What Are The Side Effects Of Brachytherapy
- Frequent urination or urinary retention or burning with urination
- Erectile dysfunction
- Urethral stricture or narrowing of the urethra
- Diarrhea or blood in the stool
- Secondary cancers
For the short time that the seeds are giving off larger amounts of radiation, you should avoid close proximity to children or pregnant women. Make sure to talk with your radiation oncologist or oncology nurse for instruction about radiation safety and exposure for family members or pets.
If you are traveling through an airport following brachytherapy treatment, there is a chance that radiation detectors will be set off. Talk to your radiation oncologist and ask for a note to indicate youve just had radiation treatment.
Focal Ablative Salvage Therapy
More recently, there is a growing body of research on focal salvage therapy to target just the identified tumor. This approach is called Focal Ablative Salvage Therapy, or FAST. Thanks to mpMRI and MRI targeted biopsy, the tumors location, extent, aggressiveness and genomics can be identified. Ablating just the tumor offers the dual advantage of cancer control plus low side effect risks. As with whole-gland primary treatment, the same three ablation methods can be used.
As of this writing, the most recent data was presented at the 2022 annual meeting of the American Urological Association by Dr. Deepika Reddy . The statistics were drawn from 288 consecutive cases of radiation recurrence that were treated with either focal HIFU or focal cryo . According to Dr. Reddys presentation, 265 patients had pertinent follow-up records for analysis. Patients had either stage T2 or T3 disease, and Grade Group 2, 3 or > 3.
Treatment was deemed successful based on failure-free survival and retreatment-free survival . The numbers are very encouraging, with 77% success rates for both FFS and RFS at 6 years post-FAST. About 7% of patients had adverse events following ablation, most of which were urinary infections. These patients avoided the surgical trauma of salvage prostatectomy, the increased cancer risk of salvage radiation, and the likely side effects of both.
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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.
An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.
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How Does Radiation Therapy Treat Prostate Cancer
Radiation therapy destroys prostate cancer cells with high-power energy beams like X-rays or protons. At CenterPoint Radiation Oncology, Dr. Morrell uses the most advanced imaging technologies, such as MRI and PET scans, to guide the radiation therapy planning process. She may also use genomic tests to analyze the prostate cancer cells and determine the type of mutation.
Then, Dr. Morrell creates a personalized prostate radiation therapy plan that treats prostate cancer while minimizing side effects. She uses the highest quality equipment, including the TrueBeam® radiotherapy system to target prostate cancer with pinpoint accuracy. Dr. Morrell may also recommend SpaceOAR Hydrogel to reduce urinary, sexual, and bowel side effects.
Common approaches to radiation therapy for prostate cancer include Image-Guided Radiation Therapy , Intensity-Modulated Radiation Therapy , and volumetric-modulated arc therapy .
For state-of-the-art treatment of prostate cancer, please call CenterPoint Radiation Oncology, or book an appointment online today.
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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Conditions Treated With Proton Therapy
Proton therapy is considered the most technologically advanced radiation delivery method for cancerous tumors. With this powerful, precise technology, tumors are more accurately targeted so healthy tissues and organs get less unnecessary radiation.
Proton therapy is commonly used to treat tumors in sensitive areas where traditional X-ray or photon radiation may not be the best option. Depending on your particular diagnosis, proton therapy may be a treatment option for cancers of the brain and central nervous system, breast, esophagus, head and neck, liver, lung, lymphatic system, eyes, pancreas, prostate, bone and others. It is particularly beneficial for many pediatric cancers.
Radiation Therapy: Effective For Prostate Cancer
Research published in the Journal of Medical Imaging and Radiation Oncology in 2015 shows that external-beam radiation therapy is a highly effective treatment option for prostate cancer.
Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer.
The 5-year survival rate using this treatment is 98.8% overall.
When compared to other common treatment options such as surgery or brachytherapy, external-beam was as effective and in some cases more effective.
A/Prof Tom Shakespeare, Radiation Oncologist at the North Coast Cancer Institute, led the eight year study comparing the effectiveness of external-beam radiation therapy with other common treatment options such as surgery or brachytherapy.
The main outcome that we have seen from this study is that external-beam radiation therapy is one of the most effective treatment options for prostate cancer, he said.
These are great results showing that radiation therapy is as effective, or even better, than other common treatment options such as surgery or brachytherapy.
In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases.
When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.
Unfortunately, this does not always happen.
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
What Is External Beam Radiation Therapy For Prostate Cancer
External beam radiation therapy treats prostate cancer with X-ray beams from a machine. The treatment is painless and only lasts for a few minutes at a time.
Siteman radiation oncologists were among the first in the U.S. to deliver external beam radiation using Intensity-Modulated Radiation Therapy . This technique enhances the delivery of high doses of radiation. In addition, they also use advanced-imaging methods such as MRI and PET scans a technique known as Image-Guided Radiation Therapy to focus treatment on the prostate, thereby reducing radiation delivery to the adjacent bladder and rectum.
Patients who develop a recurrence of their cancers after prior radical prostate surgery can be effectively treated with radiation therapy. If the prostate has been removed, radiation is delivered to the space where the prostate used to be.
Brachytherapy is radiation therapy that comes from a source implanted within the body. There are two different types: low-dose-rate brachytherapy and high-dose-rate brachytherapy.
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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 Prostate Cancer Treatments Are Available
Prostate cancer treatment is highly successful. At CenterPoint Radiation Oncology, Dr. Morrell works closely with a multidisciplinary team of specialists, including urologists, to ensure the best possible outcome through our personalized treatment plan.
Dr. Morrell considers several factors when recommending the most effective treatment, including the cancer stage, your overall health, and whether cancer has spread.
Dr. Morrell is one of the best at educating patients on their diagnoses. Every patient leaves her office with the knowledge necessary to make informed decisions regarding their treatment.
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How Does External Beam Radiation Therapy Work
External beam radiation therapy, or EBRT, uses a machine to direct high-energy X-rays at the cancer in daily doses. The radiation beam is generated by a machine called a linear accelerator or LINAC. Using treatment planning computers and software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.
To minimize side effects, the treatments are typically given five days a week over a six-to-nine week period. The break in days allows the doctors to get enough radiation into the body to kill the cancer while giving healthy cells time to recover.
Watch our expert medical oncologist, Dr. Alicia Morgans from Vanderbilt-Ingram Cancer Center, discuss external beam radiation therapy:
Detecting And Treating At Once
A previous City Stories article detailed what Yeh calls the next big thing: detecting and eradicating prostate cancer at the same time using the PSMA system. A specially modified positron emission tomography scan detects areas displaying a prostate-specific membrane antigen. A radioactive isotope can then immediately deliver a cancer-killing attack to those targeted cells. Yeh is also watching the progress of another PET scan detection method, this one using Axumin, an advanced diagnostic imaging agent, or radiotracer, which may pick up cancer cells missed by other methods.
Yehs enthusiasm for all of this progress is personal. Several of his relatives have succumbed to cancer. He entered radiation oncology to find nonsurgical ways to make a difference.
Every patient, he says, is like a family member to me.
It certainly felt that way to Oakley who, after a course of radiation treatments, went into remission and has remained cancer free. Along the way, hes also made changes to his diet and exercise regimens. Hes dropped some 140 pounds, enabling him to bring renewed energy and passion to the production company he runs with his wife, Melanie Grunder.
If youre lucky enough to get to City of Hope, you are truly lucky, he said. They are the reason Im alive. Dr. Yeh took a guy not destined to be around and made him a person with purpose.
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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.
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.
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External Beam Radiation Therapy
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.
Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.
*recipe For Black Bean And Corn Soup
- 28-ounce can of low-sodium crushed tomato and basil
- 8 ounces of low-sodium tomato juice
- 16-ounce can of rinsed black beans
- 16-ounce can of rinsed white beans
- 16-ounce can of rinsed kidney beans
- 16-ounce can of sweet corn
- 1 teaspoon of dry oregano
- ½ teaspoon of rosemary
- ½ teaspoon cracked red pepper flakes
Mix ingredients in a large pot and bring to a boil. Turn down heat and let simmer for 10 minutes. Serves 4.
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