Treatment By Stage Of Prostate Cancer
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.
The Grade Group And Psa Level Are Used To Stage Prostate Cancer
The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen test and the Grade Group. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2 to 10 and describes how different the cancer cells look from normal cells under a microscope and how likely it is that the tumor will spread. The lower the number, the more cancer cells look like normal cells and are likely to grow and spread slowly.
The Grade Group depends on the Gleason score. See the General Information section for more information about the Gleason score.
- Grade Group 1 is a Gleason score of 6 or less.
- Grade Group 2 or 3 is a Gleason score of 7.
- Grade Group 4 is a Gleason score 8.
- Grade Group 5 is a Gleason score of 9 or 10.
The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
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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.
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What Are The Different Types Of Internal Radiation Therapy
Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside. However, the similarities mostly end there. Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer. Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Read on to find the details of each.
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Side Effects Of External Radiotherapy
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing wee more often.
Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.
These side effects vary from person to person. You may not have all of the effects mentioned.
Side effects can include:
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended but it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. Its important to balance exercise with resting.
Your skin in the treatment area might get sore, or redden or darken. Following these tips can help with this:
Is Proton Beam Therapy Safer Than Other Options
Due to the concentrated nature of the radiation in proton therapy, there are usually fewer side effects than in conventional radiation therapy. Thats because theres less damage to healthy tissue around the tumor.
People who have proton therapy may have a significantly lower risk of short- and long-term complications compared with people receiving traditional photon therapy, according to a research study . These findings show a two-thirds reduction of adverse events in the 90 days after treatment, as well as a significantly reduced risk of having difficulties moving and performing daily activities.
However, long-term data is lacking on the safety of proton beam therapy. Furthermore, due to the high cost of treatment, current research has been limited in terms of demographics.
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Proton Beam Radiati On Therapy
Proton beam radiation therapy capitalizes on a unique physical property of high energy protons generated from a cyclotron. The accelerated charged particles travel through tissue until reaching a depth determined by their energy. Once they reach that depth, the remainder of the radiation dose is deposited in a sharp Bragg peak with no dose going beyond that point. When multiple proton beams are used, a very sharp and tight radiation dose distribution is created. This modality is especially attractive when tumors are in close proximity to sensitive organs. PCa is one of the more common indications in which proton therapy is utilized.
At Washington University in St. Louis we are collaborating with investigators from Massachusetts General Hospital and the Harvard Medical School conducting a randomized clinical trial of IG-IMRT versus proton beam radiation in men with low and intermediate risk PCa. The PARTIQoL trial is seeking to measure and compare relative the impact of the two modalities on patient quality of life after treatment. provides a comparison of these two treatment modalities.
Axial CT slice showing conformality of intensity modulated radiation therapy. Radio-opaque markers are apparent in the anterior aspect of the prostate gland. Axial CT slice showing conformality of proton beam radiation therapy in the same patient as panel a. More sparing of the anterior-lateral rectal wall and less dose to peripheral tissues is apparent.
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What Are Hydrogel Spacers
Hydrogel spacers are an absorbable gel that temporarily creates a space between the prostate and the rectum.
This extra space protects the rectum from radiation exposure during treatment. In addition, spacing offers many other advantages:
Reducing the harmful effects of radiation therapyAllowing for improved targetingAllowing for higher doses of radiation to improve chance of cureAllowing for a shorter treatment time with SBRT
Intensity Modulated Radiation Therapy With Smartarc
Our bodies, including cancer tumors, are three-dimensional. Using a system called SmartArc, doctors can deliver IMRT directly to the prostate in a single rotation around the patient, for precise and efficient treatments.
It is highly computer-controlled radiation and we can very carefully control where the radiation goes and where it doesnt go, says Dr. Fryefield.
SmartArc treatments typically take between 50 – 60% less time to deliver than standard IMRT.
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How Has Radiation Therapy For Prostate Cancer Evolved In Recent Years
Radiation has evolved dramatically in the last 40 years, and during that time, our ability to plan and deliver treatment has changed at about the same rate as computers have progressed. Think of your computer 10 years ago and your iPad now, says Dr. Yu. You might have heard about your fathers or grandfathers perhaps difficult radiation experience in the 1970s or 80s, so you may be wary. But todays radiation therapy is so different we plan, deliver, and aid in recoveries that have better outcomes and fewer side effects than in the past.
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How Does Radiation Therapy Work
Radiation therapy uses X-rays, radioactive particles, or radioactive materials to treat cancer. It kills cancer cells by damaging their DNA, or genetic material. Cancer cells cannot divide when their DNA is damaged. When irradiated cancer cells try to divide, they die.
Unfortunately, radiation therapy can affect nearby healthy cells, too. But unlike cancer cells, healthy ones can repair the DNA damage from radiation. This means that its easier for them to recover.
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What Is The Experience Like For A Patient
The experience with our department begins with a consultation.
If you agree to receive radiation, you will have a noncontrast computed tomography scan to map your prostate and internal anatomy.
Next, we design a radiation treatment plan.
Youâll come in for daily radiotherapy sessions, each lasting about 15 minutes. Youâll check in, change into disposable shorts and wait in a men-only waiting area.
Yale Medicine radiation therapists then escort you to the treatment room, where youâll lie down in a custom body mold.
When your positioning is confirmed and adjusted, based on a CT scan or an implanted radio-frequency tracking device, treatment begins.
Men should be in and out of our department like clockwork, with minimal disruption to their day, says Dr. Yu. Radiation therapy may continue for up to nine weeks.
Once the course is complete, recovery typically requires a few months. Typically, at their one-month follow-up visit, patients report they are on the mend, says Dr. Yu.
Comparing Side Effects Of The Various Treatments
Multiple studies have been published that compare the side effects of the 3 standard treatment options. The best of these studies are Health Related Quality Of Life studies , in which patients answer questionnaires that are validated by expert panels. Multiple HRQOL studies have been performed with the 3 standard treatment options. Unfortunately, none of these studies are randomized, thus patients in the surgical arms are typically younger and healthier before treatment than those in the EBRT or brachytherapy arms. This is because many patients that are not candidates for surgery are still good candidates for EBRT or brachytherapy. So, the average age and health of the surgically treated patient is more favorable than the average age and health EBRT or brachytherapy patient. Multiple studies prove that younger, healthier patients recover from virtually any type of treatment better than older, sicker patients. So, all these studies have a built-in bias favoring the surgically treated patients.
** Peyronies Disease: Curvature of the penis is an abnormal bend in the penis that occurs during erection. Symptoms: Bend in the penis with erection Narrowing of the penis with erection.
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What Side Effects May I Have During Or After My Imrt Treatments
There are several side effects that you may have during or after your IMRT treatments. They are urinary problems, bowel problems, erectile dysfunction or impotence , skin problems, loss of appetite and tiredness. Remember, that IMRT treatments are focused on your prostate cancer. This protects the healthy cells around your prostate, which means you may have fewer side effects and that the side effects you do have wont be as bad.
The urinary problems you may have are:
The bowel problems you may have are:
- Soreness in your rectal areaYou may have soreness in your rectal area. This usually goes away by itself. If you are very sore, let you doctor or health care team know. There are medicines and things that you can do to be more comfortable.
- Rectal Urgency
The erectile dysfunction problem you may have is:
- Fewer erectionsMost men do not have problems with erections or intercourse during or right after IMRT. Over time, you may find that you are not having as many erections as you used to. This is because the radiation can harm the nerves near your prostate that help you have erections. Talk to your doctor or health care team if you have a problem like this.
The skin problems you may have are:
Another problem you may have is:
If you have trouble figuring out how to make changes to deal with your tiredness, you may want to talk with your doctor or health care team.
Another problem you may have is:
Managing your side effects.
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What Happens On Treatment Days
External radiation therapy requires regular sessions during a period of about five to eight weeks. For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure you are positioned well, they will leave the room and start the radiation treatment.
You will be under constant observation during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Be sure to remain still and relaxed during treatment. Let the therapist know if you have any problems or discomfort.
The therapist will be in and out of the room to reposition the machine and change your position. The treatment machine will not touch you, and you will feel nothing during the treatment. Once the treatment is complete, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that you are being positioned accurately during your treatments.
Port films do not provide diagnostic information, so radiation therapists cannot learn about your progress from these films. However, port films are important to help the therapists make sure the radiation is delivered to the precise area that needs treatment.
Are There Side Effects Of The Combination Approach
There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects, both of which are common with any radiation treatment given to the prostate. But at MSK, we routinely use sophisticated planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications.
In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation that the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and after a few months dissolves on its own within the body, causing no harm or long-term effects.