Analysis Of Missing Data
Table shows the reasons for nonresponse to the 5-year survey by treatment group. Overall, statistically significantly fewer men in the external beam radiotherapy group than in the radical prostatectomy group completed the 5-year survey . However, differences between treatment groups in the specific reasons for nonresponse were relatively small for example, 7% of radical prostatectomy patients had died compared with 11% of external beam radiotherapy patients. Refusal was the leading reason for nonresponse.
We further evaluated the possible effects of differential response levels by age at diagnosis on our reported outcomes by performing a last value forward analysis on urinary, bowel, sexual, and general health outcomes. We used data from the 2-year survey or from the 12- or 6-month surveys to estimate outcomes at 5 years after diagnosis. The impact of estimating outcomes on the reported comparisons was negligible.
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If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options:
To help you through the process of making this decision, this article covers:
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Urinary And Sexual Function
Perhaps the 2 most feared complications of RP from a patient’s perspective are urinary complications and impotence. One difficulty in assessing these complications is that there are no precise definitions of incontinence or impotence in the literature. Furthermore, centers have obtained their outcomes data by widely divergent methods, including questionnaires, telephone interviews, or surgeon assessment. Lastly, continence and potency rates are improved when the patient population is highly selected .
Urinary incontinence can be a devastating complication following prostatectomy. Given the difficulty in measuring this clinical outcome, however, continence results in the literature vary widely. Most centers with a high-volume experience in this procedure report continence rates between 80% and 95% .
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Questions To Ask Your Doctor Nurse Or Radiographer
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of radiotherapy will I have?
- How many sessions will I need?
- What other treatment options do I have?
- What are the possible side effects and how long will they last?
- What treatments are available to manage the possible side effects from radiotherapy?
- Will I have hormone therapy and will this carry on after radiotherapy?
- How and when will I know if radiotherapy has worked?
- If the radiotherapy doesnt work, which other treatments can I have?
- Who should I contact if I have any questions?
- What support is there to help manage long-term side effects?
What Types Of Testing Should I Expect For Monitoring My Condition
Since metastatic prostate cancer isnt curable, your doctor will most likely set up regular visits to check the cancers location, and to manage any long-term side effects from the cancer or any medication youre taking.
And since treatments for advanced prostate cancer are changing so fast and need to be given in a certain sequence to be the most effective, youll probably have not only a prostate cancer doctor but other specialists taking care of you. Your care team should coordinate closely, say the authors of a major study of such teams published in August 2015 in the journal Annals of Oncology.
Along with regularly testing your prostate-specific antigen levels, your care team may request blood tests that measure such prostate cancer indicators as alkaline phosphatase and lactate dehydrogenase. Magnetic resonance imaging or PET scans of the spine or other bones can also help identify how your cancer responds to treatment.
If youve had radiation, youre at an increased risk for bladder and colorectal cancer and should get screened regularly for these as well.
The tests youll have and how often youll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you might have, and what stage your cancer was when you were diagnosed.
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Side Effects Of Cyberknife For Prostate Cancer Patients
Cyberknife is considered a minimally invasive procedure. While there are some side effects, most patients only experience them for a short time, and they are minimal. However, some patients experience severe side effects in the rectum or bladder wall. Some of the side effects include:
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Erectile Dysfunction
You may return to normal activities, but your doctor may minimize some physical activity on a case-by-case basis.
Get Your Free Prostate Cancer Guidebook
Make an informed prostate cancer treatment decision. Our 40-page, comprehensive guidebook provides answers to our most frequently asked questions from men diagnosed with prostate cancer, and compares various treatment methods, cure rates and side effects. Our team can also connect you with one of our oncologists at no cost.
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An Effective Less Disruptive Treatment Option
The CyberKnife System offers a non-surgical, non-invasive treatment option that delivers proven results for a wide range of cancers and metastases. CyberKnife provides stereotactic body radiation therapy and stereotactic radiosurgery , closely related types of radiation therapy that involve delivering a relatively higher dose of radiation with extreme accuracy. The high level of precision of this approach also called hypofractionation enables a higher dose of radiation to be delivered to a tumor in significantly fewer treatment sessions, while also reducing the radiation exposure to surrounding healthy tissues.
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Video: What Is Radiation Therapy
Watch this short video to learn more about radiation therapy.
A/Prof Ian Vela, Urologic Oncologist, Princess Alexandra Hospital, Queensland University of Technology, and Urocology, QLD A/Prof Arun Azad, Medical Oncologist, Urological Cancers, Peter MacCallum Cancer Centre, VIC A/Prof Nicholas Brook, Consultant Urological Surgeon, Royal Adelaide Hospital and A/Prof Surgery, The University of Adelaide, SA Peter Greaves, Consumer Graham Henry, Consumer Clin Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and Notre Dame University Australia, WA Henry McGregor, Mens Health Physiotherapist, Adelaide Mens Health Physio, SA Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, NSW Dr Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW A/Prof David Smith, Senior Research Fellow, Daffodil Centre, Cancer Council NSW Allison Turner, Prostate Cancer Specialist Nurse , Canberra Region Cancer Centre, Canberra Hospital, ACT Maria Veale, 13 11 20 Consultant, Cancer Council QLD Michael Walkden, Consumer Prof Scott Williams, Radiation Oncology Lead, Urology Tumour Stream, Peter MacCallum Cancer Centre, and Professor of Oncology, Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC.
View the Cancer Council NSW editorial policy.
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How Does Brachytherapy Work
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.
Long Term Side Effects Of Prostate Cancer Radiotherapy
Most side effects of radiotherapy gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that some side effects begin months or years later.
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Tell your doctor or nurse if you have any of these problems. They can help you to find ways of controlling the effects.
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Potential Side Effects Of Cyberknife Treatment For Prostate Cancer
Most radiation side effects are minimal and last only a short time. Side effects can, however, sometimes be severe because of rectum or bladder wall exposure to radiation. Possible side effects could include, but are not limited to:
- Constipation, fecal urgency, fecal incontinence, hemorrhoid, rectal bleeding
- Urinary retention, urinary urgency, increased frequency, incontinence, urinary bleeding
- Erectile dysfunction
Ask your doctor for more details about potential side effects associated with your specific radiation therapy treatment.
Types Of Prostate Radiation
The most common types of radiation for prostate cancer are external beam radiation and brachytherapy .
1. This type of radiation uses beams of radiation, which are focused on the prostate gland from a machine outside the body. Its very helpful in the early stage of prostate cancer or in cases when it is needed to relieve pain symptoms . Such treatment is usually done 5 days a week for several weeks, depending on the condition of the patient. External beam radiation for treatment of prostate cancer has different categories of treatment, such as:
- Three-dimensional conformal radiation therapy
- Intensity-modulated radiation therapy
- Stereotactic body radiation therapy
- Proton beam radiation therapy.
2. Brachytherapy for prostate cancer also called seed radiation for prostate cancer uses very small balls or pellets, which are placed into the patients prostate. Seed radiation differs in the dosage rate of the radioactive material: permanent and temporary .
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If Youre Getting Radiation Therapy To The Breast
If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.
Short-term side effects
Radiation to the breast can cause:
- Skin irritation, dryness, and color changes
- Breast soreness
- Breast swelling from fluid build-up
To avoid irritating the skin around the breasts, try to go without wearing a bra. If this isnt possible, wear a soft cotton bra without underwires.
If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.
Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.
Long-term changes to the breast
Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.
After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.
Less common side effects in nearby areas
Side effects of brachytherapy
How Can I Reduce Skin Reactions
- Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Donât rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
- Try not to scratch or rub the treated area.
- Donât put any ointment, cream, lotion, or powder on the treated area unless your radiation oncologist or nurse has prescribed it.
- Donât wear tight-fitting clothing or clothes made from harsh fabrics like wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers like cotton.
- Donât apply medical tape or bandages to the treated area.
- Donât expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
- Donât expose the treated area to direct sunlight. That could intensify your skin reaction and lead to a severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.
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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 personâs 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:
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A PSA test every 3 to 6 months
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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.
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Radiation Therapy In Advanced Disease:
Some forms of radiation therapy, like external radiation therapy and radiopharmaceuticals, can help with advanced prostate cancer. One type of external radiation therapy is used along with hormone therapy to treat cancer that has spread outside the prostate to nearby tissue. In addition, radiopharmaceuticals are used to manage pain and symptoms of bone metastases. Scroll down to learn more about radiopharmaceuticals.
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Who Might Benefit From Radiation Therapy
Your doctor might recommend radiation therapy in several situations.
It can be the first treatment for cancer that hasnât spread outside your prostate gland and is âlow grade.â The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are â and, in general, the more likely your cancer is slow-growing.
Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.
If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldnât remove all of the cancer or if the cancer comes back in the area of your prostate.
If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.
What Are The Dangers Of Radiotherapy Prostate Cancer Treatment
Radiotherapy is considered effective for treatment of cancer with a success rate of above 90%. But is it safe for prostate cancer treatment? Does it cause any side effects? And if yes, are radiation therapy side effects reversible?
Well, radio frequency is pain-free and considered safe for prostate cancer treatment. To help you understand the safety of this procedure we shall look at both the short and long-term side effects resulting from this treatment.
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If Youre Getting Radiation Therapy To The Chest
Radiation treatment to the chest may cause side effects such as:
Radiation can also cause other problems in the heart or lungs.
Heart complications
Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.
Radiation pneumonitis
Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:
- Shortness of breath that usually gets worse with exercise
- Chest pain, which is often worse when taking in a deep breath
Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.
Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.
Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.