Proton Treatment For 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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What Happens During Radiation Therapy Treatment

What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive.

External-beam radiation therapy

External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.

Each session is quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine. Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.

This type of radiation therapy targets only the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until the treatment period is completed. Let the health care professionals if you are experiencing side effects. Read more about the side effects of radiation therapy.

Internal radiation therapy

• The permanent implant loses it radioactivity

• The temporary implant is removed

Weekly reports

Personal care

What Are The Results Of Using Proton Therapy In Patients

For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.

For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.

Survivor Spotlight

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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 hair loss or less sweat within the treated area.

These skin reactions are common and temporary. Theyâll fade gradually within 4 to 6 weeks after you finish your treatment. If you notice any skin changes outside the treated area, tell your doctor or 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
• Skins feels more or less sensitive
• A thickening of tissue or skin

Other possible side effects of external beam radiation therapy are:

Tiredness. Your fatigue might not lift until a few weeks or months after you finish getting radiation therapy.

Lymphedema. If radiation therapy damages the lymph nodes around your prostate gland, the fluid can build up in your legs or genital area. That can bring on swelling and pain. Physical therapy can usually treat lymphedema, but it might not go away completely.

Urinary problems. Radiation can irritate your bladder, and that could lead to a condition called radiation cystitis. You might:

• Have to pee more often
• Feel like it burns when you pee
• Notice blood in your urine

How Can I Help Myself

Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.

Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.

• Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
• Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
• Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
• If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
• Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
• Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
• Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
• Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
• If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.

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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:

• Feeling tired
• Constipation

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.

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.

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Whats The Procedure Like

Since delivering the protons to the cancer cells is the goal of therapy, a lot of time is spent on positioning your body and adjusting the equipment before each session.

Youll have to remain perfectly still while the proton beam is delivered, but it will only take about 1 to 3 minutes. Its noninvasive, and you wont feel anything. Youll be able to leave right away and continue your normal activities.

Diarrhea Flatulence Or Painful Defecation

These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

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Prostate Cancer Treatment Proton Beam Therapy

Overview by Dr Sarah HarrisProfile

In 2022 , the options for the active treatment of non metastatic prostate cancer are many .This provides men with many decisions to make , knowing that the chances of cure or control of localised prostate cancer are likely to be high but the side effects are different .

Within the non-surgical options are radiotherapy treatments which have also evolved significantly in the last 2 decades . This page concentrates on the use of proton beam therapy a less common form of external beam radiotherapy .

Why might Protons be good a Cancer treatment?

Radiation is a form of energy which causes changes to the chromosomes or genetic material of cells as is passes through the body tissues . This damage preferentially kills cancer cells allowing normal body tissues to recover from the damage .

High energy Xrays deliver their highest dose of energy just under the skin and then fall away as they are absorbed passing deeper into the tissues . Protons are charged particles and deliver their majority of their energy at one depth the Bragg peak and then stop beyond this point. The energy or strength of the proton beam is selected to have this peak where the tumour is to be treated .

Why might Protons be good for treating Prostate Cancer ?

Sadly , there is no level 1 evidence comparing proton and X-ray treatment for early prostate cancer yet and clinical trials are now underway to answer this question .

How many treatments do I need?

Summary

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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What Are The Types Of Radiation Therapy Used For Prostate Cancer

Radiationtherapy for prostate cancer can be divided into two main categories.

Externalbeam radiation :Using a machine outside the body, beams of radiation are focused on theprostate gland. This can help relieve symptoms such as pain while limiting thedamage to the tissues surrounding the prostate.

The 4methods of external beam radiation are:

• Three-dimensional conformal radiation therapy
• Stereotactic body radiation therapy
• Proton beam radiation therapy

Brachytherapy:Small radioactive pellets are inserted into the prostate, each one about thesize of a grain of rice. About 100 pellets are used to limit the damage tosurrounding tissues and organs. Brachytherapy is most often used forearly-stage cases and is sometimes combined with EBRT. The pellets can eitherbe inserted for a couple of days for high dosages or a few months for lowdosage depending on the patients overall status.

Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is usually used to treat prostate cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also be given hormone therapy together with radiation therapy.

Radiation therapy is given for different reasons. You may have radiation therapy to:

• destroy cancer cells in the body
• treat cancer that is not removed completely with surgery or that comes back after surgery
• relieve pain or control the symptoms of advanced prostate cancer

The following types of radiation therapy are most commonly used to treat prostate cancer.

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Who Is On My Radiation Therapy Team

A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:

Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

• Answering questions about treatments

• Monitoring your health during treatment

• Helping you manage side effects of treatment

Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.

Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:

• Social workers

Learn more about the oncology team.

Technical Delivery Of Proton Therapy

A minimum standard of treatment delivery must be followed to ensure the accuracy and effectiveness of proton therapy for prostate cancer. The goals of delivery should be to overcome 3 fundamental radiation therapy challenges: to minimize uncertainty regarding the precise location of the target during beam exposure, to maximize target coverage, and to minimize radiation exposure to organs at risk.

Although intrafraction and interfraction variability must be accounted for with both proton- and photon-based treatment planning, there is a proton-specific uncertainty called range uncertainty, which refers to the effect on the proton beam range that the slight variations in prostate position may have on the composition of tissues in the beam path. Range uncertainty is based on modeling studies and includes the addition of a margin to the proximal and distal edge of the target.

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What Does External Beam Radiotherapy Involve

You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.

Before your radiotherapy treatment

Radiotherapy planning session

A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.

During your radiotherapy treatment

You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.

If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.

At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.

Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.

How Proton Therapy Works

A machine called a synchrotron or cyclotron speeds up protons. The high speed of the protons creates high energy. This energy makes the protons travel to the desired depth in the body. The protons then give the targeted radiation dose in the tumor.

With proton therapy, there is less radiation dose outside of the tumor. In regular radiation therapy, x-rays continue to give radiation doses as they leave the person’s body. This means that radiation damages nearby healthy tissues, possibly causing side effects.

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