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Radiation Beam Therapy For Prostate Cancer

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How Often You Will Have External Beam Radiation Therapy

External-Beam Radiation Treatment for Prostate Cancer

Most people have external beam radiation therapy once a day, five days a week, Monday through Friday. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. How many weeks you have treatment depends on the type of cancer you have, the goal of your treatment, the radiation dose, and the radiation schedule.

The span of time from your first radiation treatment to the last is called a course of treatment.

Researchers are looking at different ways to adjust the radiation dose or schedule in order to reach the total dose of radiation more quickly or to limit damage to healthy cells. Different ways of delivering the total radiation dose include:

  • Accelerated fractionation, which is treatment given in larger daily or weekly doses to reduce the number of weeks of treatment.
  • Hyperfractionation, which is a smaller dose than the usual daily dose of radiation given more than once a day.
  • Hypofractionation, which is larger doses given once a day or less often to reduce the number of treatments.

Researchers hope these different schedules for delivering radiation may be more effective and cause fewer side effects than the usual way of doing it or be as effective but more convenient.

Why Would My Doctor Prescribe External Beam Radiation Therapy For My Prostate Cancer

External beam radiation therapy is a standard treatment for prostate cancer. Its a primary treatment for cancer that is caught early before it has spread to other parts of the body. External beam radiation therapy can be used with other types of cancer treatments, such as hormone therapy, when the disease is serious.

Your doctor could also order external beam radiation after youve had surgery. This is called adjuvant therapy, and its goal is to lower the risk that your cancer will return. Your doctor will monitor the levels of prostate-specific antigen with blood work and will also watch for signs of cancer in your pelvic area.

If your prostate cancer is advanced, external beam radiation therapy may also help with bone pain or other symptoms.

Survival Rates With External Beam Radiation Therapy In Newly Diagnosed Elderly Metastatic Prostate Cancer Patients

This article was originally published here

Prostate. 2021 Oct 11. doi: 10.1002/pros.24249. Online ahead of print.

ABSTRACT

BACKGROUND: The survival benefit of primary external beam radiation therapy has never been formally tested in elderly men who were newly diagnosed with metastatic prostate cancer . We hypothesized that elderly patients may not benefit of EBRT to the extent as younger newly diagnosed mPCa patients, due to shorter life expectancy.

METHODS: We relied on Surveillance, Epidemiology and End Results to identify elderly newly diagnosed mPCa patients, aged > 75 years. Kaplan-Meier, univariable and multivariable Cox regression models, as well as Competing Risks Regression models tested the effect of EBRT versus no EBRT on overall mortality and cancer-specific mortality .

RESULTS: Of 6556 patients, 1105 received EBRT . M1b stage was predominant in both EBRT and no EBRT groups, followed by M1c and M1a . Median overall survival was 23 months for EBRT and 23 months for no EBRT . Similarly, median cancer-specific survival was 29 months for EBRT versus 30 months for no EBRT . After additional multivariable adjustment, EBRT was not associated with lower OM or lower CSM in the entire cohort, as well as after stratification for M1b and M1c substages.

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How Is Radiation Therapy Used To Treat Cancer In Dogs

To protect normal cells, veterinarians carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal. tissue as possible while they aim the radiation at the site of the cancer. There are two approaches for using radiation therapy in dogs curative and palliative.

Whats It Like To Have External Beam Radiation Therapy For Prostate Cancer

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Before you undergo external beam radiation therapy, your clinical team will map out where the cancer is located so that they can better target the radiation therapy. The goal is to treat just that area, and nothing more. This will reduce your chances of experiencing side effects. This process typically includes:

  • A radiation simulation where the clinical team helps you find the most comfortable spot to rest in during your treatment
  • Computerized tomography scanning so that your doctors can precisely map the area of your body that needs treatment

During the external beam radiation treatment, you will rest on a table and hold very still while the linear accelerator moves around you to deliver the treatment. You may have an immobilization device to hold you in position to ensure the radiation goes exactly where it should. Your job during the treatment is to relax, breathe normally, and hold still. External beam radiation therapy for your prostate is not a painful treatment. You should be able to rest comfortably while the treatment is given.

The machine will deliver a very precise dose of radiation prescribed by your doctor. Each treatment usually lasts less than an hour and most of that time is spent preparing for the dosage. The radiation treatment itself is usually just a few minutes. During this time, your clinical team will be outside the room but able to see and talk with you through cameras and an audio connection.

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If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Focal Therapy For Prostate Cancer

With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function

Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.

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What Are The Results Of Using Proton Therapy In Patients

For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.

For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.

Survivor Spotlight

What Are The Advantages And Disadvantages Of External Beam Radiotherapy

External Beam Radiation Therapy for Prostate Cancer

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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How Ebrt Is Given

Each treatment session takes about 15 minutes. You will lie on the treatment table under the radiation machine. The machine does not touch you but may rotate around you. You will not see or feel the radiation.

There are different types of EBRT. Your radiation oncologist will talk to you about the most suitable type for your situation. Usually, EBRT for prostate cancer is delivered every weekday for 49 weeks. Some newer forms of EBRT are delivered in 57 treatments over two weeks.

EBRT does not make you radioactive and there is no danger to the people around you. Most people feel well enough to continue working, driving, exercising or doing their normal activities throughout treatment.

Conventional Radiation Therapy: Results

Multiple studies using serial post-treatment serum PSA levels to assess treatment outcomes in patients treated with conventional doses of radiation have reported bNED control rates in patients with non-metastatic prostate cancer., , , Table shows bNED control rates stratified by pretreatment PSA levels for patients treated with conventional doses of external beam RT at several institutions. Direct comparison of results for older series, i.e., those conducted prior to the adoption of the consensus definition, is difficult due to different definitions of bNED control, unequal distribution of critical prognostic factors between series, and varying lengths of follow-up. In general, however, as pretreatment PSA levels increase, rates of bNED control consistently decrease for patients treated at institutions using conventional doses of RT.

Figure Figure 3

Anterior/posterior and Lateral Radiographs of Conventional Treatment Portals

Zietman et al reported outcomes on 1,044 men with stage T1 to T4 prostate cancer treated at Massachusetts General Hospital. Of 504 men with T1/T2 disease, rates of bNED control were 60% and 40% at five and 10 years, respectively. For the 540 men with stage T3/T4 disease treated with conventional doses of radiation, rates of bNED control at five and 10 years were 32% and 10%, respectively.

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When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

When Is Radiation Therapy Given

Stereotactic beam radiotherapy for prostate cancer: is less, more ...

Radiation therapy may be used:

  • for localised or locally advanced prostate cancer it has similar rates of success to surgery in controlling prostate cancer that has spread to the lymph nodes
  • if you are not well enough for surgery or are older
  • after a prostatectomy for locally advanced disease, if there are signs of cancer left behind or the cancer has returned where the prostate used to be
  • for prostate cancer that has spread to other parts of the body.

There are two main ways of delivering radiation therapy: from outside the body or inside the body . You may have one of these or a combination of both.

In intermediate and high-risk prostate cancer, radiation therapy is often combined with androgen deprivation therapy .

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Surgically Removing The Prostate Gland

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

In extremely rare cases, problems arising after surgery can be fatal.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

Image Guided Radiation Therapy

In this type of radiation therapy, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue.

In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.

Calypso is another form of IGRT where the prostate can be tracked during the treatment.

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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.

What Happens Before Your First External Beam Radiation Therapy Treatment

External Beam Radiation Therapy is a non-invasive treatment option for prostate cancer

You will have a 1- to 2-hour meeting with your doctor or nurse before you begin radiation therapy. At this time, you will have a physical exam, talk about your medical history, and maybe have imaging tests. Your doctor or nurse will discuss external beam radiation therapy, its benefits and side effects, and ways you can care for yourself during and after treatment. You can then choose whether to have external beam radiation therapy.

If you decide to have external beam radiation therapy, you will be scheduled for a treatment planning session called a simulation. At this time:

A mask fitted to your face helps make sure that you are in exactly the same position for each treatment.

  • If you are getting radiation to the head and neck area you may be fitted for a mask. The mask has many air holes. It attaches to the table where you will lie for your treatments. The mask helps keep your head from moving so that you are in exactly the same position for each treatment.

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

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