Thursday, December 8, 2022

Is Radiation For Prostate Cancer Safe

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What Happens During A Treatment Session

How Radiation Affects The Prostate | Mark Scholz, MD
  • You may be asked to change into a hospital gown or robe.
  • You will go to the treatment room where you will receive radiation. The temperature in this room will be very cool.
  • Depending on where your cancer is, you will either lie down on a treatment table or sit in a special chair. The radiation therapist will use the dots on your skin and body mold or face mask, if you have one, to help place you in the right position.
  • You may see colored lights pointed at your skin marks. These lights are harmless and help the therapist position you for treatment.
  • You will need to stay very still so the radiation goes to the exact same place each time. You will get radiation for 1 to 5 minutes. During this time, you can breathe normally.

The radiation therapist will leave the room just before your treatment begins. He or she will go to a nearby room to control the radiation machine. The therapist watches you on a TV screen or through a window and talks with you through a speaker in the treatment room. Make sure to tell the therapist if you feel sick or are uncomfortable. He or she can stop the radiation machine at any time. You will hear the radiation machine and see it moving around, but you wont be able to feel, hear, see, or smell the radiation.

Most visits last from 30 minutes to an hour, with most of that time spent placing you in the correct position.

Are There Side Effects Of The Combination Approach

There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.

In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.

Possible Side Effects Of Ebrt

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

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Range Of Radiation Treatments For Prostate Cancer

Prostate cancer can grow very slowly or more aggressively. Radiation therapy is a highly effective non-invasive method that achieves identical cure rates to radical surgical removal. Treatment courses are then adjusted based on the cancers reaction to the treatments. In addition to standard treatments, we offer many novel treatments that have been highly successful for other prostate cancer patients thanks to the Rogel Cancer Centers research and clinical trials.

Some of the more advanced radiation oncology treatments for prostate cancer we offer include:

Patient First In Region To Receive New Treatment For Advanced Prostate Cancer

Single dose of targeted radiotherapy: safe and effective for prostate ...

After managing advanced prostate cancer for nearly 20 years, Jim Duvall was the first patient in the region to receive a novel treatment for advanced prostate cancer at UC San Diego Health in September 2022.

Administering the treatment to UC San Diego Health patients requires a multi-disciplinary approach with teams in oncology, urology, radiation oncology, radiology, nuclear medicine, pharmacy, nursing and integrative medicine teams.

Newswise UC San Diego Health is the first hospital system in the region to offer a novel treatment option for patients with prostate cancer that has spread throughout the body and has not responded to other therapeutics.

In 2004, upon Jim Duvalls completion of service in the U.S. Army, college and a successful business career, he was diagnosed with prostate cancer. Shortly thereafter, he underwent surgery to treat the disease. However, three years later, it was discovered the cancer had spread to his bones. Duvall has gone through several treatments, including chemotherapy and radiation.

There is no magic potion to cure my cancer and my physicians were very clear about this, but I have two kids and four grandkids, and I want to hang out with them a little longer, said Duvall.

After managing prostate cancer for nearly 20 years, Duvall, age 80, transferred his care to UC San Diego Health. He was the first patient in the region to receive a new treatment for advanced prostate cancer.

# # #

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How Can I Choose From Among The Options

In addition to talking with family and friends, you will need a team of physicians to help advise you. You should meet with everyone involved in your treatment planning before choosing a treatment, including:

  • your primary care doctor
  • a urologist to discuss surgery
  • a radiation oncologist to discuss radiation therapy
  • a medical oncologist to discuss hormone suppression, if your cancer is more advanced

After you meet with these doctors, you can make an informed decision regarding your treatment options. You may have an early-stage or moderately advanced cancer with no evidence of spread to other organs . If so, your two major treatment options are active surveillance , surgery or radiation therapy .

You may have advanced cancer and require hormonal suppression therapy or chemotherapy. If so, you will need a medical oncologist to administer these drugs. Doctors use hormone-ablation therapy to treat advanced prostate cancer. It suppresses androgen because these hormones stimulate most prostate cancer growth. Your internist, urologist, radiation oncologist or medical oncologist may administer the treatment. Depending on the stage of the cancer, your doctor may use hormone suppression therapy and radiation therapy to help control your disease. You may receive hormone suppression therapy for as little as four to six months, or for as long as two to three years.

Improving Prostate Cancer Treatment With Hydrogel Spacers

Prostate cancer is the most common non-skin cancer diagnosed in men. Radiation therapy is an excellent treatment option for prostate cancer. However, radiation exposure can cause bowel side effects. MUSC Health Florence Medical Center is committed to improving prostate cancer treatment for our patients. Therefore, we are proud to be the first in the region to offer hydrogel spacers.

Hydrogel spacers are a new technique designed to reduce bowel injury. Spacers do this by providing a space between the bowel and the prostate. And they dont just reduce side effects to the bowel. Hydrogel spacers also reduce urinary and sexual symptoms as reported by patients1,2. These spacers are used for most prostate cancer patients treated with external beam radiation or seed implants.

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What Is Radiation Therapy

Radiation is the strategic use of ionizing radiation or photons to kill cancer cells. It works by damaging the cancer cells DNA .The targeted cells die without growing or replicating themselves. Radiation therapy, like surgery, is very effective at killing localized or locally advanced prostate cancer and has the same cure rate as surgery.

Just as surgical skill can play an important role in determining outcomes from prostatectomy, the technical skill of your radiation oncologist can play an important role in radiation outcomes. When choosing a radiation oncologist, look for a physicians who has broad experience with an assortment of approaches and can objectively help you decide on the best course of treatment.

How Does Brachytherapy Work

Which is Better – Surgery vs. Radiation for Prostate Cancer?

Brachytherapy involves implanting small, permanent radioactive seeds or temporary needles into the cancerous prostate.

After you are identified as a good candidate for brachytherapy, an ultrasound is used to guide the placement of needles into the prostate. Depending on whether you and your doctor have chosen permanent/low-dose brachytherapy or temporary/high-dose brachytherapy, these needles are then used to either put in permanent seeds or temporary radiation sources.

Placement of seeds is a minimally invasive procedure and does not require incisions. Men undergoing the procedure can return to full activity in less than a week. This is done as an outpatient procedure before you begin treatment.

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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.

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 hair loss or less sweat within the treated area.

These skin reactions are common and temporary. Theyâll fade gradually within 4 to 6 weeks after you finish your treatment. If you notice any skin changes outside the treated area, tell your doctor or nurse.

Long-term side effects, which can last up to a year or longer after treatment, may include:

  • A slight darkening of the skin
  • Skins feels more or less sensitive
  • A thickening of tissue or skin

Other possible side effects of external beam radiation therapy are:

Tiredness. Your fatigue might not lift until a few weeks or months after you finish getting radiation therapy.

Lymphedema. If radiation therapy damages the lymph nodes around your prostate gland, the fluid can build up in your legs or genital area. That can bring on swelling and pain. Physical therapy can usually treat lymphedema, but it might not go away completely.

Urinary problems. Radiation can irritate your bladder, and that could lead to a condition called radiation cystitis. You might:

  • Have to pee more often
  • Feel like it burns when you pee
  • Notice blood in your urine

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Radiation Therapy In Advanced Disease:

Some forms of radiation therapy, like external radiation therapy and radiopharmaceuticals, can help with advanced prostate cancer. One type of external radiation therapy is used along with hormone therapy to treat cancer that has spread outside the prostate to nearby tissue. In addition, radiopharmaceuticals are used to manage pain and symptoms of bone metastases. Scroll down to learn more about radiopharmaceuticals.

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What If I Have A Concession Card

Heavily promoted therapy for prostate cancer looks risky

Holding a Concession Card does not automatically mean that out of pocket costs will be lower. Please let the radiation therapy centre know that you have this as it helps them to understand your individual circumstances.

Holding a Concession Card reduces the level at which the Medicare Safety Net Threshold applies and provides extra support to reduce your out of pocket costs.

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Radiation Therapy For Prostate Cancer

Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:

  • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
  • As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
  • If the cancer is not removed completely or comes back in the area of the prostate after surgery.
  • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

Radiation Therapy In Localized Disease:

For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.

At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.

These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.

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What Is The Procedure Like And How Long Will It Stay In My Body

SpaceOAR Hydrogel is injected as a liquid through a needle inserted between the rectum and the prostate. It can be implanted via a local anesthetic that will numb the injection area or under general anesthesia that will put a patient to sleep during the procedure. SpaceOAR Hydrogel stays in place for about three months and is naturally absorbed into the body and removed through urine in about 6 months. SpaceOAR Hydrogel can be implanted during an outpatient procedure in a hospital, surgery center, outpatient clinic or doctors office prior to the start of radiation treatment. It is typically not a lengthy procedure usually about 30 minutes.2

What Is Brachytherapy

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This is a type of internal radiation. For this treatment, a surgeon places radioactive pellets about the size of a grain of rice directly into your prostate. They use imaging tests to help them place the pellets correctly, and computer programs to figure out the exact dose of radiation you need.

In general, getting brachytherapy alone is only an option for some people with early-stage prostate cancer thatâs growing relatively slow. Brachytherapy plus external radiation might be an option if your cancer is more likely to grow outside your prostate gland.

You get brachytherapy in a hospital operating room. Before the procedure, youâll get anesthesia to either numb your body or help you sleep. You may need to stay in the hospital overnight.

The two types of brachytherapy for prostate cancer are:

Permanent brachytherapy. Your doctor may also call this âlow dose rateâ brachytherapy. The pellets give off low doses of radiation for weeks or months. Theyâre very small and rarely cause pain, so doctors usually leave them in your prostate after they stop giving off radiation.

Temporary brachytherapy. Your doctor may also call this âhigh dose rateâ brachytherapy. Doctors donât use it as often as the permanent type. Temporary brachytherapy gives off higher doses of radiation for a short time. In general, you need up to four quick treatments over 2 days, and your treatment team removes the radioactive material each time.

Some possible side effects of brachytherapy are:

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How Well It Works

For someone with localized prostate cancer, radiation works about as well as surgery to treat the cancer. With either treatment, the chance of the cancer spreading is low.footnote 1

For someone with advanced prostate cancer, radiation is often combined with hormone therapy, chemotherapy, or other treatments. This can help to control cancer growth and provide longer survival.

Radiation therapy also works well to treat pain when prostate cancer has spread to the bone.

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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