Study Population And Data Collection
The National Prostate Cancer Register of Sweden captures 98% of all newly diagnosed prostate cancer cases in the Swedish Cancer Registry, to which registration is compulsory and mandated by law . NPCR data include date of diagnosis, age, tumor stage, tumor differentiation, serum level of prostate-specific antigen and primary treatment. The Prostate Cancer data Base Sweden 3.0 has recently been described in detail . In brief, by record linkage using the unique Swedish personal identity number, information for men with prostate cancer in the NPCR and five prostate-cancer free men, randomly selected from groups of men in the background population matched for birth year and county of residence, was obtained from a number of national healthcare registries and demographic databases.
This study included men diagnosed with prostate cancer between 1997 and 2012 who had received curative RT or RP within 1 year after the date of diagnosis. Men who received salvage RT or RP ended their follow-up time at the date of secondary treatment and men with stage T4, N1 or M1 disease or serum PSA above 50ng/ml at diagnosis were excluded. In a modification of the National Comprehensive Cancer Network categorization, the following risk categories were defined: low risk , intermediate risk , localized high risk and locally advanced . The intermediate- and localized high-risk categories were merged into one group.
How To Compare Radiation Vs Surgery For Prostate Cancer
When trying to decide between radiation and surgery for localized prostate cancer, many men still ask whether one approach is better or safer than the other.
Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.
How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.
What Is Involved In Cyberknife Treatment
You will see a urologist a week or two before treatment. This doctor will place gold markers, known as Ã¢fiducialsÃ¢, in your prostate as a way of marking the target. This is done under ultrasound guidance, similar to the procedure for prostate biopsy. The tumor position will be tracked during the Cyberknife treatment using the fiducials.
After the gold markers have been placed, a CT simulation is performed. During this CT scan, you will be positioned in the same way you will be positioned during the actual treatments. The physician uses this scan to outline the treatment area and organs or tissues to be avoided. This information is used to create the treatment plan.
The number of treatments and the amount of radiation per fraction can vary. Each fraction is a higher radiation dose than is used with traditional radiation, but fewer fractions are given. Typically, treatments include:
- Four or five fractions .
- Treatment is given over 1-2 weeks.
- The total dose in the mid to high 30 Gray range.
- Each treatment session is 30 to 90 minutes .
While you are being treated, the machine takes pictures of the tumor, which are compared in real-time to the images from the CT simulation. The CyberKnife robot moves around you to deliver precise treatment that can be adjusted as the prostate moves when you breathe.
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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.
What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness ” rel=”nofollow”> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
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External Beam Radiation Therapy :
Radiation focused on the prostate gland from outside the body. EBRT is often used for earlier staged cancers or to help relieve symptoms like bone pain if the cancer has spread.
Within the EBRT category there are four types of external radiation:
Three-Dimensional Conformal Radiation Therapy : High energy photon radiation delivered typically in 42 treatments.
Intensity Modulated Radiation Therapy : An advanced form of 3D-CRT. Also typically delivered in 42 treatments.
Proton Beam Radiation Therapy: This therapy focuses beams of protons instead of photon beam. Typically delivered in 40 treatments.
Stereotactic Body Radiation Therapy : This therapy uses advanced image-guided techniques to deliver larger doses of radiation to a very precise area. Since the dose of radiation is larger, only five treatments are required over a few days as opposed to many more treatment sessions with other forms of radiation.
What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
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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.
Long Term Side Effects Of External Radiotherapy
You might have long term side effects after having external radiotherapy for prostate cancer, such as erection problems . Tell your doctor or nurse if you have any of these problems, they can help you with them.
Most side effects gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that they begin months or years later.
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What Are The Advantages And Disadvantages Of External Beam Radiotherapy
What may be important for one person might not be so important for someone else. If youre offered external beam radiotherapy, speak to your doctor, nurse or therapeutic radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.
Advantages of external beam radiotherapy
- If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
- Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
- Radiotherapy can be an option even if youre not fit or well enough for surgery.
- Radiotherapy is painless .
- The treatment itself only lasts around 10 minutes, including the time it takes to get you into position. But youll probably need to be at the hospital for up to couple of hours each day to prepare for your treatment. You dont need to stay in hospital overnight.
Disadvantages of external beam radiotherapy
I was able to continue working throughout my treatment, although I got tired quickly. I had some side effects but nothing I couldnt cope with. A personal experience
How Prostate Cancer Staging And Risk Group 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.
- Localized: Theres no indication that the cancer has spread beyond the prostate.
- Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
- Distant: 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
Treatment guidelines for prostate cancer
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Prevention And Mitigation Of Radiation Enteropathy
Strategies or interventions for protecting normal tissues from radiation injury may be divided into two conceptual categories . The first approach is to directly protect against or mitigate the oxygen free radical injury that occurs during and after radiotherapy. Examples of mitigators of this type include antioxidants, free radical scavengers, and various cytoprotectors . The second approach is to target downstream tissue responses from radiation exposure. Examples include immune-modulators , enterotrophic drugs , compounds that regulate intraluminal contents , drugs that inhibit key signal transduction pathways , and alteration of fibroblast metabolic radiotherapy response . It is not possible to discuss all agents under development in this review. We summarize studies that provide quantitative data on extent of protection for preclinical and clinical studies .
Two important issues should be addressed when considering potential mitigators of radiotherapy damage. These two issues are relevant to all drugs: scheduling of mitigators with radiotherapy and verifying that mitigators do not protect tumor against radiotherapy damage. Examples of these considerations are shown below.
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Urinary Problems After Surgery
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Paulâs story for one manâs experience of managing urinary problems after surgery below.
Sexual problems after surgery
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What Does External Beam Radiotherapy Involve
You will have your treatment at a hospital radiotherapy department. Before you start your treatment, youll see a health professional who specialises in treating cancer with radiotherapy. These can include a specialist doctor known as a clinical oncologist, or a consultant therapeutic radiographer who has had additional training and specialises in prostate radiotherapy. You may also see the cancer nurse at the hospital. Theyll talk to you about your treatment options, including side effects, and ask for your consent for your radiotherapy treatment.
Before your radiotherapy treatment
Prostate radiotherapy preparation
You will need to prepare your bladder and bowel before the radiotherapy CT planning scan and before every radiotherapy treatment. The therapeutic radiographers get you to do this preparation because the prostate sits very close to your bladder, rectum and bowel. So the position of your prostate can change depending on the size of your bladder and rectum. If the size of the bladder and rectum change between your CT scan and your treatment sessions, it could mean the prostate is in a different position. This may affect the accuracy of the treatment and increase your risk of getting side effects.
Your therapeutic radiographer may ask you to have a comfortably full bladder and empty rectum so that the radiotherapy is aimed at your prostate, and that the surrounding areas get as little radiation as possible.
Radiotherapy planning session
Low Levels Of Vitamin B12
You might have low vitamin B12 after radiotherapy to the pelvis . This is called a vitamin B12 deficiency.
Radiotherapy can stop your digestive system from taking in vitamin B12 from the food you eat. This is called malabsorption. This means you can have a B12 deficiency even if you eat a balanced diet.
A B12 deficiency can be a cause of anaemia. This can lead to weakness, diarrhoea, numbness and tingling.
Its important that you go to your doctor if youre experiencing these symptoms so that they can help you.
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Side Effects Of Prostate Cancer Treatment Persist Long
Men who are treated for prostate cancer may continue to suffer from side effects 10 years after treatment, according to the results of a study published in the Journal of Clinical Oncology.
Each year in the United States, more than 192,000 men are diagnosed with prostate cancer and more than 27,000 die of the disease. Prostate cancer is typically a disease of aging. It may persist undetected for many years without causing symptoms. In fact, most men die with prostate cancer not from prostate cancer. Approximately 20% of men will develop prostate cancer during their lifetime, yet only 3% will actually die of the disease.
The screening and treatment of prostate cancer is a complicated issue. Because the cancer is so slow growing, it may never reach the point where it threatens a mans life. In fact, the U.S. Preventive Services Task Force advises against regular screening for prostate cancer. Its possible that frequent screening for the disease has led to increased treatment for it and with treatment comes side effects. The side effects of prostate cancer treatment can include bladder control problems and compromised sexual function.
The researchers found that the cancer survivors had worse sexual and urinary function compared to the non-cancer controls. In fact, up to 10 years after treatment, more than 95 percent of the cancer survivors had some degree of sexual dysfunction and about 50 percent had urinary problems.
The Initial Causes Long Term Effects Of Prostate Radiation
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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