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Beam Radiation For Prostate Cancer

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Help For Bowel Dysfunction

External Beam Radiation Therapy is a non-invasive treatment option for prostate cancer

To help with symptoms of bowel dysfunction, your healthcare team may recommend:

  • Avoiding foods that can irritate your bowels

  • Taking antidiarrheal medications

  • Increasing fiber intake from fruits and vegetables

If you have persistent rectal bleeding, your team may recommend laser therapy. Laser therapy will scar the blood vessels in your rectum so they stop bleeding.

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External Radiation Therapy Machines Linear Accelerator Is The Most Commonly Used Machine For Giving External Radiation Therapy It Delivers High

CyberKnife is a small compact linear accelerator mounted on a robotic arm that moves around the person to give radiation from many different directions. It also has several x-ray cameras . Computers track a persons position and movement. If a person moves slightly, the robotic system can adjust by repositioning the linear accelerator before the beam of radiation is delivered. CyberKnife is particularly useful for treating tumours of the lung because of movement during breathing. It is most used for treating tumours of the brain, lung, prostate and spine. CyberKnife uses larger doses of radiation for each treatment than a LINAC so fewer treatment sessions are needed. Each session may take 30 to 90 minutes. Not every cancer treatment centre has a CyberKnife.

Gamma Knife is designed to give external radiation therapy to the brain. It delivers about 200 thin beams of high-energy radiation at a tumour. The highest dose of radiation is delivered at the point where the beams cross . It is usually given in a single session and used to treat primary brain tumours or brain metastases. The technique is sometimes called Gamma Knife radiosurgery.

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Radiopharmaceuticals That Target Psma

Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.

Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.

This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.

This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.

Possible side effects

Some of the more common side effects of this drug include:

  • Feeling tired
  • Constipation

This drug can lower blood cell counts:

  • A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
  • A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
  • A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.

This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.

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What Is Prostate Cancer

Prostate cancer is a disease in which malignant cells form in the tissues of the prostate. For the most part, this is a slow-growing type of cancer that stays within the prostate for a long time before moving outside the capsule and into nearby organs.

Symptoms are not noticeable until the cancer has been growing for a long time. This is why prostate cancer screening is really important for men over the age of 50. Your doctor will monitor your PSA levels with a blood test, and perform an exam about once a year to see if anything has changed. If your PSA levels go up all of a sudden or theyre steadily getting higher every year, a biopsy may be recommended to determine if cancer is present. If the doctor notices anything unusual during a prostate exam they may also recommend more testing.

How Does External Beam Radiation Therapy Work

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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 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.

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Are There Risks Associated With External Beam Radiation Therapy For Prostate Cancer

There are risks associated with the use of radiation therapies. The severity of your side effects will depend upon the intensity of the treatments you undergo. Most of these side effects are both temporary and able to be controlled by your doctor.

With radiation treatments, we have acute side effects and late side effects. If your treatment is prostate only then you will have some irritative symptoms of the urinary tract and rectum. If your Doctor recommends the pelvic lymph nodes be treated then you see more irritated GI side effects such as bowel urgency and diarrhea.

Almost all of these side effects are reduced by managing them with medications and/or diet changes. Patients do experience some fatigue and this is more pronounced on hormonal therapy during the radiation.

Late side effects can manifest at any time. The more severe side effects such as severe bleeding are fairly rare. Erectile dysfunction is common but with the use of medications, this can often be corrected.

We are often asked about incontinence of urine and that is a very rare side effect from radiation as relates to complete leakage. Some patients may get in situations where they cannot logistically get to a bathroom on a timely basis and one of those rare occasions will have what is called urge incontinence.

There are other very rare side effects but the above covers the usual events we see.

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Low Dose Rate Brachytherapy Implants

The most common form of brachytherapy for prostate cancer, LDR involves surgically placing small radioactive pellets, about the size of a grain of rice, within the prostate. Once put in place, they remain there for life, but the radiation weakens over weeks or months, until it almost completely goes away.

Heres What You Should Know About This Treatment Option

Radiation therapy for prostate cancer: What to expect

Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.

But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.

Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.

“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.

There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.

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Radiation Therapy: Effective For Prostate Cancer

Research published in the Journal of Medical Imaging and Radiation Oncology in 2015 shows that external-beam radiation therapy is a highly effective treatment option for prostate cancer.

Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer.

The 5-year survival rate using this treatment is 98.8% overall.

When compared to other common treatment options such as surgery or brachytherapy, external-beam was as effective and in some cases more effective.

A/Prof Tom Shakespeare, Radiation Oncologist at the North Coast Cancer Institute, led the eight year study comparing the effectiveness of external-beam radiation therapy with other common treatment options such as surgery or brachytherapy.

The main outcome that we have seen from this study is that external-beam radiation therapy is one of the most effective treatment options for prostate cancer, he said.

These are great results showing that radiation therapy is as effective, or even better, than other common treatment options such as surgery or brachytherapy.

In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases.

When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.

Unfortunately, this does not always happen.

Why Might Ebrt Be Suggested

EBRT can be used in the following ways:

  • As the primary/main treatment when the cancer is localised, contained within the prostate and has not spread to other parts of the body -this is called radical radiotherapy
  • For men with low, intermediate and high-risk prostate cancer.
  • As a treatment, after a period of active surveillance. If there are signs of the cancer growing or progressing, then EBRT may be one of the treatment options offered to you
  • For men who are expected to live for at least 10 years
  • After radical prostatectomy if there are high-risk features or if there are signs of the cancer growing again
  • For men who are fit enough to have treatment and do not have other significant medical conditions that may impact on survival and life expectancy
  • In combination with hormone therapy for treatment of cancers that have spread out-with the prostate capsule or affected other organs nearby such as the seminal vesicle. Hormone treatment can be used on a short term basis or long term basis
  • Smaller doses of EBRT can also be used very effectively to treat bone pain in cases of cancer spread to the bones.

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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.

British Columbia Specific Information

Newly Diagnosed

Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.

You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.

Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency Prostate.

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Is There Any Special Preparation Needed For The Procedure

The process of external beam therapy involves three parts:

  • Simulation
  • Treatment Planning
  • Treatment Delivery

The goal of simulation is to determine the treatment position that will be used daily, to make devices that will help the patient maintain that position, and to obtain the necessary images for treatment planning. The radiation therapist places the patient in the treatment position on a CT scanner. Masks, pads or other immobilization devices are typically used to help the patient to hold still and in a specific position during the simulation. These devices will be used for the treatment to achieve the same position daily, so it is important that the patient can maintain that position. Images of the treatment area are taken in the treatment position. The radiation therapist places small marks on the patients to help guide the daily treatments. These marks may be tattoos or colored ink. The tattoos will be permanent, but the colored ink will eventually fade. Marker seeds may be placed in the target tumor or organ at simulation or during a separate surgical procedure. These seeds or markings are intended to help the radiation therapist position the patient during each treatment session.

After the simulation and planning have been completed, the treatment can begin.

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.

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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

Who Should Consider Taking Radiopharmaceuticals

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Radiopharmaceuticals are given through a vein to men with metastatic prostate cancer that has spread widely to the bone. Strontium89 and Samarium-153 are radiopharmaceuticals given to reduce the pain caused by the bone cancer. Radium-223, or Xofigo®, is a radiopharmaceutical given to prolong life.

The side effects associated with radiopharmaceuticals are mainly the suppression, or lowering, of white blood cell and platelet levels in the blood. Your doctor will be able to assess whether your body can handle this side effect before you are given the treatment and will monitor your levels after you receive it. Your doctor, specialist nurse, or nuclear medicine practitioner will be able to give you more information about the treatment and possible side effects.

If your doctor has told you that your bone metastases have spread, you may be a candidate for a radiopharmaceutical. Speak with your oncology team to see if one of these treatments may be right for you.

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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.

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