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What Is The Best Radiation Treatment For Prostate Cancer

Is Proton Beam Therapy Safer Than Other Options

Which is Better – Surgery vs. Radiation for Prostate Cancer?

Due to the concentrated nature of the radiation in proton therapy, there are usually fewer side effects than in conventional radiation therapy. Thats because theres less damage to healthy tissue around the tumor.

People who have proton therapy may have a significantly lower risk of short- and long-term complications compared with people receiving traditional photon therapy, according to a research study . These findings show a two-thirds reduction of adverse events in the 90 days after treatment, as well as a significantly reduced risk of having difficulties moving and performing daily activities.

However, long-term data is lacking on the safety of proton beam therapy. Furthermore, due to the high cost of treatment, current research has been limited in terms of demographics.

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What Side Effects Will I Have

During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation.

Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice hair loss or less sweat within the treated area.

These skin reactions are common and temporary. Theyâll fade gradually within 4 to 6 weeks after you finish your treatment. If you notice any skin changes outside the treated area, tell your doctor or nurse.

Long-term side effects, which can last up to a year or longer after treatment, may include:

  • A slight darkening of the skin
  • Enlarged pores
  • Skins feels more or less sensitive
  • A thickening of tissue or skin

Other possible side effects of external beam radiation therapy are:

Tiredness. Your fatigue might not lift until a few weeks or months after you finish getting radiation therapy.

Lymphedema. If radiation therapy damages the lymph nodes around your prostate gland, the fluid can build up in your legs or genital area. That can bring on swelling and pain. Physical therapy can usually treat lymphedema, but it might not go away completely.

Urinary problems. Radiation can irritate your bladder, and that could lead to a condition called radiation cystitis. You might:

  • Have to pee more often
  • Feel like it burns when you pee
  • Notice blood in your urine

Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes

At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.

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Treatments For Prostate Cancer

If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:

  • the type and stage of the cancer
  • the grade or Gleason score
  • prostate-specific antigen levels
  • the risk group
  • possible side effects of treatments
  • your personal preferences
  • your overall health and any existing medical conditions
  • your age and life expectancy
  • whether you have symptoms

Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction and incontinence . Many prostate cancers grow slowly and cause no symptoms or problems.

How Much Radiation Is Given

Radiation Therapy Treatment for Prostate Cancer

Based on the simulation, other tests, and your cancer type, the radiation oncologist will work with the other members of his team to decide how much radiation is needed, how it will be given, and how many treatments you should have. They figure this out based on research that has shown what the minimum and maximum dose of radiation should be for the type of cancer and area of the body being treated.

If the cancer has not completely gone away or if it comes back, more treatment might be needed. In these cases, the radiation team will help decide whether or not radiation therapy is the best option. This decision depends on the type of cancer, where the tumor is, and how much radiation was given to the area before. If the maximum dose has already been reached, radiation might not be the best option and other treatment may be offered. Getting radiation again to the same area is called re-irradiation.

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Urinary And Bladder Changes

Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:

  • Burning or pain when you begin to urinate or after you urinate
  • Trouble starting to urinate
  • Bladder spasms, which are like painful muscle cramps

Ways to manage include:

  • Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
  • Avoid coffee, black tea, alcohol, spices and all tobacco products.
  • Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
  • Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
  • Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.

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How Does Radiotherapy Work

Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy is high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body . Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.

Radiotherapy treats the whole prostate. It aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects that may cause you problems.

You may have radiotherapy to a wider area, including the nearby lymph nodes, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. If you do have radiotherapy to a wider area, you will be more likely to get side effects.

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Cyberknife For Prostate Cancer

With CyberKnife because of its precision, there is less risk of burning the rectum or testicles during treatment. There is also a reduced risk of impotence and urinary incontinence. Sexual function remains the same for most patients after treatment. There are also minimal side effects, which may include tiredness, and urinary and rectal irritation. Over-the-counter medications minimizes these, and they usually dissipate in a few days or weeks.

Here are some other benefits:

  • CyberKnife has a 98% cure rate for prostate cancer.
  • There is less toxicity than with traditional radiation.
  • Its quicker and has a high safety record.
  • CyberKnife causes less disruption to patients lives.
  • Its noninvasive. So, theres no anesthesia or cutting.
  • It doesnt come with the risks of surgery like infection and long periods of downtime.
  • CyberKnife treatments can be done infive radiation therapy sessions over 10 days. Thats compared to 42 over three months with other types of radiation treatments.
  • The CyberKnife radiation beams, which target the prostate, are extremely precise. That means there is less risk of side effects including impotence and incontinence.

Diarrhea Flatulence Or Painful Defecation

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

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What To Expect After Radiation Therapy For Prostate Cancer

Patients who receive radiation therapy for prostate cancer may experience a wide range of short-term and long-term side effects. And side effects may vary widely from patient to patient depending on a variety of factors, including the extent of the disease and the patients overall health. For instance, some patients may need a urinary catheter to help empty the bladder. Other patients may experience sexual side effects.

At CTCA, our trained supportive care providers work closely with you and your doctors to determine how best to address radiation therapy side effects. Services may include:

  • Pelvic floor therapy

Can Surgery And Radiation Be Used Together

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

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Swelling Bruising Or Tenderness Of The Scrotum

Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.

Good Prostate Cancer Care

Hypofractionated RT Noninferior for Localized Prostate Cancer

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

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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.

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What Does External Beam Radiotherapy Involve

You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.

Before your radiotherapy treatment

Radiotherapy planning session

A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.

During your radiotherapy treatment

You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.

If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.

At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.

Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.

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Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

  • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
  • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
  • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
  • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

Possible Risks And Side Effects Of Brachytherapy

Radiation therapy for prostate cancer: What to expect

Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

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Frequent Or Loose Poo

Your bowel movements might be looser or more frequent than before your treatment.

You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help. Your doctor or nurse can prescribe these for you, talk to your doctor before taking these.

You might find that you need to avoid high fibre foods. Although we normally think that a high fibre diet is the most healthy, it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .

Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

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Online Support Groups For Prostate Cancer

  • Us TOO. This organization has more than 200 support groups in the United States and abroad.
  • Prostate Cancer Research Institute. This website allows you to search for support groups by state.
  • Cancer Care. This site offers 15-week online support groups for people diagnosed with prostate cancer. Co-sponsored by the National Alliance of State Prostate Cancer Coalitions.
  • Male Care. This organization offers online support groups for people with prostate cancer and their partners or caregivers.
  • Imerman Angels. This support community offers one-on-one support with a mentor.

Proton Beam Therapy Vs Imrt For Prostate Cancer

Proton Therapy For Prostate Cancer Criticized

But what about proton beam therapy, which costs even more than IMRT — but which did no better in the Chen study?

“This is not to say that at the end of the day, proton beam radiation is not right for prostate cancer,” Potters says. “It’s just we need to do additional study of it. And given the rate of construction of proton machines on a national level, the data should be more forthcoming to show whether it’s worth the expense for prostate cancer.”

Chen notes that doctors switched from 3D conformational therapy to IMRT even before there was hard data to show it might be better. As more and more medical centers build proton beam facilities, he suggests that doctors might again switch to the next new thing.

“We are saying, ‘Wait a minute, let’s compare outcomes before we jump to a new therapy,'” Chen says. “I don’t think this study prevents a prostate cancer patient from choosing proton beam therapy. But it does tell him to ask his doctor about showing him data on whether protons are better.”

Much of the data that is available contradicts the Chen study, says Nancy Mendenhall, MD, medical director of the University of Florida Proton Therapy Institute and associate chair of the university’s department of radiation oncology.

Mendenhall says the Chen study fails to collect important data, such as the doses radiation patients received, exactly how well their tumors responded to treatment, and exactly which toxicities the patients suffered.

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