Prostate Bed Radiation Side Effects

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.

If Youre Getting Radiation Therapy To The Breast

If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.

Short-term side effects

Radiation to the breast can cause:

• Skin irritation, dryness, and color changes
• Breast soreness
• Breast swelling from fluid build-up

To avoid irritating the skin around the breast, women should try to go without wearing a bra whenever they can. If this isnt possible, wear a soft cotton bra without underwires.

If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.

Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.

Long-term changes to the breast

Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.

After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.

Less common side effects in nearby areas

Swollen Legs Or Scrotum

You might get swelling in the legs or the sack of skin around the testicles . The swelling is called lymphoedema . It happens when the lymph channels that drain fluid from the legs are damaged by the radiotherapy. The swelling can be uncomfortable.

You can do various things to lower your risk of getting lymphoedema. Early treatment can reduce the swelling and stop it from getting worse.

• Read more about lymphoedema

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Salvage External Beam Radiotherapy For Prostate Cancer After Radical Prostatectomy

James B. Yu, MD, MHSOncology

This article defines the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and makes recommendations with regard to radiotherapy volume and dose.

Prostate cancer is the second most common cause of cancer death in American men. What to do when prostate cancer recurs months or years after a patient undergoes radical prostatectomy is an area of active research. Patients who underwent radical prostatectomy without immediate adjuvant radiation therapy but subsequently have evidence of recurrent disease are candidates for Salvage Radiation Therapy . Though there are three prospective randomized trials illustrating the efficacy of post-operative ART for selected patients, similarly strong evidence is lacking for SRT. In this article, we define the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and make recommendations with regard to radiotherapy volume and dose. We discuss the known side effects from SRT, weigh the cost and benefit of SRT, and discuss possible tools that may improve the cost/benefit ratio for SRT by helping to select patients whom SRT may be more likely to benefit.

Mouth And Throat Changes

Radiation therapy to the head and neck can cause mouth changes. Radiation not only kills cancer cells but can also harm healthy cells in the glands that make saliva and the moist lining of your mouth. You may have:

• Mouth sores
• Loss/change in taste
• Thickened saliva

Some problems, like mouth sores, may go away after treatment ends. Others, such as taste changes, may last for months or even years. Some problems, such as dry mouth, may get better but never go away.

Mouth Care After Radiation

Your Throat

Radiation therapy to the neck or chest can cause the lining of your throat to become swollen and sore. Your risk for throat changes depends on how much radiation you are getting, whether you are also having chemotherapy, and whether you use tobacco and alcohol while getting radiation therapy. You may notice throat changes in 23 weeks after starting radiation. These will likely get better 46 weeks after you have finished treatment.

Nutrition During Head, Neck or Chest Radiation

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Prostate Cancer Causes & Symptoms

Unfortunately, the exact cause of prostate cancer is not always known. Some recent discoveries have linked prostate cancer to changes in DNA and also to high levels of certain male hormones.

Prostate cancer is not, however, linked to an enlarged prostate gland, a condition also called benign prostatic hyperplasia or benign prostatic hypertrophy. An enlarged prostate gland is not cancer and does not cause cancer.

The symptoms of prostate cancer are also the same type of symptoms shared by many non-cancerous conditions. Therefore, it is very important to have a doctor determine the source of the problem for men who experience changes in their urinary functions.

It is also possible to have prostate cancer and not have prostate cancer symptoms.

Prostate Cancer Symptoms may include:

• Problems with urination

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Side Effects Of Radiation Therapy To Your Prostate

Some people have side effects from radiation therapy. The type and severity of side effects varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.

This section explains the most common side effects of radiation therapy to the prostate. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.

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Side Effects Of Prostate Radiation

Side effects of prostate radiation is an important topic, which many doctors and their patients have to discuss before proceeding to the procedure further on. In most cases, radiation treatment for prostate cancer has the same side effects as brachytherapy . But its important to keep in mind that every person will have different side effects from the same procedure and health in general.

Cardiovascular Disease And Diabetes

Diabetes and cardiovascular disease are leading causes of death in men. The adverse treatment-related changes in weight, body composition, lipids, and insulin sensitivity raise the possibility that ADT may increase the risk of these medical conditions. To evaluate the relationship between ADT and risk for incident diabetes and cardiovascular disease, Keating and colleagues conducted a large population-based study using the SEER-Medicare database.107

This landmark study included 73,196 men diagnosed with local or locoregional prostate cancer between 1992 and 1999 with follow up through 2001. Of the total population, one-third of men were treated with ADT during the study period. The analysis was adjusted for both patient and tumor characteristics. After adjusting for a variety of covariates, ADT with a GnRH agonist was associated with a significantly greater risk of incident diabetes , coronary heart disease , and admission for myocardial infarction . A subsequent study using SEER-Medicare data confirmed the link between ADT and incident cardiovascular disease.150

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Evidence For The Use Of Salvage Radiotherapy

Recent evidence from these three randomized trials suggests that early intervention with ART can lengthen biochemical disease-free, metastasis-free and overall survival in patients with pathologically advanced prostate cancer. However, a disadvantage of routine ART is treating those who would never develop biochemical recurrence after RP, and unnecessarily exposing an increased number of patients to the side effects of RT.

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 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 an hour 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

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You can eat various types of other meats. I suggest to eat chicken,turkey,& lots of fish. I buy all natural chicken, all natural turkey,& wild caught & fresh fish.

I eat as much as I want of these type meats. I never thought Id like grounded turkey. I can honestly say that a turkey burger is much better than any hamburger I ever ate. I wouldnt have thought so but it honestly is a better taste & health option.

I eat all the chicken I want. I suggest you to bake it & not fry it in oils. If you do fry then please use Extra Virgin Olive Oil. I add Mrs. Dash seasonings to all my meats. This is an all natural source for seasonings. There are many different flavors by Mrs Dash.

I also eat all the fish I want. I suggest eating salmon,flounder,tilapia,pollack,catfish,trout,& many other fish. Try to eat the oily type fish. Salmon & trout are two of the top oily fish on the market. Here too I suggest baking instead of frying.

Now, I want to move onto another area of the diet. I will be discussing the importance 0f fruits & vegetables. Fruits was definitely a foreign word to me before prostate problems. I did eat limited amounts of veggies but not enough. I made that change as well in my life. Its very important to eat fruits & veggies to have a healthy diet. Disadvantages of Cyberknife for Prostate

Questions To Ask Your Doctor Nurse Or Radiographer

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• What type of radiotherapy will I have?
• How many sessions will I need?
• What other treatment options do I have?
• What are the possible side effects and how long will they last?
• What treatments are available to manage the possible side effects from radiotherapy?
• Will I have hormone therapy and will this carry on after radiotherapy?
• How and when will I know if radiotherapy has worked?
• If the radiotherapy doesnt work, which other treatments can I have?
• Who should I contact if I have any questions?
• What support is there to help manage long-term side effects?

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Problems With Your Bones

Radiotherapy can damage the bone cells in the pelvic area, and also lower the blood supply to the bones. The bones can become weaker. This is called avascular necrosis. Damage to the bones can cause pain and sometimes makes it hard to walk or climb stairs.

Your doctor will monitor you carefully, including checking your bone strength with a DEXA scan. They might suggest treatment with painkillers and walking aids to help you get around. You might also need to take medicines to strengthen the bones called bisphosphonates. These drugs can help to control pain and reduce the risk of fractures.

Sometimes, tiny cracks can appear in the pelvic bones some years after treatment. They are called pelvic insufficiency fractures. This is more likely to happen in people who have general weakening of their bones as they get older . It is also more likely in people who are taking hormone therapies or steroids.

Speak to your doctor if you have any pain in your bones. The pain usually gets worse if you move around or do exercise and gets better when you sit still or rest. Your doctor might ask you to have x-rays, a CT scan or an MRI scan to see if there are any fractures in the bones.

Analysis Of Missing Data

Table shows the reasons for nonresponse to the 5-year survey by treatment group. Overall, statistically significantly fewer men in the external beam radiotherapy group than in the radical prostatectomy group completed the 5-year survey . However, differences between treatment groups in the specific reasons for nonresponse were relatively small for example, 7% of radical prostatectomy patients had died compared with 11% of external beam radiotherapy patients. Refusal was the leading reason for nonresponse.

We further evaluated the possible effects of differential response levels by age at diagnosis on our reported outcomes by performing a last value forward analysis on urinary, bowel, sexual, and general health outcomes. We used data from the 2-year survey or from the 12- or 6-month surveys to estimate outcomes at 5 years after diagnosis. The impact of estimating outcomes on the reported comparisons was negligible.

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When A Radical Prostatectomy Is Indicated

Surgery is commonly used to cure prostate cancer if it hasn’t spread beyond the prostate gland itself. The radical prostatectomy is the main type of surgery performed. It involves the removal of the entire prostate gland and surrounding tissue, including the seminal vesicles . Nearby lymph nodes may also be removed.

In a radical prostatectomy, the prostate gland can be accessed in a number of different ways:

• Through an incision in the lower abdomen
• Through an incision between the anus and scrotum
• Through a keyhole incision using a thin, lighted surgical instrument called a laparoscope

The choice of surgery depends largely on the treatment goals. A retropubic prostatectomy is more commonly used if healthcare providers believe that the cancer has spread to the lymph nodes. A laparoscopic prostatectomy is far less invasive but required a skilled surgeon .

Of the three, the perineal prostatectomy is less commonly used because it is more likely to cause nerve damage resulting in erection problems.

Patient And Treatment Characteristics

The median age at SRT was 69 years. The median time between RP and SRT was 17 months. Regarding the year of SRT, 80 , 184 , and 157 patients underwent SRT in 20052009, 20102014, and 20152017, respectively. The patient and treatment characteristics are presented in Table . Mean doses of SRT in 20052009, 20102014, and 20152017 were 61.7, 65.4, and 67.4Gy, respectively . The proportions of IMRT in 20052009, 20102014, and 20152017 were 14%, 46%, and 82%, respectively , and those of IGRT were 43%, 71%, and 100%, respectively . The mean prescribed dose in patients treated using 3DCRT vs IMRT was 62.8 vs 67.8 Gy, respectively . The mean prescribed dose in patients treated using non-IGRT vs IGRT was 64.3 vs 65.8 Gy, respectively .

Table 1 Patient and treatment characteristics.

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Diet Guidelines To Minimize Bloating

During your radiation therapy, gas or fluid can build up in your bowels and cause bloating. When your bowels are bloated, they can expand into the treatment area and be exposed to radiation. This can cause side effects or make your side effects worse.

Follow the guidelines below to lower your risk of bloating during radiation therapy. Its best to start 2 to 3 days before your simulation and continue until you have finished your radiation therapy.

• Chew your food well.

• Prunes

If youre bloated, keeping a food journal can help you see which foods may be causing it. Write down your foods and drinks, the time you have them, and the time you start feeling bloated. Bring your food journal to your appointments. Your healthcare provider will use it to help you manage the bloating.

A clinical dietitian nutritionist can talk with you about your diet and help you design an eating plan that meets your needs. If youd like to meet with a clinical dietitian nutritionist, ask your radiation oncologist or nurse for a referral.

Remove Devices From Your Skin

The manufacturer recommends taking these devices off your skin before your simulation or treatment:

• Continuous glucose monitor
• Insulin pump

If you use one of these, ask your radiation oncologist if you need to take it off. If you do, make sure to bring an extra device to put on after your simulation or treatment.

While your device is off, you may not be sure how to manage your glucose . Ask the healthcare provider who manages your diabetes care. Make sure to do this before your simulation or treatment appointment.

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