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.
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.
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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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.
- Prunes
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.
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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What The Research Shows About Radiation Vs Surgery
The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.
The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year mark for radiation therapy, surgery or active surveillance.
If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 100,000 prostate cancer patients over a 15-year period.
As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.
The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.
Image Guided Radiation Therapy
This treatment uses radiation machines that contain scanners. These machines produce photos of the prostate gland prior to administering each dose of radiation. This allows for constant adjustments that provide precise delivery and dosing.
Volumetric modulated arc therapy is a variation of IGRT that provides faster treatments. It utilizes a radiation machine that circles the body once while delivering radiation.
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Will Radiation Therapy Make Me Tired
Everyone has their own energy level, so radiation treatment will affect each person differently.
People often feel fatigue after several weeks of treatment. For most, this fatigue is mild. But some people lose a lot of energy and need to change their daily routine.
If your doctor thinks you should limit how active you are, theyâll discuss it with you.
To minimize fatigue while youâre receiving radiation treatment:
- Get enough rest.
- Pace yourself, and plan rest breaks throughout your day.
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.
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Remove Devices From Your Skin
The manufacturer recommends taking these devices off your skin before your simulation or treatment:
- Continuous glucose monitor
- Insulin pump
If you use one of these, ask your radiation oncologist if you need to take it off. If you do, make sure to bring an extra device to put on after your simulation or treatment.
While your device is off, you may not be sure how to manage your glucose . Ask the healthcare provider who manages your diabetes care. Make sure to do this before your simulation or treatment appointment.
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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Surgery Vs Radiation For Prostate Cancer
Prostate cancer is common cancer thats affecting men. If you happen to be diagnosed with prostate cancer then you might be wondering about the best treatment methods to follow.
The most common type of cancer treatments includes radiation and surgery. Early diagnosis of any cancer is very important because it helps minimize the risks and invasive procedures that are used when the cancer is advanced.
Localized prostate cancer means that it has not spread to other parts of your body and therefore it can be safely removed and you be cured of prostate cancer. If your cancer is not acute your physician will present you with about three treatment options when is radiotherapy, surgery, or active surveillance.
Men are eager to know the best treatment type for their prostate cancer. Note that there is a misconception that only one option is the best or safer. Both radiation therapy and surgery can be used to treat prostate cancer and achieve the desired results. The best thing about prostate cancer is that it spread slowly so men have some time to think of the options to go for.
Who Might Benefit From Radiation Therapy
Your doctor might recommend radiation therapy in several situations.
It can be the first treatment for cancer that hasnât spread outside your prostate gland and is âlow grade.â The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are â and, in general, the more likely your cancer is slow-growing.
Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.
If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldnât remove all of the cancer or if the cancer comes back in the area of your prostate.
If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.
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External Beam Radiation For Prostate Cancer
When most patients think of radiation therapy, they think of external beam radiation therapy , in which a beam of radiation is directed at cancerous tissue from outside the body. Technological advances, such as intensity-modulated radiation therapy and image-guided radiation therapy , allow radiation oncologists to use computer-controlled devices and image-guidance technology to see and target a three-dimensional image of the tumor, making the treatment more precise than ever before.
EBRT used to require 40-45 daily treatments. Now, 25-28 treatments are the norm. This type of protracted, fractionated radiation therapy, however, is now generally considered to be less appropriate for low-risk and favorable intermediate-risk patients. Instead, hypofractionated techniques and brachytherapy techniques are generally more advisable for many patients.
Radiation For Prostate Cancer: Treatment And Side Effects
Radiation therapy is one of the procedures your doctor may recommend for prostate cancer. This treatment can affect other parts of your body like your mouth, teeth, and gums. It would be best if you have dental insurance, or comprehensive medical insurance, to address the radiations side effects not only on your oral health but your overall well-being too. In any case, keep reading to learn how radiation for prostate cancer works, including the side effects and when its generally used.
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Whats The Procedure Like
Since delivering the protons to the cancer cells is the goal of therapy, a lot of time is spent on positioning your body and adjusting the equipment before each session.
Youll have to remain perfectly still while the proton beam is delivered, but it will only take about 1 to 3 minutes. Its noninvasive, and you wont feel anything. Youll be able to leave right away and continue your normal activities.
Possible Long Term Side Effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later. This includes problems getting an erection.
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Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021
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Cancer: Principles and Practice of Oncology VT DeVita, TS Lawrence, SA RosenbergWolters Kluwer, 2019
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How Can I Choose From Among The Options
In addition to talking with family and friends, you will need a team of physicians to help advise you. You should meet with everyone involved in your treatment planning before choosing a treatment, including:
- your primary care doctor
- a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy
- a medical oncologist to discuss hormone suppression, if your cancer is more advanced
After you meet with these doctors, you can make an informed decision regarding your treatment options. You may have an early-stage or moderately advanced cancer with no evidence of spread to other organs . If so, your two major treatment options are active surveillance , surgery or radiation therapy .
You may have advanced cancer and require hormonal suppression therapy or chemotherapy. If so, you will need a medical oncologist to administer these drugs. Doctors use hormone-ablation therapy to treat advanced prostate cancer. It suppresses androgen because these hormones stimulate most prostate cancer growth. Your internist, urologist, radiation oncologist or medical oncologist may administer the treatment. Depending on the stage of the cancer, your doctor may use hormone suppression therapy and radiation therapy to help control your disease. You may receive hormone suppression therapy for as little as four to six months, or for as long as two to three years.
How Effective Is Modern Radiation Treatment Of Prostate Cancer
Thanks to improvements in technology and daily imaging, radiation therapy can deliver a higher radiation dose directly to the tumor while sparing surrounding healthy tissue. Doctors use different imaging techniques to see the prostate and surrounding tissues in three dimensions. This allows the doctor to tailor the radiation more precisely to the individual patient’s unique needs. Treatment planning allows them to estimate and minimize radiation exposure to the rectum, small bowel, bladder, and hips. This helps reduce the risk of side effects and complications. The goal is to safely provide a high dose of radiation, which improves the chance of cure. For similar stage and prostate cancer types, radiation therapy is as effective as surgery.
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How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
Radiotherapy For Prostate Cancer
Radiotherapy uses high energy waves similar to x-rays to destroy prostate cancer cells. It is a common treatment for prostate cancer.
You might have external beam radiotherapy or internal radiotherapy . External beam radiotherapy directs radiotherapy beams at the cancer from a machine. This is different to internal radiotherapy which means giving radiotherapy to the cancer from inside the body. For prostate cancer, you might have a type of internal radiotherapy called brachytherapy.
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.