Easier To Have Additional Treatment
In a perfect world, all you will need is one treatment. However, cancer is cancer. So, we will follow your PSA to see if there is any sign that the cancer came back.
If the PSA starts to creep up, higher than 0.2, then we can always add radiation later. However, there is some trade off to this in that some of the side effects from radiation can become more common after the prostate has been removed.
Can Surgery And Radiation Be Used Together
If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.
This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.
Is One Treatment Better Than The Other
A personalized approach is the most effective way to treat prostate cancer. Thus, it is not a question of which method is better but rather which method is the most suitable for your specific disease.
There is no overall best between surgery and radiotherapy both have advantages and disadvantages.
Your doctor may recommend surgery if you are healthy enough for a significant surgical procedure. It is also a good option if you have had previous radiation therapy to your pelvic region.
It is also better if you have an existing bowel disease, which can be exacerbated by radiation therapy. Your doctor may recommend radiation therapy if your health or other medical conditions make surgery risky.
Nonetheless, men who receive either treatment options have a low risk of prostate cancer death. A seminal study that compared active monitoring, radical prostatectomy, and radiotherapy found no significant difference among treatment options.
Surgery and radiotherapy reduced the rates of disease progression and metastases, by similar proportions, compared to active monitoring.
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A Brief History Of Prostate Treatment From Surgery To Radiation
Surgery has been the standard of care for prostate cancer for the past 150 years. Although effective, radical prostatectomies are invasive and not without complications. But then, shortly after the discovery of X-rays and radium at the turn of the last century, physicians began to explore how these modalities might improve survival and decrease potential side effects from the radical surgery. In 1917, Dr. Benjamin Barringer, chief of urology at what is now known as Memorial Sloan Kettering Hospital, espoused the use of radium needles for prostate cancer.
Initially, radioactive seed implantation was performed via free-hand technique, using direct visualization of the prostate to guide the radiation oncologist with seed placement. However, the results of this preliminary approach were hampered by suspect dose distribution in the prostate.
In 1987, Dr. John Blasko from Seattle described a reproducible system to implant radioactive iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patients perineum . The template guides the placement of the needles that are loaded with radioactive seeds. This technique allows a reproducible, uniform dose distribution to the prostate.
At Princeton Radiation Oncology, our radiation oncologists have been performing the prostate seed procedure since 1997. We use the Seattle groups criteria for implant selection.
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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. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based 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. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.
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 the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.
What Are The Benefits Of Surgery
The success rate for surgery to treat prostate cancer is very high when all the cancer is removed. Surgical treatment is generally safe, with most men making a full recovery within two months after surgery.
Further, surgery provides information about the exact genetics and state of cancer. Genetic analysis of surgically removed prostate tissue allows doctors to estimate prognosis and plan any complementary treatments.
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What Is Brachytherapy For Prostate Cancer
Brachytherapy is a form of radiation treatment. During brachytherapy, doctors take small particles or seeds that contain a source of radiation and place them inside the body in or near a tumor.
The radioactive material only affects the tissue very close to it, so it tackles the tumor but doesnt harm the rest of the body.
According to the American College of Surgeons , healthcare professionals may recommend brachytherapy as a stand-alone treatment if you have very low- or low-risk prostate cancer or favorable intermediate-risk prostate cancer.
If you have a higher-risk case, healthcare professionals might use brachytherapy in addition to external beam radiation therapy .
Seed Migration To The Kidneys And Batsons Vertebral Plexus Is Not Very Rare
The results of the present study show a total of four and five cases of seed migration to the kidneys and Batsonâs vertebral venous plexus, respectively, at only one institution, which suggests that such cases are not very rare. Meanwhile, in previous studies, a total of only four and four cases of seed migration to the kidneys and Batsonâs vertebral venous plexus, respectively, have been reported as rare cases, which is in disagreement with our conclusion . The same number or more cases of seed migration to these areas were found in our single study compared with all previous studies. A possible explanation is that, in the present study, orthogonal chest radiographs, an abdominal radiograph, and a pelvic radiograph were undertaken routinely to detect seed migration to the chest, abdomen, and pelvis at several time points after seed implantation. Moreover, in all patients who had seed migration to the abdomen and pelvis, a CT scan was undertaken to identify the exact location of the migrated seeds. Consequently, more cases of seed migration to the kidneys and Batsonâs vertebral venous plexus were found in the present study. We speculate that some seed migration to the kidneys and Batsonâs vertebral venous plexus might have gone undetected in other institutions.
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Prostate Cancer Surgery Or Radiation Which Is Better
The only other thing I was drinking in the first 6 months after my diagnosis was green tea. I would drink about 4 glasses of green tea daily to go along with the increased water intake. I wasnt putting any other liquid into my body for the first 6 months. This was a big help in starting my road to recovery.
Once I started feeling better then I added organic soy milk to my diet as well. Soy milk isnt much like regular milk but once you get used to it then its not bad at all. To this day these are the only 3 liquids I have in my diet. To recap the 3 liquids I drink today are purified water,green tea,& organic soy milk. I put no other liquids into my body period.
Now, I want to chat a little more about meat & other aspects of a proper diet. As I said we dont need meat to live. I thought cutting or limiting meat in my diet would be to hard to accomplish. Well again my thinking was wrong. Was it easy? No! However, after a couple weeks then things were starting to get easier. I didnt cut all meats out of my diet but I did cut certain meats & eat moderate amounts of all others.
One meat that needs to be completely cut or at least very minimized is red meat . Too much Red meat consumption is not good for prostate health. I was eating a lot of fast food burgers & also red meat at home. I will say to at least cut red meat completely out of your diet until you get your prostate health back.
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Quality Of Life Is Better After Modern Radiotherapy Compared With Surgery
For decades, organ preservation has been an abiding principle of radiotherapy, with the underlying belief being that a person with preserved native anatomy has better physical functioning than one who has undergone surgical removal of organs followed by reconstruction. Comparing modern radiotherapy vs surgery for prostate cancer, we argue the following points: Head-to-head comparisons have shown modern radiotherapy to be much better than surgery in terms of urinary and sexual function.
While bowel toxicity has historically been moderately worse after radiotherapy, this decline in function can now be mitigated largely by using modern radiotherapy techniques, such as image guidance and possible additional rectal spacing.
Quality of life following radiotherapy has continued to improve as advances have been made in radiotherapeutic techniques, whereas prostate surgery-despite the availability of newer, once-promising techniques such as laparoscopic or robot-assisted radical prostatectomy-remains largely unchanged in regard to long-term impacts on quality of life. Thus, radiotherapy is the better choice for treatment of prostate cancer.
Financial Disclosure: Dr. Yu and Dr. Hamstra have served as paid consultants to Augmenix, Inc. Dr. Hamstra has also received grant funding from Augmenix, Inc.
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Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
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Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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Why Choose Brachytherapy For Prostate Cancer Treatment
Prostate brachytherapy is a highly effective type of prostate cancer treatment. For some, it may be used as the only type of treatment. For other men, brachytherapy is used in combination with other cancer treatments such as external radiation or hormone therapy.
The radiation is often successful in treating the cancer cells, while nearby tissue only receives a very small amount of the radiation. This can be helpful in reducing the side effects that are experienced. Prostate brachytherapy is not usually recommended for prostate cancer that has spread to lymph nodes or distant areas of the body.
Side Effects Of Surgery For Prostate Cancer
The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.
According to the patient-reported outcomes from men who participated in the ProtecT trial, men who underwent a radical prostatectomy experienced more sexual dysfunction and urinary problems than those treated with radiation therapy.
While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.
Although men treated with radiation reported experiencing bowel function problems after treatment, the study participants who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.
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Choosing A Prostate Cancer Treatment: Surgery Versus Radiation
Although many treatment options are available, patients with newly-diagnosed prostate cancer often narrow down the choices to two surgical removal of the prostate or radiation therapy. Since many factors influence this decision, choosing which treatment to use can be daunting.
The biggest advantage to radiation therapy is that it is easier to undergo than surgery. Even with robotic technology, its small incisions are not as small as the openings made by a couple of dozen needles inserted into the skin behind the scrotum when radiation seeds are implanted. General recovery from robotic prostatectomy is usually 2-3 weeks, whereas recovery from radioactive seed implantation is 1-2 days. Many patients who choose the radiation route will also undergo daily external beam treatments for 6-7 weeks.
The biggest advantage to surgical removal is the information learned that is not available through other treatment methods. Once the prostate is removed, it can be fully analyzed to determine the extent, location, and grade of the disease within the prostate and seminal vesicles . More important, the ability to monitor a patient for possible recurrence is dramatically enhanced. When the prostate is removed, the PSA blood test should become undetectable within six weeks if all the cancer cells have been successfully eliminated. Prostate cells are the only source of PSA, a protein made by these cells and partially released into the blood stream.
Summary Of Surgery Vs Radiation For Prostate Cancer
- Both surgery and radiation can be used to treat patients who have prostate cancer.
- Surgery for prostate cancer is invasive but has the benefit of potentially completely removing the cancerous cells from the body.
- Radiation is a less invasive treatment for prostate cancer and also has the advantage of being helpful for patients needing palliative care.
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What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
Will Radiation Therapy Make Me Tired
Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.
If your doctor thinks you should limit your activity, they will discuss it with you.
To minimize fatigue while you are receiving radiation treatment:
- Be sure to get enough rest.
- Eat well-balanced, nutritious meals.
- Pace your activities and plan frequent rest periods.
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