Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
External Beam Radiation Therapy For Cancer
External beam radiation therapy comes from a machine that aims radiation at your cancer.
External beam radiation therapy comes from a machine that aims radiation at your cancer. It is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiation therapy is used to treat many types of cancer.
Reducing Side Effects During Radiotherapy For Prostate Cancer
Radiation is a very effective treatment for prostate cancer, but in a small percentage of patients it also can cause toxicities to nearby organs, particularly the rectum. Side effects are usually minor and can include hemorrhoidal type bleeding and rectal incontinence. But for a very small subset of patients, the side effects can be more serious.
Patients who take blood thinners or who have Crohns disease or ulcerative colitis, for example, are at greater risk for complications from radiation therapy for prostate cancer than are other patients. For these patients, sparing the rectum is a significant concern.
Serious complications are rare, but as Dr. Greg Cooley, Department of Human Oncology clinical associate professor and radiation oncologist at UW Health East, says, If they happen to one patient, thats one too many.
For patients who are susceptible to complications, Cooley uses a relatively new technique to move the rectum away from the treatment area to reduce the likelihood that the rectum will be exposed to radiation during treatment. He injects a substance called SpaceOAR into the space between the patients prostate and rectum, which pushes these two organs apart by about 1 cm and solidifies into a soft hydrogel that remains stable for three months.
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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
How Often You Will Have External Beam Radiation Therapy
Most people have external beam radiation therapy once a day, five days a week, Monday through Friday. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. How many weeks you have treatment depends on the type of cancer you have, the goal of your treatment, the radiation dose, and the radiation schedule.
The span of time from your first radiation treatment to the last is called a course of treatment.
Researchers are looking at different ways to adjust the radiation dose or schedule in order to reach the total dose of radiation more quickly or to limit damage to healthy cells. Different ways of delivering the total radiation dose include:
- Accelerated fractionation, which is treatment given in larger daily or weekly doses to reduce the number of weeks of treatment.
- Hyperfractionation, which is a smaller dose than the usual daily dose of radiation given more than once a day.
- Hypofractionation, which is larger doses given once a day or less often to reduce the number of treatments.
Researchers hope these different schedules for delivering radiation may be more effective and cause fewer side effects than the usual way of doing it or be as effective but more convenient.
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Dealing With Treatment Side Effects
Often there are unwanted and unexpected side effects that result from the various treatments for prostate cancer. These are not from the cancer itself, but from the surgery, radiation or hormone therapy or chemotherapy that are typically used to treat the disease.
All treatments will have some side effects, some short term, and some are long term. Short-term side effects tend to be common and reversible or diminishing. Long-term side effects are less common and are not always fully reversible.
Those side effects vary from person to person and as well as physical, they can also effect men psychologically and emotionally. Men about to undergo treatment should seek out information on what the potential side effects might be from their upcoming treatment.
Urinary Problems
Surgery can affect the ability to control the bladder. It can lead to incontinence or leaking urine when coughing or with a sudden movement. Radiation treatment can lead to other problems with urination.
Sometimes men who have had surgery or radiation therapy can experience a slowing of their urine stream and a feeling they are not able to completely empty their bladder. In rare cases, men who have had radiation therapy may also experience blood in the urine. Sometimes it can be due to the prostate cancer treatment, but it can also be a sign of other health issues that should be investigated.
It is important to report any changes or concerns about your urinary symptoms to your healthcare team.
Bowel Problems
What To Expect For Your Treatment
You’ll get ERBT at a hospital or clinic. You’ll likely not have to stay overnight. The total length of time for your treatment depends on the type and dose of radiation, as well as why you are getting it. For instance, if you’re getting radiation as the main treatment for an early-stage prostate cancer, you’ll likely get treatments 5 days a week for several weeks in a row. If you’re getting radiation therapy to treat bone pain, you’ll probably need fewer treatments.
Each treatment is much like getting an X-ray, but the radiation is stronger. You lie on a table while the machine delivers the radiation. The actual treatment is quick and doesn’t hurt, but getting you into the proper place for treatment each time takes longer. When you are in the right position, the radiation therapist leaves the room and controls the machine. The therapist can see you. And you can talk with and hear the therapist the whole time.
Your radiation oncologist or nurse can tell you what to expect during treatment.
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Who Should Consider Taking Radiopharmaceuticals
Radiopharmaceuticals are given through a vein to men with metastatic prostate cancer that has spread widely to the bone. Strontium89 and Samarium-153 are radiopharmaceuticals given to reduce the pain caused by the bone cancer. Radium-223, or Xofigo®, is a radiopharmaceutical given to prolong life.
The side effects associated with radiopharmaceuticals are mainly the suppression, or lowering, of white blood cell and platelet levels in the blood. Your doctor will be able to assess whether your body can handle this side effect before you are given the treatment and will monitor your levels after you receive it. Your doctor, specialist nurse, or nuclear medicine practitioner will be able to give you more information about the treatment and possible side effects.
If your doctor has told you that your bone metastases have spread, you may be a candidate for a radiopharmaceutical. Speak with your oncology team to see if one of these treatments may be right for you.
British Columbia Specific Information
Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.
You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.
Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency – Prostate.
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Getting Ready For Ebrt
Before starting EBRT, you may have a lymph node biopsy to see if your cancer has spread outside the prostate gland. One or more lymph nodes are removed to see if there are cancer cells in them. Other tests may also be done.
Before you start radiation, youll have an appointment to plan your treatment. This is called simulation. During this appointment:
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Youll lie on a table while a radiation therapist uses a machine to find exactly where the radiation will be aimed. The therapist may mark your skin with tiny dots of permanent ink or tattoos. These are used to aim the radiation at the exact same place each time.
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CT scans or other imaging tests might be done to help locate the cancer.
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A plastic mold or cast of your body may be made for some types of ERBT. The mold helps you get in the same position and holds you still for each treatment.
If I Choose Radiation Therapy Will Surgical Treatment Still Be An Option
Your doctor may use radiation therapy as your primary treatment. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you have the same risk of cancer recurring if surgery is performed.
If it is not successful, your doctor will likely not consider surgery or repeat radiation therapy due to the risk of serious complications. If your doctor recommends surgery after radiation or additional radiation, the doctor performing the re-treatment or surgery should have a significant level of experience. There are experimental clinical studies being evaluated for use of very localized re-irradiation for this group of patients. Some patients for whom radiation is not effective are treated with systemic therapy or closely monitored. Additional treatment will depend on the PSA level and rate of rise of the PSA.
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Online Support Groups For Prostate Cancer
- Us TOO. This organization has more than 200 support groups in the United States and abroad.
- Prostate Cancer Research Institute. This website allows you to search for support groups by state.
- Cancer Care. This site offers 15-week online support groups for people diagnosed with prostate cancer. Co-sponsored by the National Alliance of State Prostate Cancer Coalitions.
- Male Care. This organization offers online support groups for people with prostate cancer and their partners or caregivers.
- Imerman Angels. This support community offers one-on-one support with a mentor.
Swollen Legs Or Scrotum
You might get swelling in the legs or the sack of skin around the testicles . The swelling is called lymphoedema . It happens when the lymph channels that drain fluid from the legs are damaged by the radiotherapy. The swelling can be uncomfortable.
You can do various things to lower your risk of getting lymphoedema. Early treatment can reduce the swelling and stop it from getting worse.
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When Is Brachytherapy Alone The Right Choice
For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning 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 then it would be very appropriate to do active surveillance and hold off on treatment.
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Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiotherapy
This type of therapy is used to deliver high doses of radiation to a precise area in the prostate using specialized techniques not achievable by standard conventional radiation therapy. This allows the total dose of radiation to be given in a shorter amount of time, usually 4 -5 treatments over 1 2 weeks rather than the several weeks used for other types of external radiation therapy.
The radiation beam needs to be extremely accurate in order to limit the side effects on healthy tissue. During treatment, the body immobilization used is often more restrictive than with IMRT due to the high doses of radiation. Fiducials, or internal prostate markers, are often used in this type of treatment.
Cyberknife and Truebeam are two types of LINACs used for SBRT treatment of prostate cancer.
Which Approach Is Better: Active Surveillance Surgery Or Radiotherapy
The 10 year outcomes of the Prostate Testing for Cancer and Treatment trial from the United Kingdom has provided valuable insights into the management of localized PCa. The trial recruited 1643 men 50 to 69 years old. Of these 545 men underwent active surveillance, 553 surgery, and 545 radiotherapy. For the participants, the median follow-up was 10 years, the median age was 62 years, the median PSA was 4.6 , 77% were Gleason 6 and 21% were Gleason 7, and 76 % were T1c and the remaining T2. There were 17 prostate-cancerspecific deaths overall: 8 in the active surveillance group, 5 in the surgery group, and 4 in the radiotherapy group. The difference was not statistically significant among groups.
Metastases developed in more men in the active-monitoring group than in the surgery group or the radiotherapy group . Higher rates of disease progression were seen in the active-monitoring group than in the surgery group or the radiotherapy group . In summary, at a median of 10 years, prostate-cancerspecific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring, while 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.
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How Long Does External Radiation Treatment Take
In most cases the total dose of radiation needed to kill a tumor cant be given all at once. This is because a large dose given one time can cause more damage to nearby normal tissues. This can cause more side effects than giving the same dose over spread out over days or weeks into many treatments.
The total dose of external radiation therapy is usually divided into smaller doses called fractions. Most patients get radiation treatments daily, 5 days a week for 5 to 8 weeks. Weekend rest breaks allow time for normal cells to recover. The total dose of radiation and the number of treatments is based on:
- The size and location of the cancer
- The type of cancer
- The reason for the treatment
- Your general health
- Any other treatments youre getting
Other radiation schedules might be used in certain cases. For instance, radiation therapy might last only a few weeks when its used to relieve symptoms, because the overall dose of radiation needed is lower. In some cases, radiation might be given as 2 or more treatments each day. Or you might have several weeks off in the middle of treatments so your body can recover while the cancer shrinks. Your doctor will talk to you about the best plan in your case.