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.
What Happens After Radiotherapy
After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:
- check how your cancer has responded to treatment
- help you deal with any side effects of treatment
- give you a chance to raise any concerns or ask any questions.
Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have
follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.
PSA test
The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.
After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.
Treatment options after radiotherapy
Looking after yourself after radiotherapy
Potential For Benefit With Mrgrt For Prostate Cancer
MRI guidance with or without ART has multiple potential advantages in terms of improving accurate dose delivery. First, because the prostate is much better visualized on MRI images compared to CT images, prostate CTVs generated by MRI are smaller and more precise than CT-based contours . Figure 1 shows an image of the prostate from Unity. Typically, radiation-therapy planning MRIs are fused to CT simulation images to aid in contouring, but the fusion itself introduces 12 mm of residual error. Use of an MR-only workflow will bypass these issues. Second, on-board MRI imaging will allow direct tracking of the prostate, dispensing with the need for fiducials and sparing the patient an invasive procedure. Third, as a treatment course progresses, the daily image acquisition and adaptive re-planning allows for compensation related to prostate gland swelling, shrinkage, or deformation and inter-fractional motion of target or OARs. This daily sparing of OARs has the potential to decrease toxicity in both the short and long term. The ability to provide daily online adaptation minimizes inter-fraction uncertainty. Figure 2 shows a daily adaptive prostate plan from a 0.35T MR-linac.
Figure 1 Axial image of the prostate from the Unity.
Figure 2 Axial, sagittal, and coronal images of a prostate plan on the MRIdian .
Figure 3 Example workflow for the Unity.
Figure 4 Example workflow for the MRIdian.
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If This Uncertainty Would Bother You So Much That It Would Affect Your Quality Of Life Surgery May Be A Better Option For You Phuoc Tran Md Phd
However, if youre okay with waiting for the PSA nadir, and if you dont mind getting treatment over the course of a few weeks instead of in one operation, then radiation may be ideal for you.
What are my options?
Conventional external-beam radiation therapy is given in little doses, a few minutes a day, five days a week, for seven or eight weeks. These small doses minimize the injury risk for the healthy tissue near the tumor. Scientists measure radiation in units called Gy . Most men get a minimum total dose of 75.6 Gy, but could get as much as 81 Gy this works out to 2 Gy or less per day.
The treatment itself is painless just like getting an x-ray at the dentists office. But one big challenge with getting repeated treatments is making sure youre always in the exact same position, so the radiation can hit the target the way its supposed to. Thus, you will be custom-fitted with your own pelvic immobilization device, which will not only keep you from fidgeting, but will make sure youre not slightly higher and to the right on the table one day, and slightly lower and to the left the next.
When you get fitted for your device, you will have a CT scan, so doctors can get a 3D look at your prostate. Then, when you get the radiation, you wont just get it from one side, but from multiple directions, and each beam of radiation will be individually shaped to target the cancer and a 5- to 10-millimeter margin of healthy tissue around the prostate.
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.
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What Are The Study Findings
The study, published in Nanobiotechnology, shows that through the new formulation, prostate cancer cells were rendered up to 30 per cent more sensitive to the cell-killing effects of the same radiotherapy used to treat patients. Furthermore, in experiments investigating the magnitude of effect in small 3-dimensional models of prostate tumours called tumour spheres, the combination of radiation and RALA-gold nanoparticles completely suppressed tumour sphere growth.
Professor Helen McCarthy, from the School of Pharmacy at Queen’s University Belfast, explains: “The peptide enables the gold nanoparticles to be delivered more efficiently to the tumour cells. The gold then interacts with the radiotherapy, increasing the cell-killing effect in a highly localised manner.”
The gold particles are up to three times more visible on standard medical imaging equipment. This means that if the nanoparticles are located within the tumour, they should help to improve the accuracy of radiotherapy delivery, reducing the risk of off-target damage to neighbouring normal tissue such as the bladder or bowel.
The multi-disciplinary team have recently been awarded £376,000 from Prostate Cancer UK to evaluate the effectiveness of these implants at increasing the sensitivity of prostate cancer cells to radiotherapy.
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What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Traditionally, we deliver external beam radiation in 45 to 48 sessions over a span of ten weeks, using very sophisticated computer-based planning and enhanced imaging techniques and tumor tracking during the treatment. This is called image-guided IMRT and it is the current standard of care.
But there is increasing interest in giving this radiation in shorter courses of treatment. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. MSK Precise is a form of SBRT that can be given in five sessions instead of the usual 45 to 50. MSK has been doing this for the past nine years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated, with outcomes that are at least equivalent to and possibly better than the standard ten weeks of treatment. Because of its superior precision, MSK Precise has less side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low and similar to what is experienced with conventional external radiation techniques. And of course, its much more convenient for patients.
For patients with more-advanced tumors, we are completing a phase II trial in which were combining sophisticated brachytherapy approaches with MSK Precise. This kind of combination of dose-intense or escalated radiation may end up being a very effective regimen.
Managing Side Effects Of Radiation Therapy
Advances in the precision of radiation therapy have lessened the risk of complications. And our doctors are constantly developing new ways to minimize side effects. For example, we are one of the few hospitals in the United States using an FDA-approved biodegradable gel inserted before treatment to protect the rectum.
Still, radiation can cause short- and long-term side effects, including incontinence , erectile dysfunction, bowel problems, fatigue, and symptoms in other parts of the body .
Any side effects you experience depend on which part of the body receives radiation. In the case of such techniques as image-guided radiation therapy and stereotactic radiosurgery, it also depends on which normal structures are in the path of the radiations beam. In addition, radiation therapy is sometimes delivered in combination with hormonal therapy, which can cause impotence. Our experts will work closely with you and your medical team to manage any treatment-related difficulties you may experience, such as bladder, bowel, or erectile dysfunction. However, because of the sophisticated targeting systems we use, severe long-term bladder and bowel problems are now rare.
During the course of radiation treatments, some men experience diarrhea or frequent and uncomfortable urination. Please tell your treatment team if you have any of these problems. We can recommend medications and other methods that can help alleviate these uncomfortable side effects.
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Find Out What To Expect In This Overview Article
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Questions To Ask Your Doctor Nurse Or Radiographer
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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Treatment For Intermediate Risk Prostate Cancer
Intermediate risk prostate cancers are the most frequently treated prostate cancers. They are cancers that are confined to the prostate, often are Gleason 7 and have a PSA of less than 20. These cancers are treated in men with life expectancy greater than 10 years to prevent spread of the cancer in the long-term. There are a number of different effective treatment options for intermediate risk prostate cancer and the decision is often a personal one. Here at UCLA we recommend consultation with both Urologist and Radiation Oncologist to help men decide which treatment option is best for them.
Who Are At The Risk Of Developing Localised Prostate Cancer
Localised prostate cancer is divided into three risk groups according to the likelihood of the disease growing rapidly or spreading .
These factors determine your risk group:
- Size of the tumour
- The cell appearance under a microscope and The pattern of cells in the prostate tissue are both taken into consideration.
- Your prostate-specific antigen blood test
Low-risk prostate cancer
Low-risk prostate cancers are unlikely to spread or grow for many years to come. The following characteristics indicate that you have low-risk cancer:
- a T stage of T1 to T2a
- a Gleason score no higher than 6
- a PSA level less than 10 ng per ml
Medium risk prostate cancers
A cancer of medium risk is unlikely to grow or spread for a few years. If you have the following characteristics, your cancer is of medium risk.
- a T stage of T2b
- a Gleason score of 7
- a PSA level between 10 and 20 ng/ml
High-risk prostate cancer
High-risk cancers might grow or spread within a few years. Localized prostate cancer is considered to be high risk if you have any of the following characteristics:
- a T stage of T2c
- a Gleason score between 8 and 10
- a PSA level higher than 20 ng/ml
High risk localised prostate cancer is also locally advanced prostate cancer. This means that your doctor may describe your cancer as locally advanced, even if it is contained within the prostate gland.
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How Do You Choose
Choosing which of the Prostate Cancer Treatments depends upon many factors. The type of cancer, whether or not the cancer has spread , a patients age, general health status, and prior prostate cancer treatments the patient may have undergone. There are three standard prostate cancer treatments for men with organ-confined prostate cancer: Active Surveillance, Surgery and Radiation Therapy.
We suggest consultations with several specialist who can describe the pros and cons of each prostate cancer treatment. So plan to schedule consults with experts in each field of treatment. A Urologist is a trained surgeon who can review the surgical options for a prostatectomy. A Radiologist, a medical doctor who can lead you through the options of external beam or brachytherapy, seed implants. If your cancer is more advanced, you may also want to meet with a Medical Oncologist, an expert in the treatment of various types of cancer.
Patients are encouraged to compare prostate cancer treatments by looking at treatment effectiveness. Why, because for some, prostate cancer comes back. This is called recurrence. By monitoring the yearly PSA levels of thousands of patients treated for prostate cancer, year after year, long term effectiveness is revealed for low to high risk patients. See which patients remained in remission at year 5, 10, and 15, verses those whose experienced cancer recurrence. Prostate Cancer Free provides treatment comparisons in an interactive form, or printable study.