Side Effects Of Radiation Treatment For Prostate Cancer

How Long Do Side Effects Last

Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.

Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.

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, both of which are common with any radiation treatment given to the prostate. But at MSK, we routinely use sophisticated 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.

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 that the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and after a few months dissolves on its own within the body, causing no harm or long-term effects.

Help For Bowel Dysfunction

To help with symptoms of bowel dysfunction, your healthcare team may recommend:

• Avoiding foods that can irritate your bowels

• Taking antidiarrheal medications

• Increasing fiber intake from fruits and vegetables

If you have persistent rectal bleeding, your team may recommend laser therapy. Laser therapy will scar the blood vessels in your rectum so they stop bleeding.

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Radiation Therapy: What It Is

This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.

This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.

For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.

What Are The Different Types Of External Beam Radiation Therapy

Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a CT scan to map your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.

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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.

Are There Options To Prevent Or Treat These Side Effects

Yes. Your health care team can help you prevent or relieve many side effects. Preventing and treating side effects is an important part of your overall cancer treatment. This is called palliative care or supportive care. Before treatment begins, ask what side effects are likely from the specific type of treatment you are receiving and when they may happen. And during and after treatment, let your health care team know how you are feeling on a regular basis.

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What Do I Need To Do To Get Ready For My Imrt Treatment

Getting ready for IMRT takes a great deal of planning. It can take two to three days for your radiation therapy team to plan your care. After giving you a physical exam and reviewing your medical history, your radiation oncologist will use different tools to plan your treatment. These tools will help your radiation oncologist decide the dose of radiation you need for your prostate cancer and how long your treatment will last.

Your radiation oncologist may send you to have one or more imaging tests to help plan where the radiation beams will be aimed. The imaging tests your radiation oncologist will use to plan your treatment may include:

• X-ray this test uses radiation to take a picture of the inside of your body. You may have seen a chest x-ray or x-ray pictures of your teeth or your bones.
• CT Scan is a type of x-ray that uses a computer to make pictures of your prostate cancer and the area around your prostate. You may be given contrast through an I.V. in your arm or to drink by mouth. Contrast will help your prostate cancer show up better during the CT Scan.
• MRI Scan is a test that uses a large magnet to make pictures of your prostate cancer and the area around your prostate.
• PET Scan is a test where you are given contrast before you have x-rays taken. The contrast will travel to the parts of your body where your prostate cancer is active. The x-ray will give your doctor a better picture of what your prostate cancer looks like.

Getting Ready For IMRT

If I Choose Radiation Therapy Will Surgical Treatment Still Be An Option

Your doctor may use radiation therapy as your primary treatment. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you have the same risk of cancer recurring if surgery is performed.

If it is not successful, your doctor will likely not consider surgery or repeat radiation therapy due to the risk of serious complications. If your doctor recommends surgery after radiation or additional radiation, the doctor performing the re-treatment or surgery should have a significant level of experience. There are experimental clinical studies being evaluated for use of very localized re-irradiation for this group of patients. Some patients for whom radiation is not effective are treated with systemic therapy or closely monitored. Additional treatment will depend on the PSA level and rate of rise of the PSA.

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If Youre Getting Radiation Therapy To The Chest

Radiation treatment to the chest may cause side effects such as:

• Sore throat

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
• Cough
• Weakness

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.

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:

• A PSA test every 3 to 6 months

• 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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How Long Does Imrt Treatment Last

IMRT is usually given to you five days a week for four to eight weeks. The total dose of radiation and the number of treatments you need will depend on the size of your prostate cancer, your general health, and other medical treatments you may need.

Using many small doses of radiation each day rather than a few large doses helps protect your healthy cells in the treatment area. Weekend rest breaks let your healthy cells get better.

It is very important that you have all of your scheduled IMRT treatments. If you miss or put off your radiation treatments, your radiation therapy might not work as well as if you had all your radiation treatments.

When Is Radiation Treatment Used For Prostate Cancer

There are a number of circumstances in which radiation therapy is an appropriate method for treating prostate cancer:

• In early or localized stages of the disease.
• In combination with other treatment methods for cases that have spread.
• As a method of preventing cancers return after surgery.
• As a method for treating a recurrent cancer following remission.
• As pain alleviation when the disease reaches an advanced state.

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What Is Radiation Recall

Radiation recall is a rash that looks like a severe sunburn. It is rare and happens when certain types of chemotherapy are given during or soon after external-beam radiation therapy.

The rash appears on the part of the body that received radiation. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.

Typically, these side effects start within days or weeks of radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals before continuing chemotherapy.

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Who Should Consider External Beam Radiation Therapy

In most cases, external beam radiation therapy is used for men with localized prostate cancer . The intent of EBRT in this case is to kill the tumor while sparing as much healthy tissue as possible. Sometimes it is used in more advanced cases. For example, it can be used along with hormone therapy, or used to relieve pain from bone metastases.

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Mouth And Throat Changes

Radiation therapy to the head and neck can cause mouth changes. Radiation not only kills cancer cells but can also harm healthy cells in the glands that make saliva and the moist lining of your mouth. You may have:

• Mouth sores
• Loss/change in taste
• Thickened saliva

Some problems, like mouth sores, may go away after treatment ends. Others, such as taste changes, may last for months or even years. Some problems, such as dry mouth, may get better but never go away.

Mouth Care After Radiation

Your Throat

Radiation therapy to the neck or chest can cause the lining of your throat to become swollen and sore. Your risk for throat changes depends on how much radiation you are getting, whether you are also having chemotherapy, and whether you use tobacco and alcohol while getting radiation therapy. You may notice throat changes in 23 weeks after starting radiation. These will likely get better 46 weeks after you have finished treatment.

Nutrition During Head, Neck or Chest Radiation

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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Cancer That Clearly Has Spread

If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.

When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.

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When Is Brachytherapy Alone The Right Choice

For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning 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 then it would be very appropriate to do active surveillance and hold off on treatment.

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Reducing Side Effects During Radiotherapy For Prostate Cancer

Radiation is a very effective treatment for prostate cancer, but in a small percentage of patients it also can cause toxicities to nearby organs, particularly the rectum. Side effects are usually minor and can include hemorrhoidal type bleeding and rectal incontinence. But for a very small subset of patients, the side effects can be more serious.

Patients who take blood thinners or who have Crohns disease or ulcerative colitis, for example, are at greater risk for complications from radiation therapy for prostate cancer than are other patients. For these patients, sparing the rectum is a significant concern.

Serious complications are rare, but as Dr. Greg Cooley, Department of Human Oncology clinical associate professor and radiation oncologist at UW Health East, says, If they happen to one patient, thats one too many.

For patients who are susceptible to complications, Cooley uses a relatively new technique to move the rectum away from the treatment area to reduce the likelihood that the rectum will be exposed to radiation during treatment. He injects a substance called SpaceOAR into the space between the patients prostate and rectum, which pushes these two organs apart by about 1 cm and solidifies into a soft hydrogel that remains stable for three months.

What Are The Side Effects Of External Beam Radiotherapy

Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease.

Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover so side effects may only last a few weeks or months. But some side effects can start months or years after treatment. These can sometimes become long-term problems. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.

If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy. Read more about the side effects of hormone therapy and how you can manage them.

If youre having radiotherapy as a second treatment, and you still have side effects from your first treatment, then radiotherapy can make those side effects worse or last longer. It may also cause other side effects. The most common side effects of radiotherapy are described here.

Short-term side effects of radiotherapy

Urinary problems

Radiotherapy can irritate the lining of the bladder and the urethra, which is the tube men urinate and ejaculate through. This can cause urinary problems, such as:

Bowel problems

Tiredness and fatigue

Problems with ejaculation

Skin irritation and hair loss

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