Verification And First Treatment
You will first meet with the radiation oncology technologists to discuss your treatment steps. Do not hesitate to ask them YOUR questions.
This final visit will be to check if the treatment area is consistent with the treatment plan. You will need to get into the same position that you will be in for all your treatmentsyou will have the required accessories to keep you in position.
Then you will receive your first treatment immediately.
Radiation Therapy Is Proven Effective
At MRO, we use radiation, or radiotherapy, to destroy cancer cells with high doses of radiation, the same type used for x-rays. Using a medical linear accelerator , we direct precise doses of radiation at cancer cells, which are more susceptible to radiation than healthy cells. Like an x-ray, radiation therapy is painless. And theres no fear of becoming radioactive during or after treatment.
Your Role On Your Radiation Therapy Team
Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:
- Getting to your appointments on time.
- Asking questions and talking about your concerns.
- Telling someone on your radiation therapy team when you have side effects.
- Telling someone on your radiation therapy team if youre in pain.
- Caring for yourself at home by:
- Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
- Caring for your skin as instructed.
- Drinking liquids as instructed.
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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.
During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
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.
Following Psa Levels During And After Prostate Cancer Treatment
A mans prostate-specific antigen blood level is often a good indicator of how effective treatment is or has been. Generally speaking, your PSA level should get very low after treatment. But PSA results arent always reliable, and sometimes doctors arent sure what they mean.
Before starting treatment, you might want to ask your doctor what your PSA level is expected to be during and after treatment, and what levels might cause concern. Its important to know that the PSA level is only one part of the overall picture. Other factors can also play a role in determining if cancer is still there, if it is growing, or if it has come back.
Its also important to know that PSA levels can sometimes fluctuate a bit on their own, even during or after treatment, so they may not always be a sign of what is actually happening with your cancer. Understandably, many men being treated for prostate cancer are very concerned about even very small changes in their PSA levels. The PSA level is an important tool to monitor the cancer, but not every rise in PSA means that the cancer is growing and requires treatment right away. To help limit unnecessary anxiety, be sure you understand what change in your PSA level might concern your doctor.
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Image Guided Radiation Therapy
In this type of radiation therapy, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue.
In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.
Calypso is another form of IGRT where the prostate can be tracked during the treatment.
Questions To Ask The Health Care Team
Who is creating my radiation therapy treatment plan? How often will the plan be reviewed?
Which health care professionals will I see at every treatment session?
Can you describe what my first session, or simulation, will be like?
Will I need any tests or scans before treatment begins?
Will my skin be marked as part of treatment planning?
Who can I talk with if Im feeling anxious or upset about having this treatment?
How long will each treatment session take? How often will I have radiation therapy?
Can I bring someone with me to each session?
Are there special services for patients receiving radiation therapy, such as certain parking spaces or parking rates?
Who should I talk with about any side effects I experience?
Which lotions do you recommend for skin-related side effects? When should I apply it?
How else can I take care of myself during the treatment period?
Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?
What will my follow-up care schedule be?
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What Happens After Radiation Therapy Treatment Ends
Once treatment ends, you will have follow-up appointments with the radiation oncologist. It’s important to continue your follow-up care, which includes:
Checking on your recovery
Watching for treatment side effects, which may not happen right away
As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.
What Happens Between Appointments
Contact your doctor or nurse if you have any concerns or get any new symptoms or side effects between your follow-up appointments.
Its important to speak to them if youre concerned about anything dont worry about them being too busy.
You can get support or advice over the telephone, or they might bring forward the date of your nextfollow-up appointment.
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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy
Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.
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Diet Guidelines To Minimize Bloating
During your radiation therapy, gas or fluid can build up in your bowels and cause bloating. When your bowels are bloated, they can expand into the treatment area and be exposed to radiation. This can cause side effects or make your side effects worse.
Follow the guidelines below to lower your risk of bloating during radiation therapy. Its best to start 2 to 3 days before your simulation and continue until you have finished your radiation therapy.
- Chew your food well.
If youre bloated, keeping a food journal can help you see which foods may be causing it. Write down your foods and drinks, the time you have them, and the time you start feeling bloated. Bring your food journal to your appointments. Your healthcare provider will use it to help you manage the bloating.
A clinical dietitian nutritionist can talk with you about your diet and help you design an eating plan that meets your needs. If youd like to meet with a clinical dietitian nutritionist, ask your radiation oncologist or nurse for a referral.
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Cancer Treatments And Erectile Dysfunction
Following surgery, many men experience erectile dysfunction , but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. Another factor is the surgeons skill level for performing the nerve-sparing technique, which if done correctly, may improve patients likelihood of retaining erectile function, says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapybrachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
When you compare surgery with radiation, both may affect erections, says Dr. Shelfo. Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over timemonths or, sometimes, yearssexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.
What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
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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.
Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
Side Effects Of Radiation Therapy To Your Prostate
Some people have side effects from radiation therapy. The type and severity of side effects varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.
This section explains the most common side effects of radiation therapy to the prostate. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.
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What To Know About Radiation Therapy For Prostate Cancer
As treatment options for prostate cancer get better, it can be tough for men to understand what to expect, especially when it comes to radiation therapy.
Its critical that men find a care location that not only offers the latest clinical advancements, but has an experienced and diverse team that treats all aspects of cancer, including the physical, functional and emotional aspects of the disease, shares Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Healths John Theurer Cancer Center.
Dr. Gejerman, as well as radiation oncologists Prashant Desai, M.D., medical director of radiation oncology at Ocean Medical Center and Priti Patel, M.D., medical director of radiation oncology at Riverview Medical Center, helped answer some of the most commonly asked questions about radiation therapy for prostate cancer below.
Q: What are the different types of radiation therapy for prostate cancer?
There are several forms of radiation therapy, but they can be broken down into two main categories:
External Beam Radiation – This form of therapy is more common, and delivers radiation from outside your body to treat cancer. This type of therapy can be used on its own or in combination with brachytherapy, depending on how aggressive your cancer is. There are three main techniques of delivering EBRT for prostate cancer:
Q: Is radiation therapy painful?
Q: Is radiation therapy safe?
Q: When is radiation therapy the right choice?
Before Starting Your Treatment
First visit: Meeting with radiation oncologist
Before starting radiation therapy, you will first meet with the radio-oncologist who will explain the principle, objectives, and techniques to be used. You will also be informed of possible adverse reactions and the solutions that exist to prevent or limit them. Feel free to ask any questions you may have about this treatment.
Second visit: Implanting gold or platinum pellets
In some treatment centres, 34 gold or platinum pellets are implanted during the radiotherapy treatment to increase the precision of the localization. The pellets allow the radio-oncologist to see the prostate, which can slightly shift between sessions, more clearly and aim the beam with precision.
During your first visit, the medical team will implant 34 pellets into your prostate with the help of an ultrasound machine inserted into your rectum. This procedure is very similar to that used during your biopsy.
These pellets are reference markers that will permanently stay in your prostate but will have no side effects.
- Antibiotics will be prescribed to prevent infection. You will need to take them the night before your visit, the day of your visit, and the day after your visit.
- In preparation, you should also perform a Fleet enema the morning of the visit.
Third visit: Simulating a radiation therapy session
For this visit, and in all future treatments, your bladder shoul be full. You will be given instructions to guide you.
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