Monday, February 6, 2023

Prostate Cancer Radiation Side Effects Long Term

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Negative Effects On Sex Life

Radiation Therapy For Prostate Cancer

All active treatments considerably affected patients sex lives specifically, 8193% of respondents reported an effect . Prostatectomy was reported as having a stronger effect on patients sex lives than the other treatments, even after adjusting for age and the Gleason score . External beam radiotherapy and hormonal therapy had weaker effects. Of the patients who reported a permanent effect at five years, 67% indicated sexual difficulties after prostatectomy, and almost the same proportion after brachytherapy . Permanent sexual difficulties were reported more often after prostatectomy than after external radiation and brachytherapy .

Between 70 and 92% of the patients reported sexual dysfunction depending on the treatment received . More dysfunction was reported after prostatectomy , hormonal therapy , and external radiotherapy than after the other treatments. Between 22 and 57% of the respondents reported impotence, most often after prostatectomy, whereas loss of sexual desire alone was rare . 1825% reported the loss of both desire and potency after prostatectomy or radiotherapy, whereas 45% reported the loss of both after hormonal therapy.

Having External Beam Radiotherapy

You have external beam radiotherapy as an outpatient in the radiotherapy department. Radiotherapy is given using a machine that is like a big x-ray machine. This is called a linear accelerator .

You usually have it as a series of short, daily treatments. The treatments are given from Monday to Friday, with a rest at the weekend. Your course of treatment may last for 4 to 8 weeks. Radiotherapy is not painful, but you will need to lie still while you have it.

You may have radiotherapy over 4 weeks instead of over 7 weeks. The total dose of radiation is the same for both. But when it is given over 4 weeks, the dose for each treatment session is higher. Doctors call this hypofractionation. Both are effective treatments. Your cancer doctor will recommend the best timing and way for you to have your radiotherapy.

The radiotherapy does not make you radioactive. It is safe for you to be with other people during external radiotherapy, including children.

Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a persons quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Patient Satisfaction With The Outcome Of The Treatment Psychological Well

6 Side Effects of Radiation Therapy and How to Manage Them

Dissatisfaction with the treatment outcome at the time of the survey was highest after prostatectomy . 34% of the patients were dissatisfied with the outcome of hormone therapy, 24% were dissatisfied with the outcome of external beam radiation, 22% were dissatisfied with the outcome of brachytherapy and 15% were dissatisfied with the outcome of surveillance. The scale means were 1.55 , 1.48 , 1.35 , 1.34 , respectively, for the active therapies .

Three-quarters of the respondents reported at least one psychological symptom at the time of the survey . The most common symptom was worrying , followed by irritability , nervousness and problems concentrating . Regarding the satisfaction with life statements , the median response was mostly agree. Brachytherapy was associated with a lower total level of psychological symptoms, whereas surveillance was associated with greater satisfaction with life . Age was negatively associated with the total level of the psychological symptoms . Reported recurrence was associated with more psychological symptoms .

Table 4 Negative effects of treatments associated with dissatisfaction with outcome of the treatment and psychological well-being

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Possible Risks And Side Effects Of Brachytherapy

Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

Will Radiation Therapy Make Me Tired

Everyone has their own energy level, so radiation treatment will affect each person differently.

People often feel fatigue after several weeks of treatment. For most, this fatigue is mild. But some people lose a lot of energy and need to change their daily routine.

If your doctor thinks you should limit how active you are, theyâll discuss it with you.

To minimize fatigue while youâre receiving radiation treatment:

  • Get enough rest.
  • Pace yourself, and plan rest breaks throughout your day.

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Side Effects Of Surgery For Prostate Cancer

The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.

According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.

While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.

While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.

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Radiation Therapy: What It Is

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This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.

This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.

For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.

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Frequent Urination Burning With Urination And Difficulty Urinating

These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.

What Is A Late Effect

A late effect is a side effect that is caused by treatment but happens months to years after the cancer treatment has finished. Some side effects that you develop during treatment can last for months to years after treatment is completed . These are often called long-term side effects.

Late effects can be health issues or psychological, emotional, and practical challenges.

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What You Need To Know About The Prostate Long

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

Spaceoar Hydrogel Reduces Side Effects Of Prostate Cancer Radiation Therapy

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While radiation treatment for prostate cancer has become much more precise over the years, the organs location immediately next to the rectal wall can expose the rectum to high dose radiation, which can lead to disruption in bowel function for some patients.

A new method for reducing these short- and long-term side effects is SpaceOar hydrogel, now available at Fox Chase.

In a minimally invasive outpatient procedure, the two liquid components of SpaceOAR hydrogel are injected through the peritoneum into the space between the rectal wall and the prostate by a urologist. The procedure is done under anesthesia with ultrasound guidance.

The resulting interaction between the two fluids creates a temporary and absorbable gel spacer that is primarily made of water. Hydrogels have been used in other implants such as surgical sealants used in the eye, brain and spine.

The OAR in SpaceOAR stands for Organ At Risk, referring to the rectum.

The position of the prostate poses particular challenges for the higher doses of radiation treatment required for this type of cancer, Fox Chase radiation oncologist Mark Hallman MD, PhD said. The posterior prostate lies right on top of the interior rectal wall and this puts the rectum at increased risk.

SpaceOAR was approved as a medical device by the FDA in 2015 and Fox Chase is among the first in the Philadelphia area to offer it.

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Practical Management Of Bowel Changes

While lifestyle changes and medical treatments can help to improve your symptoms, we know that bowel concerns can be really difficult to manage. This is especially true when you are away from home. Not having easy access to a toilet can be a huge source of anxiety when you have bowel changes. Its always worth checking where the nearest toilets are when youre out, to reassure yourself and avoid any accidents.

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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Advantages And Disadvantages Of External Beam Radiotherapy

Advantages

  • You dont need a general anaesthetic and you dont need to stay overnight in hospital.
  • You may be able to work and carry on normal activities during the treatment.
  • You are not radioactive during or after the treatment so you can be in close contact with others.
  • Each treatment is relatively short. It usually takes about 15 minutes, although you may be in the radiotherapy department for up to an hour.

Disadvantages

How Does It Work

Side effects of radiation therapy for prostate cancer video

There are multiple types of radiation treatments that can be used for prostate cancer.

External beam radiation: This treatment is administered through a specialized machine that directs beams of radiation to targeted areas in the prostate. It is usually given in daily doses five days a week for about six weeks.

Stereotactic radiation: This type of radiation uses advanced images of the prostate with a different type of radiation machine. This may also be referred to as Gamma Knife or CyberKnife.

This type of radiation often uses much higher doses than standard external beam radiation. However, it is given in such a way that healthy tissue around the prostate is spared from high doses of radiation. Because of the high doses of radiation, this type of treatment may only need five or fewer treatments.

Brachytherapy:During this type of radiation, radioactive seeds are placed into the prostate. These radiation seeds emit radiation for a period of time and remain in the prostate even after the radiation has left.

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Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

Who Can Have Radiotherapy

The treatment is suitable if your prostate cancer is found only within your prostate gland or has spread just outside it to the pelvic lymph nodes.

Radiotherapy and hormone therapy are often used together to treat locally advanced prostate cancer. This helps to make the radiotherapy work better at controlling your prostate cancer.

It may not be the best option if you have urinary symptoms, as it may make them worse.

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How Does Brachytherapy Compare With Other Forms Of Radiation Treatments

When used appropriately, brachytherapy has been shown to be as effective as conventional external beam radiation therapy and surgery for many cancers. It is best used in patients whose cancer has not spread, or metastasized. In many cases, brachytherapy is combined with external-beam radiation therapy, including stereotactic body radiation therapy, to get the best results.

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 dont 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:

Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.

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