Radiation After Prostate Cancer Surgery

Radiopharmaceuticals That Target Psma

Surgery after Radiation Therapy for Prostate Cancer?

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.

Salvage Androgen Ablation Therapy

Hormonal manipulation is likely to be the therapy most commonly administered to patients with recurrent prostate cancer and yet it has been the least well studied to date. A total of 54% of urologists and radiation oncologists in one study recommended androgen ablation or observation with delayed androgen ablation for patients with recurrent prostate cancer.22 Certainly, androgen ablation is not a curative intervention, and therefore the optimal timing of its application is uncertain. The cancer-specific survival after androgen ablation administered upon identification of local-only recurrence in one series of 72 patients was 70 and 84 months.23 Although this relatively short survival may be a reflection of the advanced stage of disease of these patients or the intrinsic response rate of prostate cancer to hormonal therapy, the more morbid attempts at salvage therapy, such as radical prostatectomy, cryoablation, and brachytherapy, should demonstrate improved survival beyond that of androgen ablation in order to be reasonably administered to patients with recurrent prostate cancer.

Urinary And Bowel Changes

Radiation therapy can cause permanent urinary and bowel changes. Many people dont notice any changes or have any symptoms. However, some people have late side effects.

Late side effects may be similar to the ones you had during treatment. Theres a very small chance you may develop other side effects. For example:

The opening of your bladder may become narrower.
You may lose your ability to control your bladder.
You may have blood in your urine.
You may have bleeding from your rectum.
Your rectum may be injured.

These side effects are rare. They may come and go over time or be persistent and chronic. Your healthcare team will help you manage them.

Even if you dont develop any late side effects, remember that the tissues in your bladder and rectum were affected by your radiation therapy. Call your radiation oncologist if you:

Have any new urinary, bladder, or bowel symptoms.
Need to have a colonoscopy. Avoid having a colonoscopy for the first year after radiation therapy.
Need any type of urological or rectal procedure.

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How Does Radiotherapy Work

Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy is high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body . Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.

Radiotherapy treats the whole prostate. It aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects that may cause you problems.

You may have radiotherapy to a wider area, including the nearby lymph nodes, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. If you do have radiotherapy to a wider area, you will be more likely to get side effects.

Radiotherapy After Surgery For Prostate Cancer

Postoperative Radiation for Prostate Cancer

Surgical removal of the prostate has a high chance of cure when prostate cancer is confined to the prostate. High-risk features found at the time of surgery increase the risk of the cancer recurring. Recurrence of cancer might show up as an abnormal blood test ), local recurrence at the site of the prostate, or distant spread .

Radiotherapy, using external X-rays directed where the prostate was in the pelvis, has the potential to kill any prostate cancer cells left behind, and improve the chance of cure. On the other hand, it may cause problems with bladder, bowel or sexual function. In some men it may be futile if the prostate cancer cells have already spread beyond the pelvis. This review looked at whether radiotherapy given after surgery for prostate cancer with these high risk features was effective in reducing the risk of prostate cancer recurring, whether it made men live longer, and what the side effects were.

One trial with longer follow up showed improved survival with adjuvant radiotherapy but this improvement did not exist at 5 years follow up. Radiotherapy reduced the number of men whose cancer spread to other parts of the body . We found that radiotherapy improved local control in the prostate bed and did reduce the risk of cancer recurring. Radiotherapy reduced the number of men with an abnormal PSA blood test, but the importance of this is uncertain. Radiotherapy does increase the risk of side effects, affecting bladder and bowel function.

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Enlarged Prostate Or Prostate Cancer

The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia . Its not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medication.

What Are The Types Of Radiation Therapy Used For Prostate Cancer

Radiationtherapy for prostate cancer can be divided into two main categories.

Externalbeam radiation :Using a machine outside the body, beams of radiation are focused on theprostate gland. This can help relieve symptoms such as pain while limiting thedamage to the tissues surrounding the prostate.

The 4methods of external beam radiation are:

Three-dimensional conformal radiation therapy
Stereotactic body radiation therapy
Proton beam radiation therapy

Brachytherapy:Small radioactive pellets are inserted into the prostate, each one about thesize of a grain of rice. About 100 pellets are used to limit the damage tosurrounding tissues and organs. Brachytherapy is most often used forearly-stage cases and is sometimes combined with EBRT. The pellets can eitherbe inserted for a couple of days for high dosages or a few months for lowdosage depending on the patients overall status.

Treating Advanced Prostate Cancer

If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

hormone treatment

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Early And Late Effects Of Radiation Therapy

Doctor Explains Radiation for Rising PSA after Prostate Cancer Surgery

Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.

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Treatments For Recurrent Prostate Cancer

Recurrent prostate cancer is cancer that comes back after it has been treated. Recurrent prostate cancer is also diagnosed when the prostate-specific antigen level starts to rise quickly after initial treatment but there are no other signs of cancer. This is called a biochemical recurrence or PSA failure.

The following are treatment options for recurrent prostate cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The type of treatment that you receive will depend on:

the treatments you’ve already had
where the cancer comes back
whether the cancer has spread
your overall health and whether you have other illnesses
your age and life expectancy
your personal preferences

Prostate Cancer: Radiation Therapy

Radiation therapy, also called X-ray therapy, uses high levels of radiation to kill prostate cancer cells or keep them from growing and dividing while minimizing damage to healthy cells.

Radiation can be given from a machine outside the body and directed at the prostate . Or a surgeon can place radioactive materials into the tumor . These radioactive materials can be temporary or permanent.

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Why Does Radiation Therapy Cause Side Effects

In this type of treatment, high doses of radiation therapy are used to destroy cancer cells. Side effects come from damage to healthy cells and tissues near the treatment area.

There have been major research advances in radiation therapy over recent years that have made it more precise. This has reduced this treatments side effects compared to radiation therapy techniques used in the past.

Some people experience few or no side effects from radiation therapy. Other people experience more severe side effects. Reactions to radiation therapy often start during the second or third week of treatment. Or, they may last for several weeks after the final treatment. Some side effects may be long term. Talk with your treatment team about what you can expect.

How To Compare Radiation Vs Surgery For Prostate Cancer

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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.

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Treatment Options: When Cancer Returns After Radiation

After prostate cancer is treated, patients usually undergo a blood test called PSA. PSA stands for Prostate Specific Antigen and is a simple blood test that gives a number. After treatment, that number should be low. If it starts to increase, that can be a signal of cancer coming back, also known as cancer recurrence.

Often doctors will watch a series of PSA values to identify the trend. If the PSA number continues to increase, this is called biochemical failure, and your doctors will investigate the cause. Sometimes doctors will order scans to see if there is cancer recurrence locally , or distantly . Treatment is different depending on where the cancer is found.

If there is high suspicion for local recurrence, your doctors may encourage a prostate biopsy to see if there is tumor identified under the microscope. If so, there are several local treatment options including cryotherapy and prostatectomy. Some patients may choose observation.

Brachytherapy Option

What about using brachytherapy on the prostate? This has not been as popular given the concern about risk of toxicity for patients who have used external beam radiation previously

More follow up is needed and the complete results will be reported with longer follow up, but this study shows that salvage brachytherapy may be another option in the treatment of recurrent prostate cancer after radiation therapy.

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Which Treatment Is Best For You

The exact type of treatment that is best for you can depend upon many factors, such as the stage of the cancer, where in the prostate the cancer is located, and individual factors. These are all taken into account by the treating healthcare team when creating a personalized treatment plan.

When you meet with your healthcare provider, they will give you the options that will be the most effective in treating your case of prostate cancer.

For stage 1 prostate cancer, treatment may include:

Watchful waiting or active surveillance
Hormone therapy
Radical prostatectomy with pelvic lymphadenectomy
Radiation after surgery

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Surgery Vs Radiation For Prostate Cancer: Uses Benefits Side Effects

When is radiation therapy appropriate after surgery for prostate cancer? (Colleen Lawton, MD)

This article will review how surgery and radiation treat prostate cancer. Both can be very effective forms of treatment in men with the disease. Although they may have the same goals of therapy, there are differences between these treatments.

Be sure to see your healthcare provider for the diagnosis to receive the best treatment for yourself.

The Good Brigade / Getty Images

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Your Role On Your Radiation Therapy Team

Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:

Getting to your appointments on time.
Asking questions and talking about your concerns.
Telling someone on your radiation therapy team when you have side effects.
Telling someone on your radiation therapy team if youre in pain.
Caring for yourself at home by:
Quitting smoking, if you smoke. MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call . You can also ask your nurse about the program.
Caring for your skin as instructed.
Drinking liquids as instructed.

What Side Effects Can Second

Any cancer treatment can cause side effects. For example, hormone therapy side effects include erectile dysfunction, hot flashes, and breast tissue tenderness.

Youre more likely to have side effects after second-line treatments, because the first treatment you had might have already damaged the tissue around your prostate. The side effects can also be more severe during the second round of treatment.

Just because a treatment can cause a side effect doesnt mean it will affect you that way. Ask your doctor or nurse what types of side effects to expect, and what to do if you have any.

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Easier To Have Additional Treatment

In a perfect world, all you will need is one treatment. However, cancer is cancer. So, we will follow your PSA to see if there is any sign that the cancer came back.

If the PSA starts to creep up, higher than 0.2, then we can always add radiation later. However, there is some trade off to this in that some of the side effects from radiation can become more common after the prostate has been removed.