Having Radiotherapy For Prostate Cancer
You have external beam radiotherapy as an outpatient in the radiotherapy department. Radiotherapy is given using a machine that is like a big x-ray machine. This is called a linear accelerator .
You usually have it as a series of short, daily treatments. The treatments are given from Monday to Friday, with a rest at the weekend. Radiotherapy is not painful, but you will need to lie still while you have it.
You may have radiotherapy over either:
- 4 weeks the dose you get for each treatment session is higher.
- 7 weeks the total overall dose of radiation is higher.
Both ways are effective, and the side effects are the same. You usually have radiotherapy over 4 weeks as it is a shorter treatment.
If you have a type of radiotherapy called stereotactic ablative radiotherapy you have it over a much shorter time.
Your doctor or nurse will explain how long your course of radiotherapy will take. It is safe for you to be with other people during external radiotherapy, including children.
There are different techniques used to treat prostate cancer more effectively. They treat the cancer while protecting healthy tissue and reducing side effects.
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with 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. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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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Possible Risks And Side Effects Of Brachytherapy
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.
Spaceoar Hydrogel Reduces Side Effects Of Prostate Cancer Radiation Therapy
While radiation treatment for prostate cancer has become much more precise over the years, the organs location immediately next to the rectal wall can expose the rectum to high dose radiation, which can lead to disruption in bowel function for some patients.
A new method for reducing these short- and long-term side effects is SpaceOar hydrogel, now available at Fox Chase.
In a minimally invasive outpatient procedure, the two liquid components of SpaceOAR hydrogel are injected through the peritoneum into the space between the rectal wall and the prostate by a urologist. The procedure is done under anesthesia with ultrasound guidance.
The resulting interaction between the two fluids creates a temporary and absorbable gel spacer that is primarily made of water. Hydrogels have been used in other implants such as surgical sealants used in the eye, brain and spine.
The OAR in SpaceOAR stands for Organ At Risk, referring to the rectum.
The position of the prostate poses particular challenges for the higher doses of radiation treatment required for this type of cancer, Fox Chase radiation oncologist Mark Hallman MD, PhD said. The posterior prostate lies right on top of the interior rectal wall and this puts the rectum at increased risk.
SpaceOAR was approved as a medical device by the FDA in 2015 and Fox Chase is among the first in the Philadelphia area to offer it.
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What Is A Radiation Oncologist
If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the persons overall health and well-being through the process.
With advanced cancer, a patient may also be referred to a medical oncologist. This specialized doctor uses medicines such as chemotherapy and hormone therapy to treat cancers. Its common for several medical specialists to work together on a treatment plantheyre known as a cancer care team.
Side Effects Of Radiation For Prostate Cancer
The primary potential side effects of radiation treatment for prostate cancer include bowel problems, urinary problems and sexual function issues.
According to patient-reported outcomes measuring quality of life from men who participated in the 10-year, randomized Prostate Testing for Cancer and Treatment trial, men who were treated with radiation reported little increase in urinary leakage after radiation therapy. They also reported less sexual dysfunction when compared to men who were treated with surgery. However, men treated with radiation reported a higher incidence of bowel problems, such as loose and bloody stools. These side effects are often short-term for most patients, but some experience long-term side effects.
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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 Different Types Of Radiation Treatments
Radiation therapy uses concentrated doses of radiation to kill cancer cells and reduce the size of tumors. Depending on the type of cancer present in the body, one of two types of radiation therapy may be used.
External beam radiation therapy uses a large machine to send radiation into the specific area containing cancer. The radiation machine never touches the body, but it does move around to deliver radiation into precise parts of the body. External beam radiation is the most common type of treatment for many cancers.
Internal radiation therapy, on the other hand, uses a solid or liquid radiation source to physically deliver radiation inside the body. If a solid source of radiation is used, it only targets a specific part of the body for localized treatment, especially for cancers of the head, neck, breast, cervix, prostate, and eye. If a liquid source of radiation is used, its considered a systemic therapy that travels through the blood into tissues throughout the entire body.
Radiation therapy is often used in conjunction with other treatments or surgeries to target cancer in the most strategic way possible. Its often used to make surgery easier by shrinking the size of the tumor beforehand. Radiation therapy is even used during surgery to go straight into cancer cells without passing through the skin.
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Radiation Therapy In Localized Disease:
For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.
At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.
These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.
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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Are Surgery And Radiation Therapy Ever Used Together
In some cases, your care team may use both surgery and radiation therapy as part of your prostate cancer treatment plan. Typically, radiation therapy is delivered after surgery to target remaining cancer cells or that came back. However, in some situations, doctors may recommend radiation therapy first to kill cancer cells in tissues near the prostate gland before performing the prostatectomy.
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.
What Is Prostate Radiation
Radiation for prostate cancer is a special treatment of the cancer cells with the help of high-energy rays or particles. Radiation has the power to make small breaks through our DNA cells. This breakage stop the growth and spread of cancer further. Depending on the stage of prostate cancer, radiation treatment can be used in the following situations:
- To cure or shrink early-stage cancer.
- To stop cancer from coming back somewhere else.
- To treat symptoms caused by advanced cancer.
- To treat cancer that has returned .
Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
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How Does External Beam Radiation Therapy Work
External beam radiation therapy, or EBRT, uses a machine to direct high-energy X-rays at the cancer in daily doses. The radiation beam is generated by a machine called a linear accelerator or LINAC. Using treatment planning computers and software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.
To minimize side effects, the treatments are typically given five days a week over a six-to-nine week period. The break in days allows the doctors to get enough radiation into the body to kill the cancer while giving healthy cells time to recover.
Watch our expert medical oncologist, Dr. Alicia Morgans from Vanderbilt-Ingram Cancer Center, discuss external beam radiation therapy:
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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.
What Is Radiotherapy
Radiotherapy uses high-energy rays to treat cancer. It destroys cancer cells in the area where the radiotherapy is given. The aim of radiotherapy for prostate cancer is to try to cure the cancer or control it for many years. Doctors call this radical radiotherapy. At the same time, they try to make sure radiotherapy causes as little harm as possible to healthy tissue and organs close by. These include the bladder, back passage and bowel.
Radiotherapy for prostate cancer can be given in different ways:
- external beam radiotherapy radiotherapy is given from outside the body from a radiotherapy machine
- brachytherapy radiotherapy is given from inside the body .
External beam radiotherapy is the most common way of giving radiotherapy for prostate cancer. Sometimes it is given with brachytherapy.
You may be given hormonal therapy before, during and after radiotherapy. It helps make radiotherapy more effective.
We have separate information on radiotherapy for advanced prostate cancer.
Why It Is Done
Radiation therapy is used for:
- Cancer that has not spread in generally healthy men.
- Cancer that has spread to the bones, and is causing pain or other symptoms.
- Cancer that has come back in the prostate after surgery.
- Cancer cells that may remain after surgery, especially if all the cancer cannot be removed.
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What Happens On Treatment Days
If you get external radiation therapy, youâll need to get regular sessions during a period of about 5 to 8 weeks.
For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure youâre positioned well, theyâll leave the room and start the radiation treatment.
Theyâll watch you closely during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Try to stay still and relaxed during treatment. Let the therapist know if you have any problems or you feel uncomfortable.
Theyâll be in and out of the room to reposition the machine and change your position. The treatment machine wonât touch you, and youâll feel nothing during the treatment. Once the treatment is done, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that youâre being positioned accurately during your treatments.
Port films donât provide diagnostic information, so radiation therapists canât learn about your progress from them. But these films do help the therapists make sure theyâre delivering radiation to the precise area that needs treatment.