Wednesday, December 7, 2022

External Radiation For Prostate Cancer

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What Types Of Radiotherapy Are There

Radiation therapy for prostate cancer: What to expect

There are two common types of external beam radiotherapy:

  • intensity-modulated radiotherapy
  • 3-dimensional conformal radiotherapy .

You may also hear about image guided radiotherapy . This is part of all radiotherapy treatments. Taking images of the prostate before each treatment allows your radiographer to make small changes to the area that is going to be treated, in case the prostate has moved slightly since your last treatment session. This makes sure the surrounding healthy tissue gets as little radiation as possible. It also makes sure the whole prostate is treated.

Intensity-modulated radiotherapy

This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location, size and shape of your prostate. The radiotherapy machine gives beams of radiation that match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects.

The strength of the radiation can be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate without causing too much damage to surrounding tissue.

3D conformal radiotherapy

As with IMRT, the radiation beams are mapped to the size, shape and position of the prostate. But the strength of the radiation cant be controlled in 3D-CRT, so all areas are treated with the same dose.

Other types of radiotherapy

Proton beam therapy

Which Approach Is Better: Active Surveillance Surgery Or Radiotherapy

The 10 year outcomes of the Prostate Testing for Cancer and Treatment trial from the United Kingdom has provided valuable insights into the management of localized PCa. The trial recruited 1643 men 50 to 69 years old. Of these 545 men underwent active surveillance, 553 surgery, and 545 radiotherapy. For the participants, the median follow-up was 10 years, the median age was 62 years, the median PSA was 4.6 , 77% were Gleason 6 and 21% were Gleason 7, and 76 % were T1c and the remaining T2. There were 17 prostate-cancerspecific deaths overall: 8 in the active surveillance group, 5 in the surgery group, and 4 in the radiotherapy group. The difference was not statistically significant among groups.

Metastases developed in more men in the active-monitoring group than in the surgery group or the radiotherapy group . Higher rates of disease progression were seen in the active-monitoring group than in the surgery group or the radiotherapy group . In summary, at a median of 10 years, prostate-cancerspecific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring, while 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.

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Stereotactic Body Radiation Therapy

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.

The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiotherapy

This type of therapy is used to deliver high doses of radiation to a precise area in the prostate using specialized techniques not achievable by standard conventional radiation therapy. This allows the total dose of radiation to be given in a shorter amount of time, usually 4 -5 treatments over 1 2 weeks rather than the several weeks used for other types of external radiation therapy.

The radiation beam needs to be extremely accurate in order to limit the side effects on healthy tissue. During treatment, the body immobilization used is often more restrictive than with IMRT due to the high doses of radiation. Fiducials, or internal prostate markers, are often used in this type of treatment.

Cyberknife and Truebeam are two types of LINACs used for SBRT treatment of prostate cancer.

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

Prostate Cancer Radiotherapy Photograph by K H Fung/science Photo Library

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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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.

Are You A Candidate

Whether your doctor recommends radiation depends on various factors, including your age, health, and personal preferences. The type of radiation is often dictated by your risk group and whether the cancer is localized or has spread.

Sometimes hormone therapy is given before radiation or along with it. ADT reduces levels of male hormones, called androgens, which can slow or even stop the cancers growth. Studies have found this one-two punch leads to higher survival rates than radiation alone among men with localized prostate cancer and a Gleason score of 7 or higher.

If you opt for surgery, your doctor may suggest radiation afterward, called adjuvant radiation therapy. “You have surgery to remove cancer, and then radiation to eliminate any remaining tumor deposits to keep cancer from returning,” says Dr. Anthony DAmico, a radiation oncologist with Harvards Dana-Farber Cancer Institute. Cancer that has grown beyond the prostate also may require post-surgery radiation.

After youve had radiation, youll have a prostate-specific antigen test every three to six months for five years and then annually after that to check for recurrence of the cancer. “If your PSA ever rises above 2, then imaging tests are done, and if needed, additional radiation or other appropriate treatment is given,” says Dr. DAmico.

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Spaceoar Hydrogel: Reducing Radiation Exposure

The prostate and rectum are located very close to each other and are separated only by a small space. When undergoing proton therapy for prostate cancer, your doctor will determine if you are eligible for placement of a special hydrogel between the prostate and rectum . The SpaceOAR hydrogel creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum, thereby minimizing unwanted side effects and potential injury to the rectum during treatment. More than 50,000 patients worldwide have been successfully treated with SpaceOAR Hydrogel.

The placement of the hydrogel is a minimally invasive procedure done within our center and the hydrogel remains inside the body throughout treatment. The material that the SpaceOAR Hydrogel is made from has been used in other implants such as surgical sealants used in the eye, brain and spine. The biodegradable material naturally dissolves after a few months and is cleared in your urine.

External Beam Radiation Therapy

External Beam Radiation Therapy for Prostate Cancer

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

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Why Might Hormone Therapy Be Given Before Or After Ebrt

Prostate cancer grows in response to the male hormone testosterone. Hormone treatment works by reducing the amount of testosterone in your body and as a result slows down the growth of the cancer or shrinks it. However, hormone treatment does not cure prostate cancer.

Some men may be given hormone treatment for prostate cancer for several months before radiotherapy treatment with the aim of shrinking the cancer so that radiotherapy has a higher/better chance of working.

For men who have high-risk prostate cancer hormone therapy may be continued after radiotherapy. In this case radiotherapy usually starts after 3 6 months of hormone therapy and only when the PSA level is less than 1. Hormone therapy is continued for up to 2-3 years as it has been shown to reduce recurrence rates and improve survival.

Questions To Ask Your Doctor Nurse Or Radiographer

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of radiotherapy will I have?
  • How many sessions will I need?
  • What other treatment options do I have?
  • What are the possible side effects and how long will they last?
  • What treatments are available to manage the possible side effects from radiotherapy?
  • Will I have hormone therapy and will this carry on after radiotherapy?
  • How and when will I know if radiotherapy has worked?
  • If the radiotherapy doesnt work, which other treatments can I have?
  • Who should I contact if I have any questions?
  • What support is there to help manage long-term side effects?

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Whats It Like To Have External Beam Radiation Therapy For Prostate Cancer

Before you undergo external beam radiation therapy, your clinical team will map out where the cancer is located so that they can better target the radiation therapy. The goal is to treat just that area, and nothing more. This will reduce your chances of experiencing side effects. This process typically includes:

  • A radiation simulation where the clinical team helps you find the most comfortable spot to rest in during your treatment
  • Computerized tomography scanning so that your doctors can precisely map the area of your body that needs treatment

During the external beam radiation treatment, you will rest on a table and hold very still while the linear accelerator moves around you to deliver the treatment. You may have an immobilization device to hold you in position to ensure the radiation goes exactly where it should. Your job during the treatment is to relax, breathe normally, and hold still. External beam radiation therapy for your prostate is not a painful treatment. You should be able to rest comfortably while the treatment is given.

The machine will deliver a very precise dose of radiation prescribed by your doctor. Each treatment usually lasts less than an hour and most of that time is spent preparing for the dosage. The radiation treatment itself is usually just a few minutes. During this time, your clinical team will be outside the room but able to see and talk with you through cameras and an audio connection.

Getting External Beam Radiation Therapy

External Beam Radiation Therapy for Prostate Cancer

External radiation is the most common type of radiation therapy used for cancer treatment. A machine is used to aim high-energy rays or particles from outside the body into the tumor. External beam radiation is given most often as photon beams and less often as particle or electron beams .

Radiation technology allows the very careful delivery of external beam radiation therapy. The machines focus the radiation beam on the exact location in such a way to maximize the radiation reaching the cancer, but also to limit the effect on normal tissues as little as possible.

External radiation is usually done during outpatient visits to a hospital or treatment center. Most people get external radiation therapy over many weeks. Usually, they visit the treatment center every weekday for a certain number of weeks. But some people may need to go to the treatment center twice a day for a fewer number of weeks. Your cancer care team will help decide how much radiation is needed to treat your cancer and how often you need to get it.

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Next Steps & Resources:

  • Learn more about our featured clinical experts:
  • Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Healths John Theurer Cancer Center and associate professor of Oncology at the Hackensack Meridian School of Medicine.
  • Prashant Desai, M.D., medical director of radiation oncology at Hackensack Meridian Ocean Medical Center.
  • Priti Patel, M.D., medical director of radiation oncology at Hackensack Meridian Riverview Medical Center.

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What Does External Beam Radiotherapy Involve

You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.

Before your radiotherapy treatment

Radiotherapy planning session

A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.

During your radiotherapy treatment

You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.

If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.

At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.

Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.

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Will My Diet Affect My Treatment

Yes. Good nutrition is an important part of recovering from the side effects of radiation therapy.

When you eat well, you have the energy to do the activities you want to do, and your body is able to heal and fight infection. Most importantly, good nutrition can give you a sense of well-being.

Since eating when you don’t feel well can be hard, let your treatment team know if youâre having trouble. You could also consider working with a dietitian. They can help make sure that youâre getting enough nutrition during your radiation therapy.

These tips might help while youâre going through treatment:

Try new foods. Things that you havenât liked in the past may taste better to you during treatment.

Power up with plant-based foods. They can be healthy and tasty substitutes for meat. So for instance, swap out a burger or chicken for beans and peas at a few meals each week.

Eat a rainbow of fruit and vegetables. Get your fill of these healthy powerhouses every day. Good options include spinach, raspberries, yellow peppers, carrots, and cauliflower.

Limit or avoid unhealthy choices. That includes red or processed meats, sugary foods and drinks, and processed foods.

Aim to stay at a healthy weight during treatment. You can ask your doctor what your ideal range on the scale should be. Itâs normal to have small weight changes while you go through treatment.

Try to stay physically active. If youâre not active now, you can ask your doctor how to move more and exercise safely.

Talk With Your Doctor About Side Effects And What To Expect

External-Beam Radiation Treatment for Prostate Cancer

Your doctor can help you determine whether radiation therapy is right for you.

In addition, an oncologist a doctor specializing in cancer treatment can help you learn how to minimize your chance of developing side effects.

They can also refer you to local support groups where you can get in touch with other people who have undergone or are undergoing the same treatment.

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