Focal Therapy For Prostate Cancer
With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer.; Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function;
Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. ;Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.
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.
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.
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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.
Life After Radiation Therapy
For most people, the cancer experience doesnt end on the last day of radiation therapy. Radiation therapy usually does not have an immediate effect, and it could take days, weeks or months to see any change in the cancer. The cancer cells may then keep dying for weeks or months after the end of treatment. It may be some time before you know whether the radiation therapy has controlled the cancer.
Learn more about:
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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. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:
- your primary care physician as well as a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy.
Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .
If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.
Psa Levels After Treatment
A continuous rise in your PSA level can be the first sign that your cancer has come back. This should be picked up by your regular PSA tests.
The exact change in PSA level that suggests your cancer has come back will depend on which treatment you had. Speak to your doctor or nurse about your own situation.
Your PSA level should drop so low that its not possible to detect it at six to eight weeks after;surgery. This is because the prostate, which produces PSA, has been removed. A rise in your PSA level may suggest that you still have some prostate cancer cells.
After;radiotherapy;or;brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA.
Your PSA level may actually rise after radiotherapy treatment, and then fall again. This is called PSA bounce. It could happen up to three years after treatment. It is normal, and doesnt mean that the cancer has come back.
If your PSA level rises by 2 ng/ml or more above its lowest level, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options.
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Salvage Androgen Ablation Therapy
Hormonal manipulation is likely to be the therapy most commonly administered to patients with recurrent prostate cancer and yet it has been the least well studied to date. A total of 54% of urologists and radiation oncologists in one study recommended androgen ablation or observation with delayed androgen ablation for patients with recurrent prostate cancer. Certainly, androgen ablation is not a curative intervention, and therefore the optimal timing of its application is uncertain. The cancer-specific survival after androgen ablation administered upon identification of local-only recurrence in one series of 72 patients was 70 and 84 months. Although this relatively short survival may be a reflection of the advanced stage of disease of these patients or the intrinsic response rate of prostate cancer to hormonal therapy, the more morbid attempts at salvage therapy, such as radical prostatectomy, cryoablation, and brachytherapy, should demonstrate improved survival beyond that of androgen ablation in order to be reasonably administered to patients with recurrent prostate cancer.
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.
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What Type Of Follow
If prostate cancer recurs, follow-up treatment depends on what treatment you have already had, the extent of your cancer, the site of recurrence, other illnesses, your age, and other aspects of your medical situation.
One possible treatment might include hormone therapy. Researchers are working on new drugs to block the effects of male hormones, which can cause prostate cancer to grow, and drugs to prevent prostate cancer growth.
Radiation therapy, ultrasound, extreme cold, electrical current, or medicines may be used to relieve symptoms of bone pain. Chemotherapy or other treatments being medically researched are also options.
Now in clinical trials are several types of vaccines for boosting the body’s immune system against prostate cancer cells. Sipuleucel-T is the only vaccine available on the market for prostate cancer.
What Is Proton Therapy
Using proton therapy for prostate cancer is controversial in the field of radiation oncology because the prostate is relatively deep inside the patient which diminishes or eliminates any potential benefit.; Proton therapy for prostate cancer usually results in a plan which is slightly less conformal that IMRT and it usually costs 3 times the cost of IMRT.; Protons have a some disadvantages over IMRT including a poor penumbra and significant uncertainty of the path length of the proton .;; The benefit of protons is not controversial for pediatric cancers because many pediatric tumors are ideally located to exploit the benefits of protons .; I was on faculty at the MD Andersons Proton Therapy Center in Houston, Texas and can discuss all potential benefits and disadvantages with interested patients.; A good discussion about protons for prostate cancer can be found at http://jco.ascopubs.org/content/25/24/3565.full.
Written by Dr. David Kornguth on May 6, 2011 |;
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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.
Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
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What To Expect After Radiation Treatment For Prostate Cancer
What to Expect After Radiation Treatment for Prostate Cancer? Many patients wonder what to expect after receiving radiation treatment for prostate cancer. It is the most widely used method of treatment regardless of the cancers stage. Radiation therapy can be followed by a radical prostatectomy, which removes the prostate gland and nearby lymph nodes.
Prostatecancer is the most diagnosed solid tumor type among men. In the early stages ofprostate cancer, indolent cases without major symptoms will receive activesurveillance and watchful waiting to observe how the disease progresses. If thecancer spreads outside of the prostate gland, other treatment options areconsidered, the first of which being radiation.
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 Happens To Dead Cancer Cells
Many people wonder what happens to the cancer when it dies, ;A tumor is made up of billions of cancer cells. ;Over several weeks of radiation therapy the cancer cells will gradually die off. ;Dead cancer cells are recycled by the body in the same way as the other billions of healthy cells that die every day in your body. ;They are broken down into their basic components of amino acids, fats, etc, and are used by other healthy cells.
A cancer cell is only dangerous if it is alive and capable of dividing to form other cancer cells. ;A dead cancer cell is just like any other dead cell in your body. ;It is not contagious, it has no way to turn other cells into cancer, it is not poisonous. ;A dead cancer cell is like a dead tiger. ;It is just meat. ;Its just a bunch of nutrients for for your body to reuse.
When a lot of cells die in a short period of time, you can develop some inflammation and / or scarring in that part of the body. ;It is normal to develop scarring in the prostate gland after completing radiation.
Treatment For Intermediate Risk Prostate Cancer
Intermediate risk prostate cancers are the most frequently treated prostate cancers. They are cancers that are confined to the prostate, often are Gleason 7 and have a PSA of less than 20.;These cancers are treated in men with life expectancy greater than 10 years to prevent spread of the cancer in the long-term. There are a number of different effective treatment options for intermediate risk prostate cancer and the decision is often a personal one. Here at UCLA we recommend consultation with both Urologist and Radiation Oncologist to help men decide which treatment option is best for them. ;
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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.
How Come I Need The Number Of Treatments I Was Prescribed Where Does That Number Come From
Prostate cancer treatment has been studied using randomized trials.; In such trials, men were given different doses and the results were compared between the groups.; For intact prostate cancer, typical doses are close to 81 Gy in 45 treatments given 5 days a week.; Treatment after prostatectomy is typically 66-70 Gy, or 35-37 treatments Intensity modulation is necessary to achieve adequate doses because the prostate is so close to the bladder and rectum.
Written by Dr. David Kornguth on July 26, 2011 |;
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What Are The Different Types Of Internal Radiation Therapy
Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside. However, the similarities mostly end there. Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer. Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Read on to find the details of each.
What Are The Side Effects Of External Beam Radiation Therapy
As with most prostate cancer treatments, external beam radiation therapy can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment and area of treatments. These frequently include:
- Skin irritation
- Erectile dysfunction
- Secondary malignancy
If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed.
Recently, the FDA approved the use of;Space OAR, a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins. To learn more about this product, visit the manufacturers site here.
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Questions To Ask Your Doctor Or Nurse
- Is the treatment Im having for prostate cancer likely to cause any urinary problems?
- What type of urinary problems might I get?
- What should I do if I cant urinate?
- Will my urinary problems get better?
- What treatments are available?
- What are the risks and side effects of treatments for urinary problems?
- What can I do to help myself?
- Where can I get pads and other products?
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.
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Can Acupuncture Help Treat Cancer
Acupuncture is an ancient Chinese technique used to treat a variety of medical conditions.; I do not believe that Acupuncture can cure cancer, though I believe it might help manage some treatment related side effects like fatigue, discomfort and mental well being.; Cancer cells are derived from our normal cells but grow in an uncontrolled way.; Acupuncture cannot kill these cells nor does any data suggest it can.
Written by Dr. David Kornguth on June 23, 2011 |;