or pain on urination. Brachytherapy for these cancers can also lead to diarrhea, constipation and some rectal bleeding. Prostate brachytherapy can occasionally cause erectile dysfunction.
What Are The Results Of Using Proton Therapy In Patients
For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.
For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.
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How Can I Reduce Skin Reactions
- Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Donât rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
- Try not to scratch or rub the treated area.
- Donât put any ointment, cream, lotion, or powder on the treated area unless your radiation oncologist or nurse has prescribed it.
- Donât wear tight-fitting clothing or clothes made from harsh fabrics like wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers like cotton.
- Donât apply medical tape or bandages to the treated area.
- Donât expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
- Donât expose the treated area to direct sunlight. That could intensify your skin reaction and lead to a severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.
How Does Brachytherapy Compare With Other Forms Of Radiation Treatments
When used appropriately, brachytherapy has been shown to be as effective as conventional external beam radiation therapy and surgery for many cancers. It is best used in patients whose cancer has not spread, or metastasized. In many cases, brachytherapy is combined with external-beam radiation therapy, including stereotactic body radiation therapy, to get the best results.
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Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
How Brachytherapy Works
Brachytherapy works by preventing cancer cells from actively replicating. Unlike normal cells, which have a set replication cycle and a limited lifespan, cancer cells divide erratically and are essentially “immortal” .
While normal cells can be damaged by radiation, they have the ability to repair themselves and continue multiplying normally after treatment is stopped. Cancer cells are far less able to do so.
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New Study Compares Long
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.
Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.
Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.
Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:
Long Term Side Effects Of Prostate Cancer Radiotherapy
Most side effects of radiotherapy gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that some side effects begin months or years later.
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Tell your doctor or nurse if you have any of these problems. They can help you to find ways of controlling the effects.
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