What Are Side Effects Of Radiation Treatment For Prostate Cancer

Other Common Side Effects Of Radiation Therapy

Skin reaction:

A common side effect of radiation therapy is skin irritation in the area of the body that is being treated. The skin reaction can range from mild redness and dryness to severe peeling of the skin in some patients. The majority of skin reactions to radiation therapy go away a few weeks after treatment is completed. In some cases, the treated skin will remain slightly darker than it was before and it may continue to be more sensitive to sun exposure.

It is important to notify your nurse or physician when your skin becomes irritated because redness and dryness can eventually progress to peeling with oozing of fluid in the area. They can suggest measures to relieve your discomfort and possibly minimize further irritation. There are effective topical medications for treatment of radiation induced skin irritation, as well as a number of precautions that may minimize skin irritation during radiation therapy, such as:

Fatigue:

• Limit your activities, if possible.
• Exercise each day to maintain your strength.
• Prepare meals ahead of time and freeze them.
• Use convenience foods that are ready to eat.
• Accept offers of help from friends and relatives.
• Drink three quarts of fluid each day to avoid the build-up of cellular waste products.
• Increase rest by getting more sleep at night and taking naps during the day.
• Try to eat even when you are tired. Sometimes a little food will increase energy.

How Is Prostate Cancer Classified

Tumors in the prostate range from slow-growing to fairly aggressive. Theyre referred to by a number, known as a Gleason score, which combines a pattern type and a stage . The resulting score is on a scale from two to 10, where lower scores indicate cells that are more similar to surrounding cells than higher ones scores below six respond well to treatment.

Are There Side Effects With Imrt

Yes, there can be side effects or unwanted changes in your body when you have IMRT. Side effects are different from person to person. Some people have no or very mild side effects. Some have bothersome side effects that may last for only a short period of time. Other men may have side effects that last for a longer period of time or forever. Some side effects occur within days or weeks of your treatment and others may not happen for six or more months after your treatment.

The side effects that you have depend on:

• The radiation dose you get during your prostate cancer treatment, and
• Your general health

Before beginning your treatment, your doctor and health care team will talk with you about the side effects you might have, how long they might last, and what you can do to help make them better.

The good news is that most side effects will go away in time. When you do have side effects, there are ways to make you feel better. If you have a side effect that is really bad, your doctor may stop your radiation therapy for a short time or change your treatment in some way. Be sure to tell your doctor or health care team about any side effects that you have. They can help you treat the problems and tell you how to lower the chances that the side effects will come back.

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Questions To Ask Your Doctor Nurse Or Radiographer

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• What type of radiotherapy will I have?
• How many sessions will I need?
• What other treatment options do I have?
• What are the possible side effects and how long will they last?
• What treatments are available to manage the possible side effects from radiotherapy?
• Will I have hormone therapy and will this carry on after radiotherapy?
• How and when will I know if radiotherapy has worked?
• If the radiotherapy doesnt work, which other treatments can I have?
• Who should I contact if I have any questions?
• What support is there to help manage long-term side effects?

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

If radiation therapy is used as the primary treatment, and the treatment is not successful, surgery or repeat radiation therapy are not considered to be desirable treatments due to the high risk of serious complications. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you may have the same risk of cancer recurring if surgery is performed. If surgery is performed after radiation, or additional radiation is recommended, the physician performing the re-treatment should have a high 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 which radiation is not effective are treated by systemic therapy or by close surveillance.

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Potential Side Effects Of Cyberknife Treatment For Prostate Cancer

Most radiation side effects are minimal and last only a short time. Side effects can, however, sometimes be severe because of rectum or bladder wall exposure to radiation. Possible side effects could include, but are not limited to:

• Constipation, fecal urgency, fecal incontinence, hemorrhoid, rectal bleeding
• Urinary retention, urinary urgency, increased frequency, incontinence, urinary bleeding
• Blood in stool
• Erectile dysfunction

Ask your doctor for more details about potential side effects associated with your specific radiation therapy treatment.

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

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Will Radiation Therapy Make Me Tired

Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.

If your doctor thinks you should limit your activity, they will discuss it with you.

To minimize fatigue while you are receiving radiation treatment:

• Be sure to get enough rest.
• Eat well-balanced, nutritious meals.
• Pace your activities and plan frequent rest periods.

Radiation Therapy In Advanced Disease:

Some forms of radiation therapy, like external radiation therapy and radiopharmaceuticals, can help with advanced prostate cancer. One type of external radiation therapy is used along with hormone therapy to treat cancer that has spread outside the prostate to nearby tissue. In addition, radiopharmaceuticals are used to manage pain and symptoms of bone metastases. Scroll down to learn more about radiopharmaceuticals.

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Who Can I Contact If I Have Personal Concerns About My Treatment

Many hospitals and clinics have a staff social worker who can help you during your treatment. Check with your doctor to see if this is available to you.

The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation and provide information about resources. The social worker can also discuss housing or transportation needs if necessary.

People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can provide a list of support groups if you are interested. Your social worker can provide additional information, and you can look online for support group resources.

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.

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Do We Know Which Treatment Is Better For Prostate Cancer Brachytherapy Or External Beam Radiation

Its not a question of which therapy is better but rather which therapy is the most tailored, pinpointed radiation for the patients specific disease.

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level or the Gleason score or visible evidence of disease on an MRI we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best.

Data that we have published recently show that for patients with intermediate-risk disease, the combination of external beam radiation with brachytherapy not only provides better biochemical control, in terms of PSA level, but also reduces the risk of distant metastases, or spread of the disease. Another recent study from Canada, which compared outcomes in patients who were treated with external beam radiation or a combination approach, found superior results when the combined approach was used. These studies provide strong evidence that higher doses of radiation provide an important benefit to patients with intermediate-risk and high-risk prostate cancers.

Questions To Ask The Health Care Team

• What physical side effects are likely based on my specific radiation therapy treatment plan? When will they likely begin?

• How can these side effects be prevented or managed?

• How can I take care of the affected skin during my treatment period?

• Who should I tell when a side effect appears or gets worse?

• Are there specific side effects I should tell the doctor about right away?

• Who can I talk with if I’m feeling anxious or upset about having this treatment?

• If I’m having side effects that affect my nutrition, can you recommend an oncology dietitian?

• What are other ways I can take care of myself during the treatment period?

• Are there any restrictions on exercising or other physical activity during this treatment?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have a child? If so, should I talk with a fertility specialist before cancer treatment begins?

• What are the potential long-term effects of this type of radiation therapy?

• If I’m worried about managing the financial costs of cancer care, who can help me?

• Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?

• After radiation therapy is completed, what will my follow-up care plan be?

• Why is follow-up care important for managing side effects of treatment?

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Why Are There Marks On My Skin

Small marks resembling freckles will be made on your skin along the treatment area by the radiation therapist. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area. Do not try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.

How Has Radiation Therapy For Prostate Cancer Evolved In Recent Years

Radiation has evolved dramatically in the last 40 years, and during that time, our ability to plan and deliver treatment has changed at about the same rate as computers have progressed. Think of your computer 10 years ago and your iPad now, says Dr. Yu. You might have heard about your fathers or grandfathers perhaps difficult radiation experience in the 1970s or 80s, so you may be wary. But todays radiation therapy is so different we plan, deliver, and aid in recoveries that have better outcomes and fewer side effects than in the past.

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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.

Bowel Dysfunction After Prostate Cancer Treatment

The broad term of bowel dysfunction includes:

• Diarrhea or frequent stools

• Fecal incontinence or the inability to control bowel movements

• Rectal bleeding

All of these side effects are far more common following external beam radiotherapy than any other primary therapy, but as techniques and dose planning strategies improve, even these rates have been dropping.

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Inflammation Of The Back Passage

Inflammation of the back passage is a long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.

Bleeding is usually slight but can be more severe for some people. Talk to your radiographer or nurse if you have proctitis. They might suggest you use treatments such as steroid suppositories for a short time. This might reduce the inflammation.

Bowel And Bladder Problems

Radiation therapy for prostate cancer can irritate the bowel, the bladder, or both.

A person can develop:

Radiation proctitis: Symptoms include diarrhea and blood in the stool.

Radiation cystitis: Symptoms include a need to urinate more often, a burning sensation when urinating, and blood in the urine.

Bladder problems may improve after treatment, but they may not go away completely.

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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiotherapy

This type of therapy is used to deliver high doses of radiation to a precise area in the prostate using specialized techniques not achievable by standard conventional radiation therapy. This allows the total dose of radiation to be given in a shorter amount of time, usually 4 -5 treatments over 1 2 weeks rather than the several weeks used for other types of external radiation therapy.

The radiation beam needs to be extremely accurate in order to limit the side effects on healthy tissue. During treatment, the body immobilization used is often more restrictive than with IMRT due to the high doses of radiation. Fiducials, or internal prostate markers, are often used in this type of treatment.

Cyberknife and Truebeam are two types of LINACs used for SBRT treatment of prostate cancer.

What Is The Experience Like For A Patient

The experience with our department begins with a consultation.

If you agree to receive radiation, you will have a noncontrast computed tomography scan to map your prostate and internal anatomy.

Next, we design a radiation treatment plan.

You’ll come in for daily radiotherapy sessions, each lasting about 15 minutes. You’ll check in, change into disposable shorts and wait in a men-only waiting area.

Yale Medicine radiation therapists then escort you to the treatment room, where you’ll lie down in a custom body mold.

When your positioning is confirmed and adjusted, based on a CT scan or an implanted radio-frequency tracking device, treatment begins.

Men should be in and out of our department like clockwork, with minimal disruption to their day, says Dr. Yu. Radiation therapy may continue for up to nine weeks.

Once the course is complete, recovery typically requires a few months. Typically, at their one-month follow-up visit, patients report they are on the mend, says Dr. Yu.

By four months, they are back to normal.

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