Case For Combined Treatment
For treatment to be effective in patients who have more aggressive or advanced stages of prostate cancer, it must be directed at both the prostate and the surrounding areas where cancer cells may have spread. To accomplish this, a seed implant is typically combined with a few weeks of IGRT and/or a temporary hormone blocking medicine.
The seed implant delivers a high dose of radiation to the prostate, where most or all of the cancer cells reside. The IGRT not only treats the cancer in the prostate, it also attacks cancer cells that may have spread outside the prostate.
After Radioactive Seed Brachytherapy
You can usually go home on the same day, but someone will need to take you. You will not be able to drive, because of the anaesthetic. Your doctor or nurse will explain what to expect after treatment and the precautions you need to take.
Before you go home, they give you antibiotics and tablets to help you to pass urine more easily. Take them exactly as explained.
They also give you a card to carry with you at all times. It explains the treatment you have had and gives your hospital contact details.
The radioactivity from the seeds is absorbed from inside the prostate, so it is safe for you to be around other people. As a precaution, you should avoid periods of close contact with children and anyone pregnant for the first few months. It is safe for them to be in the same room as you. But you will be asked to keep a certain distance from them. Avoid holding or hugging anyone who is pregnant or children for more than a few minutes each day.
Your doctor or nurse will give you specific advice about the safety precautions you need to follow.
- Physical activity
You need to avoid heavy lifting or energetic physical activity for 2 to 3 days. The area between your legs can feel bruised and inflamed for a few days. Your doctor can prescribe painkillers to take.
Radiopharmaceuticals That Target Psma
Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.
Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.
This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.
This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.
Possible side effects
Some of the more common side effects of this drug include:
This drug can lower blood cell counts:
- A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
- A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
- A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.
This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.
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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.
What Is The Radioactive Seed Implant Procedure
During the procedure, radioactive seeds are implanted into the prostate gland using ultrasound guidance. The number of seeds and where theyre placed is determined by a computer-generated treatment plan tailored for each patient. About 100 seeds are commonly implanted.
The implants remain in place permanently, and become biologically inert after about 10 months. This technique allows a high dose of radiation to be delivered to the prostate with limited damage to surrounding tissues.
Radioactive seed implants are an outpatient procedure. Compared to external radiation which requires up to seven to seven-and-a-half weeks of daily treatments convenience is a major advantage of this treatment option.
How Does Radiotherapy Treatment Work
Radiation therapy works by use of high doses of radiation to kill or slow down its growth rate. In prostate cancer treatment it is used to kill the cancerous cells or slow the growth rate. It also kills the nearby healthy cells as it kills the cancerous cells.
Where curing the cancer is impossible, radiotherapy is used to reduce the symptoms such as pain caused by cancer tumor. It can also be used to prevent the problems that result from cancer tumor such as loss of bowel and bladder control, blindness etc.
*All individuals are unique. Your results can and will vary.
Here are different types of radiations and how they work:
New Study Compares Long
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.
Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.
Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.
Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:
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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 KnifeÂ®, X-KnifeÂ®, CyberKnifeÂ®, and ClinacÂ®.
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.
Questions To Ask Your Doctor Radiographer Or Nurse
- Will I have a planning session at a different time to the treatment, or immediately before?
- Will I have external beam radiotherapy or hormone therapy as well?
- What side effects might I get?
- How will we know if the treatment has worked?
- What should my PSA level be after treatment and how often will you test it?
- If my PSA continues to rise, what other treatments are available?
Preparing For The Implant
Two or three weeks before your implant surgery, your urologists staff will call you to schedule you for routine blood work and a chest x-ray. It is important to have these done promptly, since your seeds have been ordered.
Be sure to tell your doctor if you take aspirin, aspirin products, or blood thinners, such as coumadin®. Your doctor will instruct you on when to stop taking these medications before your surgery.
Your urologists staff will give you instructions regarding what you may eat and/or drink the day before your implant surgery. You will also be given instructions on the use of a laxative and/or enema. A nurse from the Same Day Surgery Department will call you the afternoon before the day of your surgery. The nurse will go over your instructions and will tell you where to park and when and where to report. Please plan to have a friend or family member come to the hospital with you on the day of your surgery, because you will not be able to drive home.
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.
When You Might Have Permanent Seed Brachytherapy
Permanent seed brachytherapy is a treatment for early stage prostate cancer. This means the cancer hasn’t spread outside of the prostate.
If your prostate gland is too big you might need hormone therapy for 3 months before the radiotherapy treatment. The hormone therapy shrinks the prostate and makes it easier to put the seeds into the right place.
A Brief History Of Prostate Treatment From Surgery To Radiation
Surgery has been the standard of care for prostate cancer for the past 150 years. Although effective, radical prostatectomies are invasive and not without complications. But then, shortly after the discovery of X-rays and radium at the turn of the last century, physicians began to explore how these modalities might improve survival and decrease potential side effects from the radical surgery. In 1917, Dr. Benjamin Barringer, chief of urology at what is now known as Memorial Sloan Kettering Hospital, espoused the use of radium needles for prostate cancer.
Initially, radioactive seed implantation was performed via free-hand technique, using direct visualization of the prostate to guide the radiation oncologist with seed placement. However, the results of this preliminary approach were hampered by suspect dose distribution in the prostate.
In 1987, Dr. John Blasko from Seattle described a reproducible system to implant radioactive iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patients perineum . The template guides the placement of the needles that are loaded with radioactive seeds. This technique allows a reproducible, uniform dose distribution to the prostate.
At Princeton Radiation Oncology, our radiation oncologists have been performing the prostate seed procedure since 1997. We use the Seattle groups criteria for implant selection.
What Are The Results Of The Most Common Treatments
Will Your Treatment completely rid your body of cancer throughout your lifetime?Comparing treatments for your specific situation can be extremely difficult. Unfortunately, some of the treatments have few published success rates that are long term and comparable to the other treatments. Most of the time centers have followed patients only a short time or only report on good patients after they have been treated. Randomized trials, which select a treatment for patients and allow accurate comparison of the effectiveness of the various treatments, are few.. Many studies suffer from patient selection problems, which means only the good patients are reported on while poor patents are not included. These studies make it appear that the treatment is more effective than it actually is as they are only looking at the favorable patients. A common statement given to patients is: If your cancer is confined to your prostate after surgery, you have a high chance of success. However, a more important question is: OK what is my chance of it being confined to the prostate before treatment? Prior to selecting a treatment option, a patient needs to know and ask If you treat 100 patients just like me what are your personal results? If you wish to compare modern treatment results we recommend that you visit the Prostate Cancer Treatment Research Foundation website at www.pctrf.org.
Why Choose Memorial Sloan Kettering For Brachytherapy
Memorial Sloan Kettering has long been a leader in brachytherapy, pioneering many advances in the field. In fact, MSK doctors were the first to use brachytherapy to treat cancers in the early 20th century.
That expertise continues today, as our medical physicists work with radiation oncologists to design the safest, most precise way to administer the brachytherapy using mathematical modeling and advanced computer programs. Through this collaboration, MSK specialists have developed highly specialized brachytherapy methods for specific diseases.
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What Happens During The Procedure
The entire procedure takes approximately 90 minutes. Most patients go home the same day.
A radiation oncologist and urologist perform the procedure. Both physicians are actively involved in all aspects of the implantation, from the planning to the post-operative care. During the procedure, the urologist provides ultrasound guidance and the radiation oncologist places the radioactive seeds.
The procedure is performed as follows:
Frequent Or Loose Poo
Your bowel movements might be looser or more frequent than before your treatment.
You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel, might also help. Your doctor or nurse can prescribe these for you. Talk to your doctor before taking these.
You might find that you need to avoid high fibre foods. Although we normally think a high fibre diet is the most healthy, it might worsen long term diarrhoea. Some people find it best to avoid high fibre vegetables, beans and pulses .
Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes:
- specialist nurses
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Planning For The Implant
You will need to have a special ultrasound before your implant. This is called a transrectal ultrasound . It is done by placing a probe in your rectum to view the prostate gland. This will allow the doctor to take measurements and plan for the PSI. Your radiation oncology nurse will schedule this for you.
Will I Need To See My Doctor After My Imrt Treatment Is Over
Once your IMRT is finished, it is important for you to have regular visits with your doctor to check how well your treatment is working and to deal with any side effects that you may have. Your doctor will want to see you every three to four months for two to three years. Your doctor will schedule your appointments and order any tests you need to make sure you have the best follow-up care possible. Dont be afraid to ask about any tests or treatments that your doctor orders. Use these appointments to learn about the things you need to do to take good care of yourself following your prostate cancer treatment. .
Helping Yourself After Your IMRT Treatments.
- When do you need to see your doctor or health care team?
- How can you reach your doctor or health care team?
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Prostate Cancer Treatment Side Effects Differ
2 Min Read
NEW YORK – For men with early prostate cancer, radioactive seed implantation and surgery to remove the prostate are two effective treatments, with roughly the same costs, but these treatments have different long-term side effects, French doctors report.
This study is exciting, Dr. Jean-Marc Cosset, from the Institut Curie in Paris, said in a statement, because its the first comparative study to assess the costs of the two treatments in a given country and see if the side effects are different.
The study involved 435 men with prostate cancer confined to the prostate that were treated with radioactive seed implantation or surgery to remove the prostate.
The men answered questions about quality-of-life and symptoms immediately after treatment and at various time points up to 24 months after treatment.
The drop in health-related quality of life immediately after treatment was less pronounced with seed therapy compared with surgery, the team found. However, from 6 to 24 months, surgery was associated with a better quality of life.
Impotence and urinary incontinence were more likely with surgery, whereas urinary frequency, urgency, and pain were more common with seed therapy.
As noted, the costs of each treatment were comparable at 24 months — 8019 euros for seed therapy and 8715 euros for surgery.
These findings may be used to tailor localized prostate cancer treatments to suit individual patients needs, the researchers conclude.