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Radiation Dose For Prostate Cancer Treatment

Spaceoar Hydrogel: Reducing Radiation Exposure

Treating Prostate Cancer with High Dose Rate Brachytherapy

The prostate and rectum are located very close to each other and are separated only by a small space. When undergoing proton therapy for prostate cancer, your doctor will determine if you are eligible for placement of a special hydrogel between the prostate and rectum . The SpaceOAR hydrogel creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum, thereby minimizing unwanted side effects and potential injury to the rectum during treatment. More than 50,000 patients worldwide have been successfully treated with SpaceOAR Hydrogel.

The placement of the hydrogel is a minimally invasive procedure done within our center and the hydrogel remains inside the body throughout treatment. The material that the SpaceOAR Hydrogel is made from has been used in other implants such as surgical sealants used in the eye, brain and spine. The biodegradable material naturally dissolves after a few months and is cleared in your urine.

What Happens During A Treatment Session

  • You may be asked to change into a hospital gown or robe.
  • You will go to the treatment room where you will receive radiation. The temperature in this room will be very cool.
  • Depending on where your cancer is, you will either lie down on a treatment table or sit in a special chair. The radiation therapist will use the dots on your skin and body mold or face mask, if you have one, to help place you in the right position.
  • You may see colored lights pointed at your skin marks. These lights are harmless and help the therapist position you for treatment.
  • You will need to stay very still so the radiation goes to the exact same place each time. You will get radiation for 1 to 5 minutes. During this time, you can breathe normally.

The radiation therapist will leave the room just before your treatment begins. He or she will go to a nearby room to control the radiation machine. The therapist watches you on a TV screen or through a window and talks with you through a speaker in the treatment room. Make sure to tell the therapist if you feel sick or are uncomfortable. He or she can stop the radiation machine at any time. You will hear the radiation machine and see it moving around, but you won’t be able to feel, hear, see, or smell the radiation.

Most visits last from 30 minutes to an hour, with most of that time spent placing you in the correct position.

Swelling Bruising Or Tenderness Of The Scrotum

Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.

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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.

Will Radiation Therapy Make Me Tired

Samarium

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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Helping People Imagine Their Future

The hardest thing we can do as physicians is help patients envision their future selves, Dr. Buyyounouski said. So patient-reported outcomes are very helpful, because you can tell patients exactly what side effects people had, and the frequency and bother of those side effects at points in time.

For many, he added, the trade-off in more side effects right after treatment will be worth it for a shorter treatment duration.

Unless youve been a patient, its hard for folks to imagine all the things that need to happen for somebody to go and get treatment every for weeks, Dr. Buyyounouski said.

Theres transportation costs, gas, parking, co-pays. And there are costs associated with the things youre not doing, like time away from work or responsibilities at home. Its more than just the medical bills.

I think people are itching to shorten the treatment because there are a lot of patients for whom its a barrier to getting treatment. And radiation therapy is a potentially curative treatment, added Dr. Citrin. So, making it easier for patients without increasing the long-term side effects is a huge win.

However, a less-intensive standard course of radiation will still likely appeal to some people, she added, especially if they are experiencing ongoing side effects from surgery.

What Types Of Radiotherapy Are There

There are two common types of external beam radiotherapy:

  • intensity-modulated radiotherapy
  • 3-dimensional conformal radiotherapy .

You may also hear about image guided radiotherapy . This is part of all radiotherapy treatments. Taking images of the prostate before each treatment allows your radiographer to make small changes to the area that is going to be treated, in case the prostate has moved slightly since your last treatment session. This makes sure the surrounding healthy tissue gets as little radiation as possible. It also makes sure the whole prostate is treated.

Intensity-modulated radiotherapy

This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location, size and shape of your prostate. The radiotherapy machine gives beams of radiation that match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects.

The strength of the radiation can be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate without causing too much damage to surrounding tissue.

3D conformal radiotherapy

As with IMRT, the radiation beams are mapped to the size, shape and position of the prostate. But the strength of the radiation cant be controlled in 3D-CRT, so all areas are treated with the same dose.

Other types of radiotherapy

Proton beam therapy

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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.

How Does Brachytherapy Work

What to Expect Before Starting Radiation Treatment for Prostate Cancer

Brachytherapy involves implanting small, permanent radioactive seeds or temporary needles into the cancerous prostate.

After you are identified as a good candidate for brachytherapy, an ultrasound is used to guide the placement of needles into the prostate. Depending on whether you and your doctor have chosen permanent/low-dose brachytherapy or temporary/high-dose brachytherapy, these needles are then used to either put in permanent seeds or temporary radiation sources.

Placement of seeds is a minimally invasive procedure and does not require incisions. Men undergoing the procedure can return to full activity in less than a week. This is done as an outpatient procedure before you begin treatment.

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Stereotactic Body Radiation Therapy

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.

The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

How Do I Choose Which Radiation Therapy Is Right For Me

Localized prostate cancer means it has not spread outside the prostate. Radiation therapy for early-stage, localized prostate cancer includes:

  • Low dose rate or high dose rate brachytherapy.
  • Hypofractionated radiation therapy .

Your radiation treatments will depend on the type of prostate cancer you have. Your radiation oncologist can help you decide which radiation treatments are best for you.

When the disease has spread outside the prostate gland, there are 2 common treatment options.:

  • IG-IMRT combined with hormone therapy. Treatments last about 5 weeks.
  • High-dose-rate brachytherapy combined with a short course of daily IG-IMRT with or without hormone therapy. Treatments may be as few as 5 or as many as 25.

With advanced or aggressive cancer, theres risk of the tumor spreading into areas outside the prostate. In such cases, we may combine radiation therapy with hormone therapy.

Hormone therapy slows or blocks the growth of prostate cancer cells. Testosterone is a male sex hormone that can cause prostate cancer cells to grow. Hormone therapy lowers the amount of testosterone your testicles make.

We start your hormone therapy before you have radiation therapy. This is because radiation therapy works better when hormone therapy continues throughout treatment. Sometimes hormone therapy also is given after radiation therapy treatment is over. Our doctors will talk with you about whether hormone therapy is right for you.

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What Happens During Radiation Therapy

Radiation therapy uses high-energy x-rays or a stream of particles . High doses of radiation can destroy abnormal cancer cells. Each treatment destroys some of the cancer cells at a microscopic level. Patients do not feel the radiation during treatment. They will only hear some electrical noise and may see light from the machine.

Heres What You Should Know About This Treatment Option

Prostate Tumor Treatment

Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.

But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.

Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.

“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.

There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.

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What Are The Advantages And Disadvantages Of External Beam Radiotherapy

What may be important for one person might not be so important for someone else. If youre offered external beam radiotherapy, speak to your doctor, nurse or radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.

Advantages of external beam radiotherapy

  • If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
  • Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
  • Radiotherapy can be an option even if youre not fit or well enough for surgery.
  • Radiotherapy is painless .
  • The treatment itself only lasts around 10 minutes, including the time it takes to get you into position. But youll probably need to be at the hospital for up to an hour each day to prepare for your treatment. You dont need to stay in hospital overnight.

Disadvantages of external beam radiotherapy

I was able to continue working throughout my treatment, although I got tired quickly. I had some side effects but nothing I couldnt cope with. A personal experience

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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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.

How Can I Choose From Among The Options

Overview: Radiation Therapy & Prostate Cancer | Michael Steinberg, MD | 2021 PCRI Con

In addition to talking with family and friends, you will need a team of physicians to help advise you. You should meet with everyone involved in your treatment planning before choosing a treatment, including:

  • your primary care doctor
  • a urologist to discuss surgery
  • a radiation oncologist to discuss radiation therapy
  • a medical oncologist to discuss hormone suppression, if your cancer is more advanced

After you meet with these doctors, you can make an informed decision regarding your treatment options. You may have an early-stage or moderately advanced cancer with no evidence of spread to other organs . If so, your two major treatment options are active surveillance , surgery or radiation therapy .

You may have advanced cancer and require hormonal suppression therapy or chemotherapy. If so, you will need a medical oncologist to administer these drugs. Doctors use hormone-ablation therapy to treat advanced prostate cancer. It suppresses androgen because these hormones stimulate most prostate cancer growth. Your internist, urologist, radiation oncologist or medical oncologist may administer the treatment. Depending on the stage of the cancer, your doctor may use hormone suppression therapy and radiation therapy to help control your disease. You may receive hormone suppression therapy for as little as four to six months, or for as long as two to three years.

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Single Dose Of Targeted Radiotherapy Is Safe And Effective For Prostate Cancer

Date:
European Society for Radiotherapy and Oncology
Summary:
A single high dose of radiation that can be delivered directly to the tumor within a few minutes is a safe and effective technique for treating men with low-risk prostate cancer.

A single high dose of radiation that can be delivered directly to the tumour within a few minutes is a safe and effective technique for treating men with low risk prostate cancer, according to a study presented at the ESTRO 38 conference.

Radiotherapy traditionally involves a series of lower dose treatments that take place over several days or week. The new treatment is called high dose-rate brachytherapy and it delivers radiation via a set of tiny tubes.

Researchers say this technique could offer an effective treatment that is convenient for patients and brings potential time and cost savings for hospitals.

The research was presented by Dr Hannah Tharmalingam, a Clinical Research Fellow at Mount Vernon Cancer Centre, Northwood, and The Christie NHS Foundation Trust, Manchester, UK.

The research included 441 men with prostate cancer who were treated at one of seven UK hospitals between 2013 and 2018. Their cancers were classified, depending on how likely they were to spread, as either low risk , medium risk or high risk . All were treated with a single high dose of radiation 166 men also received hormone therapy but none had any surgery or chemotherapy.

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