What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
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.
Proton Therapy For Prostate Cancer: Side Effects
Many patients experience fewer side effects from proton therapy for prostate cancer than from traditional radiation. When side effects do occur, they may be less severe but can last several weeks or months after treatment. They include:
- Bladder irritation
- Feeling of the need to urinate or have a bowel movement often or urgently
- Skin irritation at the radiation beam entry point
Other side effects that can occur after proton therapy for prostate cancer may not show up right away. These long-term effects include:
- Erectile dysfunction
- Rectal bleeding
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Frequent Urination Burning With Urination And Difficulty Urinating
These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.
Coping And Support For You And Your Family
Coping with the side effects of prostate cancer radiotherapy can be difficult. There are things you can do, and people who can help you and your family to cope.
Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021
Long-term urinary adverse effects of pelvic radiotherapy.P Elliott, B Malaeb.World Journal of Urology, 2011. Volume 29, Pages 35-41
Secondary malignancies following radiotherapy for prostate cancerPetros and others
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What Happens During Radiation Therapy Treatment
What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive.
External-beam radiation therapy
External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.
Each session is quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine. Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.
This type of radiation therapy targets only the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until the treatment period is completed. Let the health care professionals if you are experiencing side effects. Read more about the side effects of radiation therapy.
Internal radiation therapy
The permanent implant loses it radioactivity
The temporary implant is removed
How Does Radiotherapy Treat Advanced Prostate Cancer
Radiotherapy can be used in different ways to treat prostate cancer that has spread from the prostate to other parts of the body :
- as part of your first treatment for advanced prostate cancer
- to improve symptoms in areas where the cancer has spread
- to help some men with bone pain live longer and to treat bone pain.
All types of radiotherapy aim to destroy cancer cells.
If youre offered radiotherapy as part of your first treatment for advanced prostate cancer, youll have a type of radiotherapy called external beam radiotherapy.
If youre having 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.
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 tell you if radiotherapy can help you and 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. They can also tell you about any clinical trials that might be suitable.
A team of radiographers will give you the treatment. They will also give you support and information during your treatment.
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Proton Beam Radiati On Therapy
Proton beam radiation therapy capitalizes on a unique physical property of high energy protons generated from a cyclotron. The accelerated charged particles travel through tissue until reaching a depth determined by their energy. Once they reach that depth, the remainder of the radiation dose is deposited in a sharp Bragg peak with no dose going beyond that point. When multiple proton beams are used, a very sharp and tight radiation dose distribution is created. This modality is especially attractive when tumors are in close proximity to sensitive organs. PCa is one of the more common indications in which proton therapy is utilized.
At Washington University in St. Louis we are collaborating with investigators from Massachusetts General Hospital and the Harvard Medical School conducting a randomized clinical trial of IG-IMRT versus proton beam radiation in men with low and intermediate risk PCa. The PARTIQoL trial is seeking to measure and compare relative the impact of the two modalities on patient quality of life after treatment. Figure 1 provides a comparison of these two treatment modalities.
Axial CT slice showing conformality of intensity modulated radiation therapy. Radio-opaque markers are apparent in the anterior aspect of the prostate gland. Axial CT slice showing conformality of proton beam radiation therapy in the same patient as panel a. More sparing of the anterior-lateral rectal wall and less dose to peripheral tissues is apparent.
What Happens On Treatment Days
If you get external radiation therapy, youâll need to get regular sessions during a period of about 5 to 8 weeks.
For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure youâre positioned well, theyâll leave the room and start the radiation treatment.
Theyâll watch you closely during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Try to stay still and relaxed during treatment. Let the therapist know if you have any problems or you feel uncomfortable.
Theyâll be in and out of the room to reposition the machine and change your position. The treatment machine wonât touch you, and youâll feel nothing during the treatment. Once the treatment is done, the therapist will help you off the treatment table.
The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that youâre being positioned accurately during your treatments.
Port films donât provide diagnostic information, so radiation therapists canât learn about your progress from them. But these films do help the therapists make sure theyâre delivering radiation to the precise area that needs treatment.
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What Happens During Radiation Therapy
Radiation therapy uses high-energy x-rays or a stream of particles . High doses of radiation can destroy abnormal cancer cells. Each treatment destroys some of the cancer cells at a microscopic level. Patients do not feel the radiation during treatment. They will only hear some electrical noise and may see light from the machine.
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How Ebrt Is Given
Each treatment session takes about 15 minutes. You will lie on the treatment table under the radiation machine. The machine does not touch you but may rotate around you. You will not see or feel the radiation.
There are different types of EBRT. Your radiation oncologist will talk to you about the most suitable type for your situation. Usually, EBRT for prostate cancer is delivered every weekday for 49 weeks. Some newer forms of EBRT are delivered in 57 treatments over two weeks.
EBRT does not make you radioactive and there is no danger to the people around you. Most people feel well enough to continue working, driving, exercising or doing their normal activities throughout treatment.
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Who Can Have Radiotherapy
External beam radiotherapy can be suitable for you if:
- your cancer hasnt spread outside the prostate
- your cancer hasn’t spread to the area just outside the prostate
- your cancer has come back after treatment that aimed to cure it .
If your prostate cancer is localised or locally advanced, or if you have recurrent prostate cancer, radiotherapy will aim to get rid of the cancer completely.
If you have some types of inflammatory bowel disease , external beam radiotherapy may not be suitable for you as it could make your bowel problems worse. Talk to your doctor or nurse to discuss if radiotherapy is suitable for you.
Radiotherapy for localised and locally advanced prostate cancer
If youre having radiotherapy for localised or locally advanced prostate cancer you might also have hormone therapy for six months before, during or after treatment. Hormone therapy can shrink the prostate and the cancer inside it, and make the treatment more effective. Your doctor will let you know if you need hormone therapy and for how long you should have it. If there is a risk of the cancer spreading outside your prostate, you may continue to have hormone therapy for up to three years after radiotherapy. Read more about hormone therapy.
Other treatment options
- docetaxel chemotherapy
- high-intensity focused ultrasound or cryotherapy, but these are less common and only available as part of a clinical trial.
If you have advanced prostate cancer
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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Q: Is Radiation Therapy Safe
Radiation therapy is safe when you go to a center that has a lot of experience and a system for quality assurance. Multiple members of our team look at a plan before its ever applied to a patient, says Dr. Gejerman. Our experienced team at John Theurer Cancer Center, who treats an extremely high volume of patients, has a robust review process to make sure everything is drawn properly before treatment is delivered.
New Prostate Cancer Guideline Offers Shortened Radiation Time
Men being treated for early-stage prostate cancer with external beam radiation therapy can safely choose an option that reduces the number of treatment sessions, according to a panel of experts from the American Society for Radiation Oncology, American Society of Clinical Oncology, and American Urological Association. The new guideline for doctors who treat men with prostate cancer was published October 11, 2018 in Practical Radiation Oncology, Journal of Clinical Oncology, and The Journal of Urology.
Men diagnosed with prostate cancer while its still at an early stage often have several treatment options, including active surveillance , surgery, or radiation. All have about the same cure rates for the earliest stage prostate cancers, although each type of treatment has pros and cons.
External beam radiation therapy , is a type of radiation therapy used to treat prostate cancer. A machine focuses beams of radiation on the prostate gland to kill the cancer cells. Patients typically receive treatments 5 days a week for several weeks. The new guideline uses hypofractionated radiation, where external beam radiation is given in larger doses and fewer treatments. Men treated with this approach can typically expect to complete treatment in 4 to 5 weeks, compared with 8 to 9 weeks for conventional EBRT. Ultrahypofractionated therapy increases the radiation dose even more and can be completed in as few as 5 treatments.
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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
Benefits Of Think Five Prostate Cancer Radiation
- Less impact on your schedule: Previously, radiation therapy for prostate cancer meant daily radiation treatments five days a week for up to nine weeks. While that treatment works very well, the frequent travel to radiation appointments can take a toll. Our approach allows you to complete your entire course of radiation treatment in only five total visits.
- Less time on the radiation table: Using SBRT, we can deliver the radiation quicklywithin five minutes of treatment time. This is much shorter than the time other systems need to deliver the same level of radiation. That means less time in which your prostate may move out of placeand a lower risk that healthy tissue may be affected.
- More time getting back to your life: With fewer total visits, you have more time to live your life how you wantaway from the hospital.
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Side Effects Of Brachytherapy
Brachytherapy causes the same types of side effects that external beam radiation therapy does, such as erectile dysfunction.
In some instances, side effects to the bowels may be less severe than those caused by EBRT. Side effects that impact the bladder, however, may be more severe.
High-dose brachytherapy may cause temporary pain and swelling. It may also cause your urine to look red or brown for a short period of time.
Brachytherapy presents with some risks that external beam radiation therapy does not. If you have permanent brachytherapy, you may emit radiation to others for several weeks or months. Your doctor may advise you to stay away from pregnant people and small children during this time.
Occasionally, the seeds may migrate away from their original placement. For this reason, you may also be instructed to wear condoms during sexual activity, to protect your partner.
What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youÃ¢ll have follow-up visits with your cancer doctor. TheyÃ¢ll ask about side effects and check your PSA levels.
Doctors donÃ¢t know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itÃ¢s a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
YouÃ¢ll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
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