Three Methods To Provide External Beam Therapy
Image Guided Radiation Therapy Normal structures and tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT is radiation therapy guided by imaging equipment such as CT, ultrasound or stereoscopic X-rays that are taken in the treatment room just before the radiation is delivered. All patients first undergo a CT scan as part of the planning process. The digital information from the CT scan is then transmitted to the treatment console to allow the therapists to compare the earlier image with the images taken just prior to treatment. This allows for better targeting of the cancer while avoiding nearby healthy tissue. In some cases, a tiny piece of material called a fiducial marker may be implanted near or in the tumor to help localize the tumor during IGRT.
Intensity Modulated Radiation Therapy Intensity modulated radiation therapy is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit your tumor. With IMRT, the radiation beam can be broken up into many âbeamlets,â and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the exact amount of radiation that is received by normal tissues that are near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, increasing the chance of a cure.
How Effective Is Modern Radiation Treatment Of Prostate Cancer
Radiation therapy can give more radiation dose directly to the prostate than to surrounding healthy tissues, given the improvements in technology and imaging techniques. Physicians use various imaging techniques to see the prostate and surrounding tissues in three dimensions, so that the radiation beams can be tailored more precisely to the individual patients unique needs. Physicians can estimate and minimize the dose of radiation that will be received near the rectum, small bowel, bladder and hips during the course of radiation treatment to reduce the risk of side effects and complications. The goal is to safely provide a higher dose of radiation than even five years ago, which helps to improve the chances of cure. For similar stage and prostate cancer types, radiation therapy is as effective as surgery but with a different treatment process and different side effects.
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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 a loss of hair or decreased perspiration within the treated area.
These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. If skin changes appear outside the treated area, inform your doctor or primary 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, increased or decreased sensitivity of the skin, and a thickening of tissue or skin.
Another possible side effect is erectile dysfunction and urinary symptoms such as frequency, bleeding, or, rarely, incontinence. Keep these side effects in mind when considering your treatment options. If you have any concerns, donât hesitate to talk to your doctor about them.
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How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density , weight gain , higher cholesterol, and a higher risk of diabetes and heart attack. Some men experience fatigue, memory loss, and/or depression. Dont be afraid to discuss these issues with your doctors. Maintaining a healthy lifestyle through good nutrition and exercise can help reduce the impact of these side effects.
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Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
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A PSA test every 3 to 6 months
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A DRE at least once every year
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Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
Treating Stage Iii Colon Cancer
Stage III colon cancers have spread to nearby lymph nodes, but they have not yet spread to other parts of the body.
Surgery to remove the section of the colon with the cancer along with nearby lymph nodes, followed by adjuvant chemo is the standard treatment for this stage.
For chemo, either the FOLFOX or CapeOx regimens are used most often, but some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs.
For some advanced colon cancers that cannot be removed completely by surgery, neoadjuvant chemotherapy given along with radiation might be recommended to shrink the cancer so it can be removed later with surgery. For some advanced cancers that have been removed by surgery, but were found to be attached to a nearby organ or have positive margins , adjuvant radiation might be recommended. Radiation therapy and/or chemo may be options for people who arent healthy enough for surgery.
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Prices And Where To Get It
The cost of a radical prostatectomy varies depending on insurance status and location of surgery.
Costs may include hospital fees, anesthesia fees, and surgeon fees. The average cost of hospital fees for prostatectomy in the United States is about $34,000. Anesthesiologist and surgeon fees average about $8,000. What out-of-pocket expenses the person being treated incurs will depend on their insurance.
The location of the procedure can be with a local surgeon, or the person being treated may travel to see a regional or national expert.
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What The Results Showed
What Chesnut and his colleagues wanted to know was if the mens pre-operative findings were consistent with tumor details in their surgically removed prostates. And that turned out to be the case. The men truly did have treatable index lesions without other aggressive cancer, meaning that the biopsy and MRI results had accurately predicted PGA eligibility. Moreover, six additional men were found to be eligible for PGA based on tumor slide analysis, even though the pre-operative and MRI evidence had suggested otherwise.
Given that, the authors concluded that 21 of the initial 77 men, or 27% in all, had recurring prostate cancer that was amenable to PGA.
While the results are promising, the authors also cautioned that, given the small number of men evaluated and other study limitations, they are currently unable to recommend PGA as treatment for recurring prostate cancer outside of clinical trials.
The authors have addressed a very important problem and one that has no easy answers, which is what to do about recurrent or persistent prostate cancer following radiation therapy, says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
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Understanding The Recurrent Prostate Cancer
Recurrent prostate cancer is when prostate cancer returns after the initial treatment or partial to complete remission has occurred. This is due to the reemergence of surviving prostate cancer cells that have grown large enough to be detected.
Following a prostatectomy, your prostate-specific antigen levels being to decrease. Eventually, they are no longer detectible, which is an indication that prostate cancer is no longer present. However, there is no clear reference for a normal PSA. It differs between men and can be affected by a number of factors. Following your initial prostate cancer treatment, PSA levels should stabilize and be low enough to where theyre not detected on blood tests. In some cases, PSA levels begin to rise again, indicating a need for further tests.
Even if youve had a prostatectomy, prostate cancer can recur in the immediately surrounding tissue, lymph nodes, seminal vesicles, muscles that control urination, the rectum, the wall of the pelvic, or metastasize into lymph nodes and bones further away.
Who Should Consider External Beam Radiation Therapy
In most cases, external beam radiation therapy is used for men with localized prostate cancer . The intent of EBRT in this case is to kill the tumor while sparing as much healthy tissue as possible. Sometimes it is used in more advanced cases. For example, it can be used along with hormone therapy, or used to relieve pain from bone metastases.
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Questions Patients Might Be Reluctant To Ask About Radiation Therapy
Getting a recommendation for radiation therapyas part of cancer treatment comes with a learning curve and a lot ofquestions. Morethan half of all patients with cancer receive radiation therapy at somepoint in their care, and patients and their families want to know how radiationworks and how it might affect their lives during and after treatment.
Still, we know some patients feel nervousasking questions about their cancer therapy. In a word: Dont. Asking questionshelps your doctors provide the best care.
Radiationoncologists at the UT Southwestern Harold C. Simmons Cancer Center areleaders in the field, conducting research studies and pioneering advancedradiation techniques such as stereotactic ablative radiotherapy ,brachytherapy, and novel combinations of radiotherapy with chemotherapy.
Were always happy to share the most currentradiation knowledge with our patients. So, here are answers to five of the mostcommon questions patients have said they were nervous to ask but were gladthey did.
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How Can I Help Myself
Urinary problems can affect your self-esteem and independence, and affect your work, social and sex life.
Making some changes to your lifestyle may help, and there are some practical steps that can make things easier.
- Try to drink plenty of fluids, but cut down on fizzy drinks, alcohol, tea and coffee as these may irritate the bladder
- Do regular pelvic floor muscle exercises to help strengthen the muscles that control when you urinate.
- Try to stay a healthy weight. Being overweight can put pressure on your bladder and pelvic floor muscles.
- If you smoke, try to stop. Smoking can cause coughing which puts pressure on your pelvic floor muscles. NHS Choices has more information about stopping smoking
- Plan ahead when you go out. For example, find out where there are public toilets before leaving home.
- Pack a bag with extra pads, underwear and wet wipes. Some men also find it useful to carry a screw-top container in case they cant find a toilet.
- Get our Urgent toilet card to help make it easier to ask for urgent access to a toilet.
- Disability Rights UK runs a National Key Scheme for anyone who needs access to locked public toilets across the UK because of a disability or health condition.
- If you often need to use the toilet at night, leave a light on in case youre in a hurry, or keep a container near your bed.
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Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
We have excellent reviews from patients and their partners. Information for out-of-state and international patients. Find out our office hours or directions to our office.
We offer affordable appointment prices with or without insurance. We offer weekday, weekend, and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men. He is one of the few urologists who offers a full range of treatment options for BPH . He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence. He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
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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.
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Prostate Cancer: Radiation Therapy
Radiation therapy, also called X-ray therapy, uses high levels of radiation to kill prostate cancer cells or keep them from growing and dividing while minimizing damage to healthy cells.
Radiation can be given from a machine outside the body and directed at the prostate . Or a surgeon can place radioactive materials into the tumor . These radioactive materials can be temporary or permanent.
The Natural History Of Bcr
Although a rising PSA level universally precedes metastasis and PCa-specific mortality , BCR is not a surrogate for PCa-specific mortality or OS, and may pre-date local recurrence or metastasis by several years. On average, BCR precedes the appearance of clinical metastasis by 8 years after RP and by 7 years after primary definitive RT .
The natural history of BCR and the risk of subsequent metastasis may be predicted by pre- and post-treatment clinical features . These prognostic indicators are used as a means to assess the patients level of risk, and therefore, help physicians to determine whether to initiate early treatment or to adopt a strategy of active surveillance. Treatment decisions following BCR must balance the risk of metastatic disease or death with the impact of treatment, and necessitate involvement of a multi-disciplinary team, as well as informing the patient of the potential for a prolonged natural history of PSA-only recurrence .
Table 1.
Pre- and post-treatment prognostic factors in PSA-recurrent prostate cancer
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Which Treatment Should I Have
Your doctor will recommend a treatment based on the location of your cancer and which treatment you had before.
When the cancer is only in your prostate:
- If you had surgery before: You can now have radiation therapy, sometimes combined with hormone therapy. Or you might get hormone therapy on its own.
- If you had radiation therapy before: Your options include cryotherapy and surgery. Doctors don’t recommend getting radiation a second time because it can cause severe side effects. Brachytherapy may still be an option if you had external beam radiation the last time.
If cancer has spread to other parts of your body:
- Hormone therapy is often the treatment for recurrent prostate cancer that is advanced. You may get chemotherapy, too.
Can I Lower My Risk Of Getting A Second Cancer
There are steps you can take to lower your risk and stay as healthy as possible. For example, prostate cancer survivors should do their best to stay away from all tobacco products and tobacco smoke. Smoking can increase the risk of bladder cancer, as well as increase the risk of many other cancers.
To help maintain good health, prostate cancer survivors should also:
- Get to and stay at a healthy weight
- Keep physically active and limit the time you spend sitting or lying down
- Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
- Not drink alcohol. If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other health problems.
See Second Cancers in Adults to learn a lot more about the causes of second cancers.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Bostrom PJ, Soloway MS. Secondary cancer after radiotherapy for prostate cancer: Should we be more aware of the risk? Eur Urol. 2007 52:973-982.
Moon K, Stukenborg GJ, Keim J, Theodorescu D. Cancer incidence after localized therapy for prostate cancer. Cancer. 2006 107:991-998.
Last Revised: June 9, 2020
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