Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Read more about living with advanced prostate cancer, or speak to our Specialist Nurses. They are here to support you and your family.
You may also find it helpful to visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
Conditions Treated With Proton Therapy
Proton therapy is considered the most technologically advanced radiation delivery method for cancerous tumors. With this powerful, precise technology, tumors are more accurately targeted so healthy tissues and organs get less unnecessary radiation.
Proton therapy is commonly used to treat tumors in sensitive areas where traditional X-ray or photon radiation may not be the best option. Depending on your particular diagnosis, proton therapy may be a treatment option for cancers of the brain and central nervous system, breast, esophagus, head and neck, liver, lung, lymphatic system, eyes, pancreas, prostate, bone and others. It is particularly beneficial for many pediatric cancers.
What To Expect With Proton Therapy
The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.
Patients with prostate cancer typically undergo a minor procedure to place three small markers in the prostate, called fiducial markers. These markers allow the treatment team to accurately align the treatment each day to the location of the prostate. Your doctor will also determine if you are also eligible for placement of a special hydrogel between the prostate and rectum , which creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum and dissolves after a few months.
After placement of the markers , most patients return another day for a simulation or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.
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Radiopharmaceuticals That Target Psma
Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.
Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.
This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.
This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.
Possible side effects
Some of the more common side effects of this drug include:
This drug can lower blood cell counts:
- A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
- A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
- A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.
This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.
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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Radiation Therapy For Advanced Prostate Cancer
When prostate cancer spreads, it tends to travel first to the bones. This may be diagnosed using imaging tests such as computed tomography scans. Cancer in the bones may cause pain and discomfort, so radiation is one tool that doctors may recommend to help manage the disease. Other commonly used treatments for advanced prostate cancer include chemotherapy, hormone therapy or immunotherapy.
External radiation therapy may be used to help reduce bone pain by targeting specific tumors, especially on the spine.
Some patients with advanced cancer may qualify to be part of a clinical trial involving radiation. In clinical trials, researchers study the effect of new treatments to see whether these are as safe and comprehensive as current treatments, or better.
Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification.
| Grade Group | Gleason Score | Gleason Pattern |
|---|---|---|
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | ||
| 1 | ||
| 4+4, 3+5, or 5+3 | ||
| 5 | 4+5, 5+4, or 5+5 |
| Stage | Gleason Score Gleason Pattern g | Illustration | |
|---|---|---|---|
| T = primary tumor N = regional lymph nodes M = distant metastasis cT = clinical T PSA = prostate-specific antigen pT = pathological T. | |||
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | |||
| The explanations for superscripts b through g are at the end of Table 5. | |||
| I | cT1ac, cT2a, N0, M0 | cT1 = Clinically inapparent tumor that is not palpable. | < 10 |
| cT1a = Tumor incidental histologic finding in 5% of tissue resected. | |||
| cT1b = Tumor incidental histologic finding in > 5% of tissue resected. | |||
| cT1c = Tumor identified by needle biopsy found in one or both sides, but not palpable. | |||
| cT2 = Tumor is palpable and confined within prostate. | |||
| cT2a = Tumor involves 1/2 of one side or less. | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. | |||
| Gleason Score, 6 Gleason Pattern, 3+3 . | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. |
References
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Proton Therapy For Pediatric Cancers
Proton therapy is particularly beneficial for treating children and adolescents with cancerous and noncancerous tumors. Children are at a significantly higher risk of late effects from cancer treatments compared to adults. Two-thirds of children who survive a cancer diagnosis face at least one chronic health condition. One-fourth of pediatric cancer survivors face a severe or life-threatening side effect from treatment that occurs later in life. These include heart damage, lung damage, infertility, cognitive impairment, growth deficits, hearing loss, vision loss, secondary cancers and more.
Thanks to treatment advances, including radiation, pediatric cancer survival rates have dramatically increased to nearly 85% today from 10% only decades ago. One of these advancements, proton therapy, reduces a childs risk of experiencing harmful long-term side effects. Proton therapy limits and reduces radiation doses to healthy tissues and organs while delivering curative doses to the cancer.
We treat a number of childhood cancers with proton therapy. In certain situations, the cancer center will coordinate with Childrens Mercy specialists to develop a care plan suited to the childs individual treatment requirements. Childhood cancers we treat with proton therapy include:
- Atypical teratoid rhabdoid tumor
- Rhabdomyosarcoma
What Side Effects Will I Have
During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation. Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice a loss of hair or decreased perspiration within the treated area.
These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. If skin changes appear outside the treated area, inform your doctor or primary nurse.
Long-term side effects, which can last up to a year or longer after treatment, may include a slight darkening of the skin, enlarged pores, increased or decreased sensitivity of the skin, and a thickening of tissue or skin.
Another possible side effect is erectile dysfunction and urinary symptoms such as frequency, bleeding, or, rarely, incontinence. Keep these side effects in mind when considering your treatment options. If you have any concerns, donât hesitate to talk to your doctor about them.
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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 . 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 .
What Are The Different Types Of External Beam Radiation Therapy
Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a CT scan to map your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.
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What Are The Side Effects Of Brachytherapy
- Frequent urination or urinary retention or burning with urination
- Erectile dysfunction
- Urethral stricture or narrowing of the urethra
- Diarrhea or blood in the stool
- Secondary cancers
For the short time that the seeds are giving off larger amounts of radiation, you should avoid close proximity to children or pregnant women. Make sure to talk with your radiation oncologist or oncology nurse for instruction about radiation safety and exposure for family members or pets.
If you are traveling through an airport following brachytherapy treatment, there is a chance that radiation detectors will be set off. Talk to your radiation oncologist and ask for a note to indicate youve just had radiation treatment.
How Is Radiation Therapy Given
Radiation therapy can be given externally or internally . During external radiation, the most common type of radiation therapy, a machine directs high-energy rays at the cancer and some normal surrounding tissue. In brachytherapy, a radioactive source is implanted directly into the cancerous area. The implants can be permanent or temporary.
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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.
Radiation Therapy And Radiopharmaceutical Therapy
External-beam radiation therapy
Candidates for definitive radiation therapy must have a confirmed pathologic diagnosis of cancer that is clinically confined to the prostate and/or surrounding tissues . Staging laparotomy and lymph node dissection are not required.
Radiation therapy may be a good option for patients who are considered poor medical candidates for radical prostatectomy. These patients can be treated with an acceptably low complication rate if care is given to the delivery technique.
Long-term results with radiation therapy are dependent on stage and are associated with dosimetry of the radiation.
Evidence :
Evidence :
Brachytherapy
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How Long Does Radiation Therapy For Prostate Cancer Take
The length of prostate cancer varies depending on a number of factors, such as the type, stage and location of the cancer. And while some people may be treated with only one therapy session, most of the time patients are subjected to a series of regular treatments that may run anywhere between one and eight weeks.
The treatment is usually administered once in a day, five days of a week, with each session only taking a few minutes. But then again, this may vary depending on the intensity of the spread, the type and stage of the cancer, as well as the type of radiation therapy being administered.
Ctca Approach To Managing The Side Effects Of Ebrt
At Cancer Treatment Centers of America®, we understand that many patients do not realize how the side effects of cancer treatments may affect them. Thats why we take the time to educate patientsbefore, during and after treatmentabout how their bodies will respond and provide an array of supportive care therapies designed to help them maintain their strength, stamina and quality of life. Evidence-informed therapies that may help manage the side effects of EBRT include:
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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:
-
A PSA test every 3 to 6 months
-
A DRE at least once every year
-
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.
Which Type Of Radiation Therapy Is Right For You
It can be confusing to know which radiation treatment approach is your best choice. Were here to help. When recommending one approach or another, our team of radiation oncologists will consider a number of factors, including the aggressiveness of your tumor, how advanced your disease is, and your own preferences.
It can be helpful to know about different radiation treatment scenarios that occur based on the types of conditions we commonly see. Here are a few.
Localized prostate cancer refers to a tumor that is clearly confined within the prostate. Radiation therapy options for men with early-stage, localized prostate cancer include:
- low-dose-rate brachytherapy
- stereotactic radiosurgery
For men with locally advanced prostate cancer which means the cancer has spread outside the prostate to nearby tissues options may include:
- LDR brachytherapy combined with a short course of daily IG-IMRT
- IG-IMRT combined with hormone therapy
- High-dose-rate brachytherapy combined with a short course of daily IG-IMRT
Together with your radiation oncologist, we can help you figure out which of these approaches is best for you.
Often, when a tumor is more advanced or aggressive, men receive hormone therapy before radiation therapy begins and continue it throughout the course of their treatment. Some receive hormone therapy after radiation therapy finishes as well. Hormone therapy reduces the level of testosterone throughout the body .
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