What Happens After Radiotherapy
After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:
- check how your cancer has responded to treatment
- help you deal with any side effects of treatment
- give you a chance to raise any concerns or ask any questions.
Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have
follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.
The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.
After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.
Treatment options after radiotherapy
Looking after yourself after radiotherapy
What Types Of Hormone Therapy Are Used For Prostate Cancer
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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How Does Radiotherapy Treat Advanced Prostate Cancer
Radiotherapy can be used in different ways to treat advanced prostate cancer:
- As part of your first treatment for advanced prostate cancer If youre offered radiotherapy as part of your first treatment, youll have a type called external beam radiotherapy.
- To improve symptoms in areas where the cancer has spread You may have external beam radiotherapy to the part of the body where the cancer is causing problems.
- To help some men with bone pain live longer If your cancer is causing bone pain, you may be offered a type of internal radiotherapy called radium-223 to help you live longer and to treat the bone pain.
A clinical oncologist or radiographer will plan your radiotherapy with you. They will explain which type of radiotherapy you will have, how long the treatment could take and the possible side effects. This could depend on where your cancer has spread to, any symptoms youre having, and your general health and fitness.
A team of treatment radiographers will give you the treatment. They’ll also give you support and information during your treatment.
The information on this page is for men with advanced prostate cancer. If your cancer hasn’t spread to other parts of the body, read our information on external beam radiotherapy for localised or locally advanced prostate cancer instead.
When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
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New Radiation Therapy For Prostate Cancer Reduces Deaths Study Shows
By the time Michael Rosenblums prostate cancer was discovered, it was already at a late stage. Hed initially sought medical help because of excruciating back pain, but, during an exam, doctors found a tumor on his spine and tests revealed a skyrocketing prostate-specific antigen, or PSA, score. Chemotherapy didnt help much, so when doctors offered the opportunity to be in a clinical trial for a new experimental treatment, Rosenblum jumped at it.
The trial was investigating a new, potentially groundbreaking type of treatment for prostate cancer, a therapy that specifically targets a protein on the cancer cells. The treatment, part of a new class of liquid radiation drugs, obliterates most prostate cancer cells without hurting the surrounding tissue.
Its wonderful. I have no symptoms or anything, said Rosenblum, a 75-year-old retiree, who was diagnosed four years ago. He participated in the clinical trial at Memorial Sloan Kettering Cancer Center in New York. “My PSA went from 100 … to zero.
Higher PSA levels suggest that prostate cells are growing, which may indicate cancer.
Results from the trial Rosenblum participated in were released Thursday ahead of the annual meeting of the American Society of Clinical Oncology. The study finds that the new drug reduced the risk of death by 38 percent in patients with advanced prostate cancer. Progression of the disease was reduced by 60 percent.
The patients who received the new drug got it intravenously once every six weeks.
Who Can I Contact If I Have Personal Concerns About My Treatment
Many hospitals and clinics have a staff social worker who can help you during your treatment. Check with your doctor to see if this is available to you.
The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation and provide information about resources. The social worker can also discuss housing or transportation needs if necessary.
People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can provide a list of support groups if you are interested. Your social worker can provide additional information, and you can look online for support group resources.
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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.
Who Should Consider Taking Radiopharmaceuticals
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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Who Can Undergo External Radiation Therapy
- Radiation therapy is for men with prostate cancer of all stages and risks of progression. It can be used as the sole treatment or in conjunction with hormone therapy.
- Men who are not good candidates for surgery because of other health problems or their age.
- Men in whom the cancer has not been completely eliminated or in whom the cancer has reappeared after surgery.
- Men whose cancer has spread beyond the prostate and into the surrounding tissues. The treatment is combined with hormone therapy before and after radiation therapy. This treatment can also be offered to men who have few metastases.
- Men whose cancer cells have spread to the bones, to help reduce the size of the tumor or to ease the pain caused by bone metastases.
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 Rosenberg’s 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.
What Is The Experience Like For A Patient
The experience with our department begins with a consultation.
If you agree to receive radiation, you will have a noncontrast computed tomography scan to map your prostate and internal anatomy.
Next, we design a radiation treatment plan.
You’ll come in for daily radiotherapy sessions, each lasting about 15 minutes. You’ll check in, change into disposable shorts and wait in a men-only waiting area.
Yale Medicine radiation therapists then escort you to the treatment room, where you’ll lie down in a custom body mold.
When your positioning is confirmed and adjusted, based on a CT scan or an implanted radio-frequency tracking device, treatment begins.
Men should be in and out of our department like clockwork, with minimal disruption to their day, says Dr. Yu. Radiation therapy may continue for up to nine weeks.
Once the course is complete, recovery typically requires a few months. Typically, at their one-month follow-up visit, patients report they are on the mend, says Dr. Yu.
By four months, they are back to normal.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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Are There Any Long
Long-term risks are slight, but do exist. Its rare but possible that a patient will suffer worsening urinary and rectal function, and there is always a risk of radiation causing cancer.
“Because there are some risks, albeit small ones, we do not treat a patient unless we believe that we can have a real impact on his survival,” says Dr. Yu. “For a patient with a very slow-growing cancer, we typically monitor instead of advising immediate treatment.”
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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Do We Know Which Treatment Is Better For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which therapy is better but rather which therapy is the most tailored, pinpointed radiation for the patients specific disease.
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level or the Gleason score or visible evidence of disease on an MRI we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best.
Data that we have published recently show that for patients with intermediate-risk disease, the combination of external beam radiation with brachytherapy not only provides better biochemical control, in terms of PSA level, but also reduces the risk of distant metastases, or spread of the disease. Another recent study from Canada, which compared outcomes in patients who were treated with external beam radiation or a combination approach, found superior results when the combined approach was used. These studies provide strong evidence that higher doses of radiation provide an important benefit to patients with intermediate-risk and high-risk prostate cancers.
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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Types Of External Radiation Therapy
Radiation therapy has become much more precise over the past few years. The standard treatment now used in most radiology departments is known as 3D conformal radiation therapy or intensitymodulated radiation therapy .
Powerful computers and tomographic scans generate a more exact, three-dimensional picture of the prostate. These images enable increased precision when administering radiation which maximizes the impact on cancer cells. This in turn reduces the negative effects of radiation exposure on healthy surrounding tissues which then reduces the risk of side effects.
Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
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Other Key Findings In The Study
Patients who had lower PSA scores:
- Experienced an eight-year disease-free survival rate of 75 percent, compared with only 18 percent for those with the highest PSA scores.
- Had a 97 percent distant metastasis-free survival rate, compared with 73 percent for those with the highest PSA scores.
However, the study also indicated that, when a PSA is falling, there is no specific number that predicts future survivability.
While there is no magic number for the PSA that guarantees that prostate cancer has been cured in an individual patient, in general, the lower the PSA number, the better chances that the cancer will not return or spread, said Michael E. Ray, M.D., Ph.D., lead author of the study and a radiation oncologist at the University of Michigan Medical Center.