Thursday, June 23, 2022

Can You Have Your Prostate Removed After Radiotherapy

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What Can I Do To Take Care Of Myself During Imrt

Hormone therapy with radiotherapy after prostatectomy – how long should the hormone therapy go for?

Before your treatment, your doctor, in conjunction with radiation specialists, will carefully plan your care and advise you on specific steps to get you ready for IMRT. Additionally, they will give you information about the potential side effects of the treatment and details for what to do if you notice any changes.

Importantly, IMRT to treat prostate cancer can be physically and psychologically draining. Some of the actions below can help you manage the impact of IMRT on your daily life.

  • Get ample amounts of sleep to help manage the impact of radiation-induced fatigue and tiredness.
  • Eat a healthy and balanced diet to help heal and repair damaged tissues. Your doctor will help you make changes to your diet, especially if you have appetite-related side effects.
  • Clean the skin affected by radiation with products approved by your doctor.
  • Talk to your doctor before initiating any new medications or supplements.

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.

Hormone Therapy Side Effects

Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

Side Effects From Radiation

Managing erectile dysfunction

Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

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Studies Of Prostate Cancer Recurrence

At the University of California, San Francisco, investigators reported that 15 percent of 1,439 men who underwent prostatectomy experienced recurrence. Prostate cancer recurrence was defined as:

  • a PSA level of 0.2 ng/mL or greater on two consecutive tests, or
  • the patient needed a second cancer treatment at least six months after surgery

Anotherstudy extended that 15 percent figure to 40 percent, noting that this was the number of men who will experience prostate cancer recurrence within 5 years.

If you want to improve your chances of survival after prostatectomy, a course of radiation therapy may be in order, as already mentioned. The potential benefit of radiation therapy after prostate removal was explored in a study published in the Journal of the American Medical Association.The researchers evaluated 635 men who had a prostatectomy between 1982 and 2004 and then followed up through 2007, evaluating the number of men who had a recurrence of prostate cancer and received no treatment , radiation treatment , or radiation plus hormone therapy .

At a median of six years after prostate cancer recurrence and nine years post prostatectomy, a total of 116 men had died of prostate cancer. They included the following:

  • 89 men who were not treated after cancer recurrence
  • 18 men who underwent radiation treatment only
  • 9 men who received both radiation and hormone therapy

Also notable in this study are the following findings:

What Are The Side Effects Of Hormone Therapy For Prostate Cancer

Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:

  • loss of interest in sex
  • Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.

  • Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenbergâs Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.

  • Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.

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    What Factors Increase The Chance Of Cancer Recurrence

    The likelihood of metastasis occurring increases with higher grade and stage of the cancer as the more aggressive and developed the cancer is, the higher the chance of it breaking out of the prostate. More specifically:

    • High Gleason grades
    • High clinical stages
    • Positive surgical margins .

    However, most prostate cancers are cured with surgery. As an example, using my results from operations performed on over 2,300 men with a variety of stages and grades, 96.3% of operations resulted in full cancer cure. Some combinations of minor prostate cancer had a 100% cancer cure rate, but the higher you go, the lower the full cancer cure rate.

    The commonest sites of recurrence of prostate cancer following surgery are:

    • the prostate bed 80% of recurrence cases
    • lymph nodes 15% of cases
    • bones 5% of cases.

    Which Treatments Are Best In Keeping Men In Remission

    What happens after your prostate radiotherapy treatment

    Here is your opportunity to compare prostate cancer treatments. Over 129,000 patients underwent PSA monitoring after treatment to see which treatments were most effective at keeping the cancer in remission. The charts show which treatments are more likely to leave patients Prostate Cancer Free, for how many years. Share this data, talk with your Doctor, or multiple Doctors and make an informed decision. Select the treatment option, that is best for you.

    Compare Prostate Cancer Treatments by gathering information about your own Prostate Cancer Diagnosis. Your Doctor will provide three elements that describe your prostate cancer. Your PSA, Stage and Gleason Score. These three elements help you determine your risk group. Find and select your Risk Group in the table below. This will take you to the comparing prostate cancer treatments page, where you can select different prostate cancer treatments on an interactive chart and graphically see their effectiveness over time.

    The treatments included in this study are Prostate Surgery or Prostatectomy, , Brachytherapy or Seeds, High Dose Rate Radiation, HDR, External Beam Radiation Therapy or EBRT, Androgen Deprivation Therapy, ADT, or Hormone Treatment, Proton Therapy, High-Intensity Focused Ultrasound, HIFU, Cryotherapy, Cryo and Hypo-Fractionated External Beam Radiation Therapy. For more advanced prostate cancer, treatments are combined to increase effectiveness.

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    Treatment Options After Recurrence

    After surgery to remove your prostate

    PSA levels are usually extremely low about a month after surgery. You may hear your doctor saying that your PSA level is undetectable . If your PSA level starts to rise, this might mean the cancer has come back.

    Your doctor might recommend:

    • hormone treatment

    After external beam radiotherapy

    PSA levels usually get lower slowly over months or years. Defining the limit for cure is complicated and you should ask your cancer specialist. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence, or 3 increases in a row .

    Your treatment options may be:

    • surgery to remove your prostate
    • hormone treatment
    • high frequency ultrasound

    After internal beam radiotherapy

    PSA can rise temporarily after brachytherapy. This is called PSA bounce. The level then lowers slowly. Usually a level of 2 ng/ml above the lowest point after treatment is taken as a sign of recurrence.

    After hormone treatment

    If you are given hormone treatment alone, the PSA can rise after you finish hormone treatment. It may then become stable or static. If it rises this may suggest the cancer is becoming resistant to the hormone treatment.

    If hormone treatment is no longer controlling your cancer, your doctor may suggest:

    • abiraterone

    What Are The Side Effects Of Brachytherapy

    • Frequent urination or urinary retention or burning with urination
    • Erectile dysfunction
    • Urethral stricture or narrowing of the urethra
    • Diarrhea or blood in the stool
    • Secondary cancers

    For the short time that the seeds are giving off larger amounts of radiation, you should avoid close proximity to children or pregnant women. Make sure to talk with your radiation oncologist or oncology nurse for instruction about radiation safety and exposure for family members or pets.

    If you are traveling through an airport following brachytherapy treatment, there is a chance that radiation detectors will be set off. Talk to your radiation oncologist and ask for a note to indicate youve just had radiation treatment.

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    Chances Prostate Cancer Will Recur

    Overall, a man who has undergone prostatectomy for localized prostate cancer has a 10 to 30 percent chance of experiencing prostate cancer recurrence during his lifetime. Among these cases of recurrence, about half happen during the first three years after prostatectomy, another 30 percent occur from years 3 to 5 post-prostatectomy, and about 19 percent happen after year 5. Some experts say the figure of recurrence is even higher.

    During Watchful Waiting Or Active Surveillance

    What is Prostate Cancer? The early signs and symptoms to ...

    If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.

    Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.

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    How Prostate Cancer Staging And Risk Stratification Affect Treatment Options

    Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

    Prostate cancer staging

    Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

    Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

    The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

    Localized, meaning theres no indication that the cancer has spread beyond the prostate

    Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue

    Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate

    Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

    Prostate cancer risk assessment

    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.

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    Prostate Specific Antigen Blood Tests

    • Have a PSA blood test done at the following times:
    • 6 to 8 weeks after surgery
    • 3 to 6 months after surgery
    • 12 months after surgery
  • Starting 12 months after your surgery, have a PSA blood test done every 6 months. Do this until 5 years following your surgery.
  • Starting 5 years after your surgery, have a PSA blood test done every 12 months. Do this for life.
  • Your doctor might ask you to have PSA blood tests done more often. If they do, your nurse will give you more information.
  • If you can, have your PSA blood test done at a MSK location. If you cant have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK doctors office.

    MSK doctor: ___________________________

    What Are The Side Effects

    What to Expect after Radiation Therapy for Prostate Cancer

    Urinary symptoms are the most common. These include frequent urination and a need to get to the bathroom quickly. Some men have a burning with urination and, in a few cases, an inability to empty the bladder completely.

    These symptoms can usually be managed with medicine, and they improve over time. Temporary self-catheterization may be necessary to help drain the bladder.

    Urinary incontinence from brachytherapy is rare. The risk may be somewhat increased in patients who have undergone a previous surgical procedure to remove a part of the prostate called a TURP . A doctor can minimize this risk by doing a careful prostate ultrasound before the procedure to determine how much prostate tissue is still present to implant the seeds.

    Rectal bleeding occurs in less than 1% of patients. Diarrhea is rare.

    The impotence rate at five years after the procedure is about 25% using brachytherapy alone. If hormone therapy is added, the impotence rate rises depending on the duration of the hormonal treatment.

    Bowel problems can sometimes happen and include rectal pain, burning pain and diarrhea.

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    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.

    Will I Need To See My Doctor After My Imrt Treatment Is Over

    Once your IMRT is finished, it is important for you to have regular visits with your doctor to check how well your treatment is working and to deal with any side effects that you may have. Your doctor will want to see you every three to four months for two to three years. Your doctor will schedule your appointments and order any tests you need to make sure you have the best follow-up care possible. Dont be afraid to ask about any tests or treatments that your doctor orders. Use these appointments to learn about the things you need to do to take good care of yourself following your prostate cancer treatment. .

    Helping Yourself After Your IMRT Treatments.

    • When do you need to see your doctor or health care team?
    • How can you reach your doctor or health care team?

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    Staging Of Prostate Cancer

    Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .

    The stage of the cancer will determine which types of treatments will be necessary.

    If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

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