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.
Genitourinary Toxicity With Intensity
Intensity-modulated radiotherapy has been shown to deliver higher doses to the target area while minimizing complications. IMRT is increasingly used for the treatment of prostate cancer doses of 81 Gy have been delivered. The complication rate with IMRT is lower than that with 3-dimensional conformal beam therapy, although not all studies show a significant difference.
The frequency of toxicity with IMRT versus the frequency with 3D conformal radiotherapy is as follows.
- Grade 2: IMRT, 17-36% 3D conformal radiotherapy, 42-60%
- Grade 3: IMRT, 0.3-0.5% 3D conformal radiotherapy, 1-2%
After treatment for prostate cancer, rectal complications are much lower with conformal beam therapy than with 4-box, small-field therapy however, the incidence of bladder complications is unchanged, probably because of the proximity of the bladder neck and unavoidable exposure to the urethra.
IMRT has also demonstrated a significant improvement in rectal complications compared with 3D conformal radiation therapy. Fewer grade 2 bladder complications occur with IMRT, but the rates of grade 3 complications are similar. GI symptoms can be further reduced by using fiducial markerbased position verification in patients with prostate cancer.
A multicenter, phase II study conducted by Kim et al found that in patients with rectal cancer, preoperative chemoradiation with cetuximab, irinotecan, and capecitabine was active and well tolerated.
Also Check: Prostate Cancer Incidence By Country
Association Between Rectal Bleeding And The Absolute Dose Volume Of The Rectum Following Imageguided Radiotherapy For Patients With Prostate Cancer
This article is mentioned in:
Abstract
Introduction
In a nationwide randomized trial in the UnitedKingdom, the prostate cancer-specific mortality and diseaseprogression rates in patients with prostate cancer who haveundergone external-beam radiotherapy at a dose of 74 Gy in 37fractions were demonstrated to be comparable to those of surgery. Prior to that landmark trial,dose-escalation randomized studies reported that high-doseradiotherapy resulted in a lower incidence of biochemical diseaseprogression compared with conventional doses . Ameta-analysis also reportedimproved biochemical disease free-progression rates, but anincreased incidence of late gastrointestinal toxicities .
Patients and methods
Patients and follow-up
Table I. |
| 4 |
PSA,prostate-specific antigen.
Radiotherapy treatment
Dosimetric analysis
Statistical analysis
Results
Rectal bleeding rate
Absolute and rectal volumes
Table II.Comparison of grade 1 rectalbleeding or non-bleeding by the absolute and relative volume ofrectum. |
Table II.
Table III.
SD, standarddeviation.
Table IV.
Don’t Miss: Life Expectancy Stage 4 Prostate Cancer No Treatment
Treatment Of Rectal Bleeding
Except for 19 patients with relatively severe bleeding, 45 patients were first observed without treatment for at least 3months. A steroid suppository or a steroid enema was administered as pharmacotherapy in 29 patients 18 received steroid as an initial therapy and 11 with poor improvement after observation over 3months were given steroid treatment. One of the following suppositories was prescribed to 23 patients: Posterisan® Forte Ointment , Neriproct® Suppository , and Rinderon® Suppository 1.0mg . These suppositories were assumed to have similar efficacies, and choice of the suppositories was dependent upon the availability of the drugs at pharmacies of the patients preference. In the early stage of this study, Steronema® Enema 3mg was initially prescribed to 6 patients. In 1 patient, a steroid suppository was used at first but treatment was later changed to an enema because of ineffectiveness. Steroid enemas were more difficult to use for patients than steroid suppositories, and 2 patients could not undergo the enema successfully, so treatment was changed to a suppository immediately. Therefore, more recent patients were preferably treated with a steroid suppository. The frequency of steroid administration was once or twice daily, depending on the severity.
Sbrt Treatment Planning And Delivery
Simulation, contouring, and treatment planning were performed using our institutional protocol . Patients underwent a treatment planning CT and pelvic MRI at least one week after placement of 4 to 6 gold fiducial markers in the prostate. The clinical target volume included the prostate and proximal seminal vesicles. The planning target volume was expanded 3 mm posteriorly and 5 mm in all other directions from the CTV. The bladder and rectum were contoured structures that were evaluated on dose-volume histogram analysis during treatment planning using Multiplan inverse treatment planning. Five fractions of 7-7.25 Gy were delivered to the PTV over one to two weeks.
The bladder volume receiving 37 Gy was limited to 5 cc and the rectal volume receiving 36 Gy was limited to 1 cc. Additional bladder dose constraints included volume less than 40% receiving 50% of prescribed dose and volume less than 10% receiving less than 100% of the prescribed dose. For the rectum, secondary dose constraints included volume less than 40% receiving 50% of prescribed dose, volume less than 25% receiving 75% of prescribed dose, volume less than 20% receiving 80% of the dose, volume less than 10% receiving 90% of the dose, and volume less than 5% receiving 100% of prescription dose.
Don’t Miss: Prostate Cancer Statistics By Age
Robotic Assisted Laparoscopic Radical Prostatectomy
Minimally invasive surgical technique to remove the prostate and seminal vesicles. The surgeon performs the procedure through five 1-cm incisions spread in the shape of a fan across the lower abdomen. The surgeon performs the procedure using a robotic surgical assist device called the daVinci® Surgical System. Takes 2.5-3.5 hours to perform with a hospital stay of 24-48 hours.
Blood In Urine After Radiation For Prostate Cancer
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
- 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 .
Recommended Reading: End Of Life Prostate Cancer Symptoms
Hematuria May Occur Years After Brachytherapy
Gross hematuria can occur in men up to several years after undergoing prostate brachytherapy, according to a study.
The condition is more likely to develop in men with larger prostates volumes , those who also undergo external beam radiotherapy , and those who are free from biochemical failure, researchers reported online ahead of print in BJU International.
Michael S. Leapman, MD, and collaborators at the Mount Sinai School of Medicine in New York reviewed hematuria outcomes in 2,454 patients who had transperineal prostate brachytherapy over a 20-year period. The study population had a median follow-up of 5.9 years.
Of the 2,454 patients, 218 reported gross hematuria at a median time of 772.2 days after seed implantation.
Only 3.8% of men with PSA failure reported hematuria compared with 9.4% of those with biochemical control, the researchers noted. A possible explanation for this finding is that differences among patients may affect their response to radiation, with respect to both toxicity and disease control. Patients who are more sensitive to radiation may be more likely to have a favorable treatment response, but also experience increased mucosal injury or necrosis that leads to hematuria, Dr. Leapmans group explained.
The authors pointed out that the significance of observed blood in urine after permanent brachytherapy remains unclear and warrants further study to understand the etiology and clinical course of this morbidity.
Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. âIf a man has only six months of treatment, their level of testosterone rises again, and theyâll go back to feeling like themselves,â Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. âIf we can manage those other side effects, then often that improves mood,â she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
Recommended Reading: Super Beta Prostate Ingredients Label
Radiation Cystitis Causing Hematuria
Less common but challenging to treat is what we call radiation cystitis. This occurs in 1-2% of men after radiation treatment to the pelvis all the prostate. The bladder and the prostate become friable and bleed easily. Hematuria as a result of radiation cystitis typically occurs many years after treatment. A number of treatment options available, including fulguration, intravesical instillations, medical treatment. Hyperbaric oxygen treatment has been shown to be beneficial for men with persistent intermittent hematuria.
If you experience blood in urine before, after, or during treatment for prostate cancer, urological evaluation should be sought.
Uncertainty About Radiation For People With A Higher Risk Of Recurrence
After a diagnosis of early-stage breast cancer, radiation therapy following a lumpectomy is used to reduce the chance that the cancer will come back in the same breast. There are multiple options for breast radiation therapy, including whole-breast radiation and partial-breast radiation, Dr. Salerno said, and the decision of which treatment is most appropriate is made jointly between a patient and their radiation oncologist.
For whole-breast radiation, previous studies have shown that 3 weeks of treatment at slightly higher doses is as safe and effective as conventional whole-breast radiation over 56 weeks.
However, when the trial began a decade ago, this shorter, more intensive course of radiation, known as hypofractionated radiation therapy, had not yet been widely adopted in the United States, according to Lori Pierce, M.D., of the University of Michigan. Dr. Pierce, who was not involved with the trial, provided expert comments on the findings at the ASTRO meeting.
One reason for this slow adoption, Dr. Pierce said, was the uncertainty of whether and how to incorporate a boost of radiation for people who had a higher risk of recurrence.
Also Check: What Age Should You Get Tested For Prostate Cancer
Do You Have Signs Of Prostate Cancer
What are Prostate Cancer Symptoms? To quote Wikipedia, “A symptom is a departure from normal function or feeling which is noticed by a patient, reflecting the presence of an unusual state, or of a disease.” In this case Prostate Cancer. The early stages of Prostate Cancer, usually have no signs or symptoms. So if you have symptoms, a possible sign of more advanced cancer, it is important that you be tested. Be aware that these symptoms can also be a signs of non-cancerous conditions such as BPH, Benign Prostatic Hypertrophy, or another condition known as Prostatitis. If you have symptoms, we recommend that you have them checked by a physician.
Classification Of Late Rectal Adverse Events
Most studies grade late rectal adverse events using the Radiation Therapy Oncology Group scoring criteria or a slightly modified version., An alternative instrument for classifying rectal adverse events after prostate brachytherapy is the National Cancer Institute Common Terminology Criteria for Adverse Events . The CTCAE leads to a more detailed classification of adverse events than the modified RTOG scale, further subdividing late rectal symptoms to include item-specific events, such as diarrhea, incontinence, urgency, proctitis, pain, spasms, and hemorrhage. Proponents of the CTCAE believe it yields a more comprehensive rectal toxicity profile that better captures the diverse and subtle rectal toxic effects of brachytherapy, which may not be appreciated adequately with the RTOG morbidity scoring criteria alone. By using the CTCAE late rectal toxicity reporting criteria, Shah and Ennis identified a novel rectal toxicity profile after brachytherapy in which most items had nontrivial event rates after brachytherapy. The objective of a more specific rectal toxicity profile is to help physicians and patients make more informed management decisions after brachytherapy.
- RTOG indicates Radiation Therapy Oncology Group.
Don’t Miss: How Can You Tell If Your Prostate Is Enlarged
Lower Rates Of Rectal Complications With Improved Brachytherapy Techniques
Rectal outcomes have improved as implantation and planning techniques have been optimized and as experience with brachytherapy has grown. Until the late 1980s, brachytherapy was performed with an open laparotomy approach. The second generation was developed using a transperineal approach under ultrasound guidance, as described and pioneered in the US by Blasko et al., Further generational improvements have emerged over the last decade with the use of ultrasound and computed tomography-based treatment planning systems and stranded seeds during implantation to improve seed placement and optimize dosimetry. This has led to a resurgence in the use of brachytherapy for localized prostate cancer, in which local control and biochemical outcomes are comparable to those observed with external-beam radiation therapy and radical prostatectomy., –
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
Don’t Miss: Advanced Prostate Cancer Institute Oxford Fl
Study Design And Setting
After signing informed consent, patients undergoing proton therapy for prostate cancer were enrolled on a multi-institutional, prospective registry in the United States. Data on disease outcomes, toxicities, and patient-reported outcomes were collected. Only patients at our institution were included for the current analysis after local institutional review board approval.
Prognostic Factors According To Multivariate Analysis
The age, prostate volume, treatment method , presence of hypertension, presence of diabetes mellitus, use of anticoagulants, and rectal dose were assessed by multivariate analysis as potential risk factors for Grade 2 or 3 rectal bleeding. As a result, the rectal dose, especially V65 17%, was found to be a significant risk factor for rectal bleeding , while the other variables were not .
Read Also: Side Effects Of Prostate Supplements
Watchful Waiting Or Active Surveillance
In select patients with prostate cancer, the best choice may be active surveillance, also is called watchful waiting. Of the prostate cancer treatments, active surveillance may be recommended only if a cancer is not causing any symptoms and is expected to grow very slowly. This approach is sometimes suited for men who are older or have other serious health problems. Because some prostate cancers spread very slowly, older men who have the disease may never require treatment. Other men choose active surveillance because they feel the side effects of treatment outweigh the benefits. The cancer is regularly and carefully monitored with PSA, clinical evaluation and intermittent prostate biopsies to ensure that the cancer is not becoming more aggressive. If progression of the cancer is evident, active treatment can be started.
Save Article To Kindle
To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the name part of your Kindle email address below.Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. @free.kindle.com emails are free but can only be saved to your device when it is connected to wi-fi. @kindle.com emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Don’t Miss: What To Know About Prostate Cancer
How Long Do Prostate Radiation Side Effects Last
After completing external beam radiation therapy , urinary and bowel side effects may persist for two to six weeks, but they will improve over time. You may need to continue some medications.
Why does radiation make you bleed?
It can cause people to bruise easily and to bleed internally as well and even to vomit blood. The problems occur because radiation depletes the body of platelets, the cellular fragments in the blood that are form clots to control bleeding.
What happens if prostate cancer spreads to the bladder?
Bladder and urinary troubles If the tumor is pressing on your urethra, you might have trouble passing urine. One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
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.
Recommended Reading: Effects Of Radiation Therapy For Prostate Cancer
You May Like: Adam And Eve Prostate Massager