Side Effects Of Radiation For Prostate Cancer After Prostatectomy

Intensity Modulated Radiation Therapy

Side Effects of Radiation Therapy for Prostate Cancer | Prostate Cancer Staging Guide

IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.

Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

Radiation Therapy Side Effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body.

Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section. Discuss this chart with your doctor or nurse. Ask them about your chances of getting each side effect.

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Will My Faecal Incontinence Get Better

There is no doubt that your poo related problems are having a significant impact on your life and mental strength. You may have noticed it negatively affecting your personal relationships, social life and desire to do the things you love. On top of this, much of your time getting out of the house will be spent with concern and meticulous planning around toilet visits. These factors can quickly take their toll on your quality of life and others around you, which makes it much more important to best prepare yourself and minimise its impact.

Unfortunately there is a degree of uncertainty regarding your ability to recover normal bowel control after radiotherapy due to the complexity of side effects and the reaction from each individual. With the research showing that symptoms can begin and persist long after treatment, it can seem like a doom and gloom scenario. Despite the scary statistics, you need to take a position of strength and control the things you can to combat faecal incontinence. Fortunately, the positives are that radiotherapy techniques are becoming more effective at treating the cancer and reducing its side effects.

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How Prostate Cancer Staging And Risk Group Affect Treatment Options

Complications of Prostate Cancer Treatment: Spectrum of Imaging ...

Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

Prostate cancer staging

Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

Localized: Theres no indication that the cancer has spread beyond the prostate.
Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
Distant: Theres evidence the cancer has spread to other organs or body parts farther from the prostate.

Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

Prostate cancer risk assessment

Treatment guidelines for prostate cancer

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What Are The Side Effects Of Prostate Radiation

Even though both external beam radiation and brachytherapy use the same radiation as the cure from the cancer cells, they have some common side effects.

Bowel problems: Radiation proctitis is a very common inflammation of the rectum that occurs as a result of the radiation treatment of prostate cancer where damage to the rectum was acquired. Proctitis can lead to diarrhea, with the 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. In order to minimize bowel problems, doctors will advise what kind of diet to follow during radiation therapy to help limit bowel movement during treatment.
Urinary problems: Radiation cystitis is the side effect of inflammation and subsequent destruction of the normal work of the urinary bladder at the cellular level after the usage of radiation in the treatment. Patients will feel the need to urinate more often, have a burning sensation while the urinate process, and/or find blood in the urine itself. Urinary problems usually improve over time, but in some men, they never go away.
Erection problems : Patience after the treatment, with radiation or through surgery, has the same rate of impotence level. These problems do not occur right after radiation therapy but are slowly developing over time. The effect of radiation treatment is more visible if the patient is elderly, where impotence is already on the low level.

Treatment Vs Side Effects

Prostate cancer treatment side effects can vary greatly from little to none, or create lifetime issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.

Treatment or the combination of treatments in advanced cases can lead to a wide range of side effects. Prostate cancer treatment side effects include erectile dysfunction, incontinence, urinary issues, diarrhea, hot flashes, weight gain, loss of muscle, vomiting and hair loss. There are short term prostate cancer treatment side effects that subside over time, as well as long term side effects that can last for years. Question your Doctor about the side effects of the treatment you have selected. Make an informed decision.

Possible Side Effects Of Radiation Treatment For Prostate Cancer

The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.

You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.

How Long Will My Follow

What are the side effects of radiation therapy for prostate cancer? (Colleen Lawton, MD)

You will have follow-up appointments for some time after your treatment. Exactly how long will depend on your cancer, any side effects of treatment and the services in your area. You will usually have appointments for several years.

After your follow-up appointments finish, you may continue to have PSA tests. Speak to your GP if you have any problems or concerns they can refer you back to the hospital. Make sure you remind them about your prostate cancer, especially if its been a while since you had treatment or a PSA test.

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Side Effects Of Prostate Cancer Radiotherapy

Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing urine more often.

Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so after treatment finishes

Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.

How To Decide Between Radiation And Surgery For Localized Prostate Cancer

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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:

Active surveillance: Oncologists use this method for less aggressive prostate cancer. Your care team will runs test periodically to evaluate whether the cancer has progressed. If so, they may recommend additional treatment.
Radiation therapy: This treatment uses targeted radioactive energy to reduce tumor size, destroy cancer cells and alleviate some cancer-related symptoms.
Surgery: Typically, this involves a procedure called a prostatectomy, which removes the prostate and surrounding cancer cells.

If you arent comfortable with active surveillance , or if your oncologist says it isnt the right option for you, you may have to decide between radiation therapy and surgery to treat your cancer.

Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.

To help you through the process of making this decision, this article covers:

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Vitamins And Dietary Supplements

Its OK to take a multivitamin during your radiation therapy. Do not 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 care team. Vitamins, minerals, and herbal or botanical supplements are examples of dietary supplements.

Sore Skin In The Treatment Area

External Beam Radiation Therapy for Prostate Cancer

Your skin in the treatment area might get sore, or redden or darken. Following these tips can help with this:

Wear loose fitting underwear and clothes. Natural fibres can be more comfortable than man-made fibres.
Gently wash the area each day. Use mild, unperfumed soap and warm or cool water. Try baby soap or liquid baby wash but check with the radiotherapy staff first.
Gently pat the skin dry with a soft towel. Rubbing the skin can make it sore.
Dont use perfumed lotions on the area. Use only creams or dressings recommended by your specialist or radiographer.
Dont use talcum powder because it can contain tiny metal particles. The particles can make the soreness worse.

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Lipid Alterations And Insulin Resistance

Treatment-related changes in body composition are accompanied by adverse metabolic effects. GnRH agonists increase serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides.116,144 In a prospective 12-month study, for example, GnRH agonists increased serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides by 9.0%, 7.3%, and 26.5%, respectively.142 GnRH agonists increase fasting plasma insulin level, a surrogate for insulin resistance.142,145 In a prospective study of non-diabetic men with prostate cancer initiating GnRH-agonist therapy, fasting plasma insulin levels increased by 26%, and the whole-body insulin sensitivity index decreased by 11%.146

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.

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Cardiovascular Disease And Diabetes

Diabetes and cardiovascular disease are leading causes of death in men. The adverse treatment-related changes in weight, body composition, lipids, and insulin sensitivity raise the possibility that ADT may increase the risk of these medical conditions. To evaluate the relationship between ADT and risk for incident diabetes and cardiovascular disease, Keating and colleagues conducted a large population-based study using the SEER-Medicare database.107

This landmark study included 73,196 men diagnosed with local or locoregional prostate cancer between 1992 and 1999 with follow up through 2001. Of the total population, one-third of men were treated with ADT during the study period. The analysis was adjusted for both patient and tumor characteristics. After adjusting for a variety of covariates, ADT with a GnRH agonist was associated with a significantly greater risk of incident diabetes , coronary heart disease , and admission for myocardial infarction . A subsequent study using SEER-Medicare data confirmed the link between ADT and incident cardiovascular disease.150

What Happens At A Follow

Radiation Therapy Side Effects for Prostate Cancer Patients

Discussion with your doctor or nurse

At each appointment, your doctor or nurse will ask how youve been since your last appointment.

Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.

Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.

You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.

PSA test

You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.

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Late Effects After Radiation For Prostate Cancer

Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.

Bladder Problems

Radiation to the pelvic area can cause late effects to the bladder including:

Bowel Problems

The bowel is sensitive to the effects of radiation. The late effects that may occur after radiation including the rectum, colon, or small bowel include:

Lymphedema Risk

Surgery to remove lymph nodes or radiation to lymph nodes can cause damage to lymph nodes and lead to lymphedema. Lymphedema is swelling that can occur in the genital area, belly, buttocks, legs or feet after treatment. It can cause pain, be disfiguring, make activity difficult and increase the risk of infection in the area.

Talk to your provider if you are having any new swelling. A Certified Lymphedema Therapist should be consulted at the first sign of swelling to try to keep the lymphedema from worsening.
You are at risk of infection in any area with lymphedema or that is at risk for lymphedema. If you experience any signs of infection, contact your care team right away or go to the emergency room. These signs include a sudden increase in swelling, an increase in pain, redness, the area is warm to the touch, or fever.