Radiotherapy Injections For Prostate Cancer

How Radium 223 Works

Radium targets bone cancer cells. This is because it is similar to calcium, which is also absorbed by bone cells. The cancer cells in the bone take up radium 223 and it then releases radiation which travels a very short distance.

This means that the cancer cells receive a high dose of radiation which can destroy them. And healthy cells receive only a low dose or no radiation. So this treatment causes few side effects.

Image Guided Radiation Therapy

In this type of radiation therapy, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue.

In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.

Calypso is another form of IGRT where the prostate can be tracked during the treatment.

Additional Eating And Drinking Tips For Radiation Therapy

• Chew your food slowly. Take your time eating each small meal.
• To make sure youre getting enough calories during radiation, ask yourself, What can I add to this meal to make it more calorie-rich? Think about topping your dishes with dressings and sauces. Or, think about adding extra ingredients you can add in or on top of your dishes.
• Cook foods that smell good
• Drink beverages that are high in calories, like hot chocolate and fruit juice
• Eat foods in a stress-free relaxing setting to make eating a positive experience
• Eat every few hours vs waiting until youre hungry

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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.

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:

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Radiation Therapy With Or Without Bicalutamide And Goserelin In Treating Patients With Prostate Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.

First Posted : August 11, 2003Last Update Posted : December 22, 2015

RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Giving radiation therapy in different ways may cause less damage to normal tissue and may improve quality of life and help patients live more comfortably. Androgens can stimulate the growth of prostate cancer cells. Drugs such as goserelin and bicalutamide may fight cancer by stopping the production of androgens. It is not yet known whether radiation therapy is more effective with or without goserelin and bicalutamide in treating prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of high-dose radiation therapy with or without bicalutamide and goserelin in treating patients who have prostate cancer.

Condition or disease

Phase
Prostate Cancer	Drug: bicalutamideDrug: goserelin acetateProcedure: assessment of therapy complicationsProcedure: quality-of-life assessmentRadiation: radiation therapy	Phase 3

OBJECTIVES:

In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.

What Are The Side Effects Of External Beam Radiation Therapy

As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:

• Skin irritation
• Erectile dysfunction
• Secondary malignancy

If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.

Recently, the FDA approved the use of Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someoneâs risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

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Vitamins And Dietary Supplements

Its OK to take a multivitamin during your radiation therapy, but dont take more than the recommended daily allowance of any vitamin or mineral.

Dont take any other dietary supplements without talking with a member of your radiation therapy team. This includes vitamins, minerals, and herbal or botanical remedies.

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Side Effects Of Hormone Treatment

The loss of testosterone that hormone therapy causes leads to side effects in nearly all men. These can include:

• Trouble getting an erection
• Thinning of bones
• Depression and mood swings

Other side effects depend on the type of hormone therapy you get. For instance, anti-androgens tend to have less effect on your sex life. But they can cause diarrhea, tiredness, and liver problems.

Most side effects go away over time after treatment ends. Thats not the case with testicle-removal surgery, though. Its side effects are permanent.

Your doctor can treat many of the side effects. And there are things you can do to help prevent some of them. You might take statins to help control your blood cholesterol, or calcium supplements to help with bone problems.

Talk to your treatment team so you know what to expect when youre on hormone therapy. Tell them about any changes you notice. Treating side effects right away can keep them from getting worse.

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Types Of Radiation Therapy

There are two broad categories of radiation therapy: external beam radiation therapy and brachytherapy. They work as follows:

• In EBRT, an external source of radiation beams photons or particles into the tumor. In the modern era of radiation oncology, the most common external radiation source is a megavoltage linear accelerator equipped with devices that allow precise shaping of X-ray photons and accurate tumor targeting.
• In brachytherapy, radioactive sources are implanted in the tumor, either temporarily or permanently.

Prostate cancer may be treated with EBRT alone, brachytherapy alone, or a combination of the two.

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Malignant Spinal Cord Compression

If a tumour is close to or pressing on the spinal cord, it is called malignant spinal cord compression. Doctors can treat this with a short course of external radiotherapy to the spine. You may have a single treatment or up to 2 weeks of radiotherapy.

MSCC causes symptoms, such as:

• a new pain in your neck or back
• numbness or pins and needles in your feet or hands
• difficulty walking.

Spinal cord compression is not common, but it needs to be treated quickly to stop permanent damage to the nerves. Always tell your doctor straight away if you have any of these symptoms.

Possible Side Effects Of Ebrt

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

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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.

What To Expect During Ebrt

The first day of treatment may be longer than other sessions because additional imaging is performed that day as part of quality assurance. In most cases, you’ll be scheduled for daily treatments, Monday through Friday. SBRT may be scheduled every other day, instead of daily. You’ll be assigned a treatment time slot, typically but not necessarily at the same time each day. A specifically trained radiation therapist will administer your treatments.

During treatment, you’ll be asked to lie motionless on the treatment table. The area being treated will be exposed and positioned beneath the linac. To deliver the radiation, the head of the machine will move around your body to predetermined angles. On a gantry-based linac, such as a Varian TrueBeam, each treatment takes from five to 20 minutes. On the CyberKnife, each treatment is typically 30 to 60 minutes. Expect to be in the radiation oncology clinic approximately 30 to 60 minutes each day if the TrueBeam is used or 60 to 90 minutes with the CyberKnife.

Please note that many people will be involved in your treatment â your doctor, residents, nurses, therapists, dosimetrists â but your radiation oncologist will supervise your treatment and ensure all steps are being performed accurately.

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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

What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

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