Recurrent Prostate Cancer Treatment
For most patients, initial prostate cancer treatment includes either radiation therapy or surgery. If a patients prostate cancer returns, the other treatment option may be used. In addition, doctors may recommend the use of systemic therapies , like hormone therapy and possibly chemotherapy.
In some cases, patients can have what is known as biochemical recurrence. These patients have elevated PSA levels that indicate the disease has returned, but imaging exams do not show any cancer. Patients with biochemical recurrence are given intermittent hormone therapy and are monitored closely for further changes.
Treatment For A Rising Psa After Brachytherapy
A PSA test measures prostate-specific antigen levels in the blood. Benign enlargement of the prostate, inflammation of the prostate, and prostate cancer can all cause a high PSA.
PSA levels sometimes rise after brachytherapy. However, your doctor wont recommend further cancer treatment based on this test alone. Theyll look for a rising trend in PSA over time and consider other factors, such as imaging tests, before recommending further treatment.
Even if your doctor cant see cancer cells with imaging, they may recommend you undergo treatment again based on a risk-benefit analysis. The benefit of catching all the cancer may outweigh the risk of additional treatment.
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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Bowel And Bladder Problems
Radiation therapy for prostate cancer can irritate the bowel, the bladder, or both.
A person can develop:
- Radiation proctitis. The symptoms include diarrhea and blood in the stool.
- radiation cystitis. The symptoms include a need to urinate more often, a burning sensation when urinating, and blood in the urine.
Bladder problems may improve after treatment, but they may not go away completely.
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.
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Metastatic Prostate Cancer Treatment
If a patients prostate cancer has spread beyond the prostate and the surrounding area, he is given systemic therapies like hormone therapy and possibly chemotherapy. While cancer responds to hormone therapy, it is called castrate-sensitive disease. Over time, the disease may become less responsive to hormone therapy and start growing again. This is called castrate-resistant disease. Patients with castrate-resistant disease can be treated with a number of additional therapies. Many are eligible for clinical trials with newer drugs or drug combinations, including immunotherapy.
Some cases of prostate cancer can be passed down from one generation to the next. Learn more about genetic testing.
Video: What Is Radiation Therapy
Watch this short video to learn more about radiation therapy.
A/Prof Ian Vela, Urologic Oncologist, Princess Alexandra Hospital, Queensland University of Technology, and Urocology, QLD A/Prof Arun Azad, Medical Oncologist, Urological Cancers, Peter MacCallum Cancer Centre, VIC A/Prof Nicholas Brook, Consultant Urological Surgeon, Royal Adelaide Hospital and A/Prof Surgery, The University of Adelaide, SA Peter Greaves, Consumer Graham Henry, Consumer Clin Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and Notre Dame University Australia, WA Henry McGregor, Mens Health Physiotherapist, Adelaide Mens Health Physio, SA Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, NSW Dr Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW A/Prof David Smith, Senior Research Fellow, Daffodil Centre, Cancer Council NSW Allison Turner, Prostate Cancer Specialist Nurse , Canberra Region Cancer Centre, Canberra Hospital, ACT Maria Veale, 13 11 20 Consultant, Cancer Council QLD Michael Walkden, Consumer Prof Scott Williams, Radiation Oncology Lead, Urology Tumour Stream, Peter MacCallum Cancer Centre, and Professor of Oncology, Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC.
View the Cancer Council NSW editorial policy.
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Side Effects Are Fewer In Therapy With Pellets
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Like other prostate cancer patients deciding on treatment, Mayor Rudolph W. Giuliani had to weigh both medical and personal factors. In choosing to have radioactive pellets implanted in his prostate yesterday morning, he selected an effective treatment with far fewer side effects than surgery.
But the procedure, called brachytherapy and carried out with hollow needles inserted into the prostate, offers less assurance of a cure than the removal of the prostate.
”People choose brachytherapy because it is less disruptive to day-to-day activities than either surgery or external beam radiation,” said Dr. E. Darracott Vaughan Jr., chairman of urology at New York Weill Cornell Center in Manhattan. ”You walk in, get it done, and then you go home.”
Patients often can return to work within a couple of days, as Mr. Giuliani says he plans to do.
In addition, no surgical incision is required, and the risk of sexual dysfunction is probably lower than that for surgery, which can injure critical nerves in the pelvis. Experts say the procedure involves almost no risk of urinary incontinence, a problem that occurs in approximately 60 percent of patients who have surgery.
Benefits And Disadvantages Of Brachytherapy For Early Prostate Cancer
If you have a low-risk cancer, you may be asked to decide between external beam radiotherapy and brachytherapy. This is because your doctor thinks they are both effective treatments for you. It is important to talk about the possible advantages and disadvantages of each treatment with your doctor or nurse. You can then decide with them which treatment is right for you.
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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.
Heres What You Should Know About This Treatment Option
Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.
But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.
Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.
“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.
There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.
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What Happens During The Radioactive Seed Implant Procedure
The entire procedure takes about 90 minutes. Most patients go home the same day.
A radiation oncologist and urologist perform the procedure. Both doctors 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 prostate ultrasound and treatment planning are both done at the same time as implantation of the radioactive seeds.
Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
Who Is Eligible For Brachytherapy
Brachytherapy is widely used to treat men with all different stages of prostate cancer. Brachytherapy alone is used for men with early-stage and some intermediate risk prostate cancers and in combination with intensity modulated radiation therapy for men with larger prostate cancers. All men should be evaluated to see if it is a good treatment option for them. However, it may not be ideal for men who already have significant urinary issues such as frequency, urgency, or incomplete emptying, since those may be exacerbated by brachytherapy treatments. For patients with larger prostate glands, it can also be harder to accurately place the radiation.
According to Horwitz, there are some instances where traditional, noninvasive radiation therapies may be preferable.
The brachytherapy implant is a small surgical procedure, but it does involve anesthesia, he said. So for people who have a cardiac history, it may not be as safe for them. In addition, people using blood thinners may want to opt for a less invasive treatment.
But if a person is relatively healthy and it’s safe for them to have anesthesia, then they can do either.
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Side Effects Of Radiation Therapy
Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.
With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.
This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.
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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Prostate Cancer Clinical Trials
As one of the worlds leading cancer centers, MD Anderson is home to many clinical trials for prostate cancer patients. Your care team may discuss clinical trials with you if they believe they offer you a better outcome than standard treatments.
Trials are designed to improve prostate cancer survival rates, minimize treatment side effects and support a higher quality of life for patients. They may include new drugs or drug combinations, new approaches to prostate cancer surgery, different forms of radiation therapy, or some combination of all three. Learn more about clinical trials.
Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy causes similar side effects to external beam radiotherapy. If you have brachytherapy on its own, some side effects may be less severe. If you have it with external beam radiotherapy, they may be more severe.
Brachytherapy causes similar side effects to external beam radiotherapy. Having brachytherapy with external beam radiotherapy may make some side effects more severe. Some side effects may take several weeks to develop and may last for longer.
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Brachytherapy Or Internal Radiation Therapy
Internal radiation therapy , also known as brachytherapy, involves placing radioactive seeds on the prostate gland inside the body. The seeds are around the size of a grain of rice.
The implant may be temporary or permanent:
- Temporary: The doctor inserts the seeds into a small tube and leaves them there for between 5-15 minutes . A person may need 1-4 sessions, typically over the course of 2 days.
- Permanent: The doctor will place around 1000 radioactive seeds that release radiation for several weeks to months. Often, they leave the seeds in place when not active since they likely will not cause discomfort.
Before inserting the seeds, the doctor will give the patient either a general or local anesthetic. They may use imaging technology to help ensure they position the seeds accurately.
Prostate Cancer Treatment Trial Uses Gold Nanoparticles
Gold has built fortunes and inspired Olympic dreams, but can it treat cancer?
A team of doctors and researchers aims to find out, with help from patients including local meteorologist Frank Billingsley.
Gold is a safe material and it has been used in humans for hundreds of years, said Steven Canfield, M.D., chief of urology at McGovern Medical School at The University of Texas Health Science Center at Houston and Memorial Hermann-Texas Medical Center. Think about all of the people who have gold fillings in their teeth for their whole life.
Canfield has partnered with researchers at Rice University, medical device company Nanospectra Biosciences and the Icahn School of Medicine at Mount Sinai in New York City to perform a small clinical trial using gold nanoparticles to treat prostate cancer.
The gold nanoparticles, known commercially as AuroShells, were developed by biomedical engineering professor Naomi Halas, Ph.D., principal investigator for the Halas Research Group at Rice University and Nanospectra. Made of silica glass and wrapped in a thin layer of gold, the AuroShells are about 50 times smaller than a red blood cell and act as tumor-seeking missiles when they enter the patients bloodstream. They are the main component in the AuroLase therapy used on patients in Canfields clinical trial.
The two Franks
For Halas, it was a different Frank who inspired her work to find a less invasive way to treat prostate cancer.
$6.50 worth of gold
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How Is Prostate Cancer Treated
Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.
Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are
- Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
- Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
- Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.