Expert Review And References
- American Cancer Society. Prostate Cancer. Atlanta, GA: American Cancer Society 2015: .
- American Society of Clinical Oncology. Prostate Cancer. 2014: .
- Garnick MB . Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
- National Cancer Institute. Prostate Cancer Treatment . 2015: .
- National Cancer Institute. Prostate Cancer Treatment for Health Professionals . 2015: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . .
- Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015: .
- Saad F, Chi KN, Finelli A, Hotte SJ, Izawa J, Kapoor A, et al. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer . Canadian Urological Association Journal. 2015: .
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
Treatments For Prostate Cancer
If you have prostate cancer, your healthcare team willcreate a treatment plan just for you. It will be based on your health andspecific information about the cancer. When deciding which treatments to offerfor prostate cancer, your healthcare team will consider:
- the type and stage of the cancer
- the grade or Gleason score
- prostate-specific antigen levels
- the risk group
- possible side effects of treatments
- your personal preferences
- your overall healthand any existing medical conditions
- your age and life expectancy
- whether you have symptoms
Prostate cancer treatments can seriously affect your qualityof life and cause side effects such as erectile dysfunction and incontinence . Manyprostate cancers grow slowly and cause no symptoms or problems.
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Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
What Are The Advantages And Disadvantages Of External Beam Radiotherapy
What may be important for one person might not be so important for someone else. If youre offered external beam radiotherapy, speak to your doctor, nurse or radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.
Advantages of external beam radiotherapy
- If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
- Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
- Radiotherapy can be an option even if youre not fit or well enough for surgery.
- Radiotherapy is painless .
- The treatment itself only lasts around 10 minutes, including the time it takes to get you into position. But youll probably need to be at the hospital for up to an hour each day to prepare for your treatment. You dont need to stay in hospital overnight.
Disadvantages of external beam radiotherapy
I was able to continue working throughout my treatment, although I got tired quickly. I had some side effects but nothing I couldnt cope with. A personal experience
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A New Treatment For Advanced Prostate Cancer Improves Survival
Radiation therapy is getting more precise, enabled by technologies that make it easier to kill tumors while sparing their surrounding tissues. Some newer therapies are even given intravenously rather than by machines, and that they deliver radiation particles onto the neoplastic cell itself. one among these new therapies a kind of bomb targeted at malignant cells is now generating promising data for men with the foremost aggressive prostatic adenocarcinoma.
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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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.
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.
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What Are Male Sex Hormones
Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.
Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
Q: When Is Radiation Therapy The Right Choice
Whether or not to pursue radiation therapy depends on a lot of factors unique to each person, and the decision should be made through a detailed discussion with your doctor.
Its often based on the stage of the cancer, age, risk factors and personal choice, says Dr. Patel. But it really is an individual choice made in collaboration with your doctor and whats best for you.
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
Targeted Radioligand Improves Survival In Advanced Prostate Cancer
Cancer researchers say they have established a new, life-extending treatment option for men with prostate cancer that has spread and become resistant to hormone therapy. The injected treatment combines a targeting compound with a radioactive isotope to irradiate and kill cancer cells.
An international clinical trial sponsored by Endocyte, Inc., a Novartis company tested the targeted radioligand therapy in study participants with advanced prostate cancer. All subjects had cancers that had spread to other organs and continued to progress after previous treatment with two kinds of drugs, androgen axis inhibitors and taxanes. The experimental treatment significantly extended survival, delayed progression and was generally well tolerated by study subjects, researchers said.
This is a completely new treatment option that extends life and disease control in metastatic castration-resistant prostate cancer the most aggressive and deadly type, said Tom Beer, M.D., one of the study leaders and deputy director of the Oregon Health & Science University Knight Cancer Institute.
The added option is particularly important, Beer said, because the existing most effective treatments developed for metastatic castration resistant prostate cancer are now being used to treat early-stage disease.
Some of our best treatments are being used earlier, so by the time you get to metastatic castration resistant disease, you have fewer options, he said.
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Building On A Natural Affinity
Delivering radiation directly to cells isnt itself a new approach. One such therapy, called radioactive iodine, has been used to treat some types of thyroid cancer since the 1940s. Iodine naturally accumulates in thyroid cells. A radioactive version of the element can be produced in the lab. When ingested , it accumulates in and kills cancer cells left over after thyroid surgery.
A similar natural affinity was later exploited to develop drugs to treat cancer that has spread to the bones, such as radium 223 dichloride , which was approved in 2013 to treat metastatic prostate cancer. When cancer cells grow in the bone, they cause the bone tissue they invade to break down. The body then attempts to repair this damage by replacing that bonea process called bone turnover.
The radioactive element radium looks like a calcium molecule, so it gets incorporated into areas of the body where bone turnover is highest, such as areas where cancer is growing, Dr. Kunos explained. The radium is then able to kill nearby cancer cells.
These radioactive compounds all travel to cancer cells without any help. Researchers wondered whether it would be possible to engineer new radioactive molecules that specifically target other cancers.
The game-changer for the field came in 2018, said Jacek Capala, Ph.D., of NCIs Radiation Research Program, when FDA approved lutetium Lu 177-dotatate for the treatment of certain cancerous neuroendocrine tumors affecting the digestive tract.
Exceptions To Early Salvage Radiation Treatment For Recurrence After Prostatectomy The New Prostate Cancer Infolink
Heres an interesting article about salvage radiation.
Three major randomized clinical trials and a meta-analysis have proved that for most men waiting for early signs of recurrence after prostatectomy to give radiation gave the same outcome as immediate radiation . But there are exceptions. In some men, adjuvant
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Remission And The Chance Of Recurrence
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.
Are There Any Long
Long-term risks are slight, but do exist. Its rare but possible that a patient will suffer worsening urinary and rectal function, and there is always a risk of radiation causing cancer.
“Because there are some risks, albeit small ones, we do not treat a patient unless we believe that we can have a real impact on his survival,” says Dr. Yu. “For a patient with a very slow-growing cancer, we typically monitor instead of advising immediate treatment.”
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Q: What Is The Success Rate Of Radiation Therapy For Prostate Cancer
Long-term studies show the success rate for patients who undergo radiation therapy is actually the same as those who get surgery. If you catch it in its early stages, the 5-year survival rate is very high in the high 90s, but early screening and early intervention is key and makes all the difference in the world, says Dr. Gejerman.
What Are The Pros And Cons Of Brachytherapy
Brachytherapy is highly effective at treating prostate cancer. But its main benefit is that it limits radiation exposure to the surrounding areas. The normal structures around the prostate get close to no radiation, which is really dramatic, and that’s why people tolerate these treatments so well, Horwitz said.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
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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Radiation Therapy In Localized Disease:
For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.
At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.
These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.
What To Expect After Radiation Treatment For Prostate Cancer
What to Expect After Radiation Treatment for Prostate Cancer? Many patients wonder what to expect after receiving radiation treatment for prostate cancer. It is the most widely used method of treatment regardless of the cancers stage. Radiation therapy can be followed by a radical prostatectomy, which removes the prostate gland and nearby lymph nodes.
Prostatecancer is the most diagnosed solid tumor type among men. In the early stages ofprostate cancer, indolent cases without major symptoms will receive activesurveillance and watchful waiting to observe how the disease progresses. If thecancer spreads outside of the prostate gland, other treatment options areconsidered, the first of which being radiation.
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