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Radiation For Advanced Prostate Cancer

Shorter Radiation Course Ready For Broad Use

Surgery or radiotherapy for locally advanced prostate cancer

Because the trial was conducted at large medical centers as well as smaller community cancer centers and required careful quality control of the radiation treatment procedures at each center, the results show that use of a concurrent boost can be implemented in many clinics, Dr. Salerno said. We can move forward delivering the radiation boost concurrently for appropriate patients.

She also emphasized that not all people with early-stage breast cancer need a radiation boost, and whether to incorporate one is a discussion for each person with their treatment team.

Other large, ongoing clinical trials, including one in the UK and one in Germany, are also looking at this question, Dr. Salerno said, so there will be even more data addressing this .

Radiation oncologists are continuing to refine the way that radiation therapy is given for breast cancer and other cancers, including studying ways to further shorten treatment times without reducing the overall effectiveness of the treatment, Dr. Salerno said.

Thanks to we can continue to individualize the treatments for breast cancer and also maximize convenience for patients, Dr. Pierce concluded.

Questions To Ask Your Doctor Radiographer Or Nurse

  • Which type of radiotherapy is suitable for me and why?
  • Will I have any other treatments while Im having radiotherapy?
  • How long will the pain relief last? What other treatments are available to help with my pain?
  • Will I get any side effects and if so, how can I manage them?
  • Are there any safety guidelines I should follow during and after treatment?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Will having this treatment mean I cant have other types of treatment later on for example, chemotherapy?

When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with 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. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

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What Happens Before Radiation Therapy Treatment

Each treatment plan is created to meet a patientâs individual needs, but there are some general steps. You can expect these steps before beginning treatment:

Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.

Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an âinformed consentâ form. Signing the document means:

  • Your team gave you information about your treatment options.

  • You choose to have radiation therapy.

  • You give permission for the health care professionals to deliver the treatment.

  • You understand the treatment is not guaranteed to give the intended results.

Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:

Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.

You may also be fitted for an immobilization device. This could include using:

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Study Data And Findings

Figure 1 from Evolution of advanced technologies in prostate cancer ...

Investigators reviewed data from 143,886 men who were treated for localized prostate cancer at Veterans Affairs medical facilities between 2000 and 2015. The men ranged from 60 to 71 years in age, and came from diverse racial and ethnic backgrounds. Among them, 52,886 were treated with radiation within a year of being diagnosed. The other 91,000 men opted either for surgery over a similar time frame, or chose to have their cancers monitored and treated only when or if routine exams showed signs of progression.

After a median follow-up of nine years, 3% of the radiation-treated men had developed secondary cancers, compared to 2.5% of the men who chose other options. The four most common cancers in the order of how frequently they were detected were bladder cancer, leukemia, lymphoma, and rectal cancer. The risk of developing these secondary cancers increased steadily with time, peaking five to six years after radiation treatment was finished.

Dr. Oliver Sartor, an oncologist at Tulane University School of Medicine in New Orleans who was not involved in the study, says the potential for secondary cancers is an important issue that men should discuss with their doctors when evaluating treatment options.

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Chemotherapy For Prostate Cancer

Patients who no longer respond to hormone therapy have another option.

The chemotherapy drug docetaxel taken with or without prednisone is the standard chemotherapy regimen for patients who no longer respond to hormone therapy. Docetaxel works by preventing cancer cells from dividing and growing. Patients receive docetaxel, along with prednisone, through an injection. Side effects of docetaxel are similar to most chemotherapy drugs and include nausea, hair loss, and bone marrow suppression . Patients may also experience neuropathy and fluid retention.

Docetaxell, when used with or without prednisone, was the first chemotherapy drug proven to help patients live longer with advanced prostate cancer. The average survival was improved by about 2.5 months when compared to mitoxantrone with or without prednisone. Docetaxel has the best results when given every three weeks as compared to weekly dosing.

Cabazitaxel is another chemotherapy drug, used in combination with the steroid prednisone, to treat men with prostate cancer. Cabazitaxel is used in men with advanced prostate cancer that has progressed during, or after, treatment with docetaxelâââââââ .

Side effects in those treated with cabazitaxel included significant decrease in infection-fighting white blood cells , anemia, low level of platelets in the blood , diarrhea, fatigue, nausea, vomiting, constipation, weakness, and renal failure.

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.

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Will Radiation Therapy Make Me Tired

Everyone has their own energy level, so radiation treatment will affect each person differently.

People often feel fatigue after several weeks of treatment. For most, this fatigue is mild. But some people lose a lot of energy and need to change their daily routine.

If your doctor thinks you should limit how active you are, theyâll discuss it with you.

To minimize fatigue while youâre receiving radiation treatment:

  • Get enough rest.

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Staging Of Prostate Cancer

ASCO 2012: Radiotherapy for Locally Advanced Prostate Cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .

The stage of the cancer will determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

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Surgery For Prostate Cancer

In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.

Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.

To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.

Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.

Having External Beam Radiotherapy

At the start of the session, the radiographer will make sure you are in the correct position on the couch and that you are comfortable. Radiotherapy is not painful. But you must lie still during the treatment. You may want to take your painkillers before you have it.

When everything is ready, the radiographer leaves the room so you can have the radiotherapy. The treatment only takes a few minutes. You can talk to the radiographers through an intercom or signal to them during the treatment. They can see and hear you from the next room.

Your cancer doctor, nurse or radiographer will explain your treatment and its possible side effects. They can give you advice on what you can do to manage any side effects. They can also help answer any questions you may have.

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Radioactive Injections For Metastatic Prostate Cancer

Radioactive injections can help with symptoms of prostate cancer that has spread to the bones. They can shrink any areas of cancer in the bone by killing the cancer cells, which can relieve pain and improve your overall prognosis. Radioactive injections will not lower your PSA. Examples of radioactive injections are strontium 89 and radium-223 .

Getting your treatmentYou will normally have the injection every month in the radiotherapy department as an outpatient, so you shouldnt need to stay in hospital overnight.

Will I get side-effects?Side-effects are mild and may include diarrhoea and sickness, and sometimes reduced levels of blood cells. Bone pain may get a little worse before it gets better.

Will I be radioactive?After the injection, a small amount of radiation remains in your urine, poo and blood. It is best to use flush toilets instead of urinals afterwards. This will reduce the risk of others being exposed to the radiation. Do flush the toilet a couple of times after passing urine as well. Be careful of any spills of urine or blood, but it is quite safe to be around people and pets. The radiation usually lasts about 7 days. Your doctor or nurse will discuss any special precautions with you before you go home.

How Is Prostate Cancer Classified

Postoperative Radiotherapy for Prostate Cancer: A Comparison of Four ...

Tumors in the prostate range from slow-growing to fairly aggressive. Theyre referred to by a number, known as a Gleason score, which combines a pattern type and a stage . The resulting score is on a scale from two to 10, where lower scores indicate cells that are more similar to surrounding cells than higher ones scores below six respond well to treatment.

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Dealing With Feelings Of Sadness

If you have continued feelings of sadness, have trouble getting up in the morning or have lost motivation to do things that previously gave you pleasure, you may be experiencing depression. This is quite common among people who have had cancer.

Talk to your GP, as counselling or medication even for a short time may help. Some people can get a Medicare rebate for sessions with a psychologist. Ask your doctor if you are eligible. Cancer Council may also run a counselling program in your area.

For information about coping with depression and anxiety, call Beyond Blue on 1300 22 46 36. For 24-hour crisis support, call Lifeline on 13 11 14.

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Immunotherapy For Advanced Prostate Cancer

Immunotherapy is indicated for some men with metastatic prostate cancer. This therapy uses the patients own immune system to fight their cancer. The process begins by harvesting dendritic immune cells from the body, and exposing them to specific molecules that have been designed to target and attack cancer cells. This molecule and the resulting treatment option are called Provenge immunotherapy. Provenge is indicated for advanced prostate cancer patients whose cancer continues to spread after hormone deprivation therapy.

The process of creating Provenge immunotherapy involves the following steps:

  • The patient is scheduled for a blood draw so that dendritic immune cells can be harvested.
  • Their blood is shipped to Dendreon labs, the manufacturer of Provenge.
  • While at the lab, the patients immune cells are exposed to Provenge molecules. After exposure, the resulting vaccine will be shipped back to ACFRO for prompt infusion into the patient.

Provenge immunotherapy is dispensed over three separate appointments during the course of several weeks.

Video courtesy of Dendreon

Video courtesy of Dendreon

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Testing A Sequential Versus Concurrent Radiation Boost

The trial included 2,262 women with early-stage breast cancer who had a lumpectomy and an elevated risk of recurrence in the same breast. Risk factors for recurrence included higher tumor grade, being younger than 50 years old, having cancer in lymph nodes in the armpit region, and having a hormone receptornegative breast cancer.

In addition, Dr. Vicini said, 60% of participants had received chemotherapy prior to radiation, which is another sign that a persons risk of recurrence may be higher.

The trial, known as NRG Oncology/RTOG 1005, was run by the NCI-funded NRG Oncology clinical trials group.

Half of the participants were randomly assigned to receive conventional whole-breast radiation given 5 days a week for 35 weeks, followed by a boost given over 67 days . The other half received the boost doses during 3 weeks of hypofractionated whole-breast radiation given 5 days a week . Participants were followed for a median of 7.4 years.

Cancer recurrence rates after 5 and 7 years were very similar in women who received a sequential boost and in those who received a concurrent boost. The percentage of people who had severe side effects was also about the same. Side effects of radiation therapy may include fatigue, hair loss, and effects on nearby organs, including the heart.

Recurrence/side effect rate
Rate of severe side effects 3.3% 3.5%

Online Support Groups For Prostate Cancer

External Beam Radiation Therapy for High Risk/Locally Advanced PCa: The Shifting Landscape
  • 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.

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Endocrine Therapy And Prostate Cancer

Male hormones, specifically testosterone, fuel the growth of prostate cancer. By reducing the amount and activity of testosterone, the growth of advanced prostate cancer is slowed. Hormone therapy, known as androgen ablation or androgen suppression therapy, is the main treatment for advanced prostate cancer. It is the first line of treatment for metastatic prostate cancer.

In many patients, endocrine therapy provides temporary relief of symptoms of advanced prostate cancer. Endocrine therapy may reduce tumor size and levels of prostate specific antigen in most men. PSA is a substance produced by the prostate gland that, when present in excess amounts, signals the presence of prostate cancer.

However, hormone therapy is not without side effects. Some of the more serious side effects include loss of sex drive, impotence, weakened bones , and possibly heart problems.

Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. Doctors call this castrate-resistant prostate cancer.

If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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