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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How Spaceoar Hydrogel Fits Into The Treatment Options
SpaceOAR Hydrogel, a minimally invasive pre-treatment option for men undergoing prostate cancer radiation therapy, is an absorbable gel that temporarily creates space between the prostate and rectum, designed to reduce the radiation dose delivered to the rectum during prostate cancer radiation therapy. The reduction in radiation exposure lowers a patients chance of developing late rectal complications, helping them maintain their quality of life.4
SpaceOAR Hydrogel is made up of two liquids that are mostly water and PEG, a material that is commonly used in other medical implants in the eye, brain and spine. SpaceOAR Hydrogel is biocompatible, biodegradable and naturally excreted through urine in 6 months.
*Other treatment options include chemotherapy, vaccine treatment, cryotherapy and hormone therapy.
What Does External Beam Radiotherapy Involve
You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.
Before your radiotherapy treatment
Radiotherapy planning session
A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.
During your radiotherapy treatment
You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.
If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.
At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.
Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.
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The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
Who Should Consider Taking Radiopharmaceuticals
Radiopharmaceuticals are given through a vein to men with metastatic prostate cancer that has spread widely to the bone. Strontium89 and Samarium-153 are radiopharmaceuticals given to reduce the pain caused by the bone cancer. Radium-223, or Xofigo®, is a radiopharmaceutical given to prolong life.
The side effects associated with radiopharmaceuticals are mainly the suppression, or lowering, of white blood cell and platelet levels in the blood. Your doctor will be able to assess whether your body can handle this side effect before you are given the treatment and will monitor your levels after you receive it. Your doctor, specialist nurse, or nuclear medicine practitioner will be able to give you more information about the treatment and possible side effects.
If your doctor has told you that your bone metastases have spread, you may be a candidate for a radiopharmaceutical. Speak with your oncology team to see if one of these treatments may be right for you.
Radiation Therapy Side Effects
Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.
Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body.
Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section. Discuss this chart with your doctor or nurse. Ask them about your chances of getting each side effect.
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Hypofractionated Radiation Therapy For Prostate Cancer
At Fox Chase Cancer Center, we believe delivering high quality clinical care should be convenient for our patients. Our radiation oncologists have worked to help pioneer an advanced treatment technique that is quickly becoming a standard of care for prostate cancer patients.
Its called hypofractionation.
Using hypofractionation, or hypofractionated radiation therapy, more doses of radiation are delivered per treatment, so patients can complete their course of radiation therapy much faster than conventional treatment and costs patients less money.
The CyberKnife at the Fox Chase Buckingham facility.
At Fox Chase, hypofractionation is delivered on regular linear accelerators or the , a linear accelerator on a robotic arm.
Many clinical trials, , have proven hypofractionation to be just as safe and effective as conventional radiation therapy.
When appropriate, it can shave weeks off the traditional treatment length with the possibility of fewer short term side effects and a better quality of life.
Though the length of treatment using hypofractionation depends on the cancer type being treated, prostate cancer patients can complete their treatment course in as little as 2 ½ weeks with extreme hypofractionation and 5½ weeks with hypofractionation – compared to conventional treatment which typically takes 8 weeks.
Two types of hypofractionation are used in prostate cancer. Fox Chase radiation oncologists have been performing both of these methods for many years:
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Side Effects From Radiation Therapy
September 13, 2017PCRI
Radiation for prostate cancer may cause short- or long-term side effects. Even though radiation targets the cancer cells, normal body tissues near the tumor can be affected. Specifically, we are talking about the rectum, small intestine, bladder, urethra, bone marrow, and sexual organs. If these organs repair incompletely, the radiation effects may devolve into scar tissue. Most side effects from radiation resolve within 1-2 months after treatment. However, a minority of men encounter long-term problems.
There is one radiation-related side effect that has nothing to do with the surrounding organsfatigue, which may begin to be noticeable after two weeks or so. The maximum level of fatigue usually occurs after about four weeks of treatment and persists until the end of the treatment. After the radiation is complete, normal energy levels typically recover in four to eight weeks. Moderate-intensity exercisewalking 30 minutes at least three days each weeksubstantially reduced fatigue.
How To Decide Between Radiation And Surgery For Localized Prostate Cancer
This page adheres to our medical and editorial policy and guidelines.
If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options:
- Active surveillance: Oncologists use this method for less aggressive prostate cancer. Your care team will runs test periodically to evaluate whether the cancer has progressed. If so, they may recommend additional treatment.
- Radiation therapy: This treatment uses targeted radioactive energy to reduce tumor size, destroy cancer cells and alleviate some cancer-related symptoms.
- Surgery: Typically, this involves a procedure called a prostatectomy, which removes the prostate and surrounding cancer cells.
If you arent comfortable with active surveillance , or if your oncologist says it isnt the right option for you, you may have to decide between radiation therapy and surgery to treat your cancer.
Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.
To help you through the process of making this decision, this article covers:
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Online Support Groups For Prostate Cancer
- Us TOO. This organization has more than 200 support groups in the United States and abroad.
- Prostate Cancer Research Institute. This website allows you to search for support groups by state.
- Cancer Care. This site offers 15-week online support groups for people diagnosed with prostate cancer. Co-sponsored by the National Alliance of State Prostate Cancer Coalitions.
- Male Care. This organization offers online support groups for people with prostate cancer and their partners or caregivers.
- Imerman Angels. This support community offers one-on-one support with a mentor.
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What Is A Late Effect
A late effect is a side effect related to a cancer diagnosis or treatment that happens months to years after treatment. 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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Bowel Changes After Pelvic Radiotherapy
Bowel changes caused by pelvic radiotherapy can show as a variety of symptoms. These may be uncomfortable and inconvenient, or even painful and distressing.
We hope the information on this page helps explain why you might have bowel symptoms and how to manage them. We are also here if you need some extra support or arent sure where to start.
Side Effects And How To Manage Them
Your radiation doctors plan treatments very carefully to lessen side effects. While some patients have little or no side effects from radiation therapy, others feel some discomfort. Side effects are usually short-term and can be treated. No matter what type of therapy you receive, our doctors and nurses are skilled in helping to manage side effects.
Side effects most often start by the second or third week of treatment. They can last up to several weeks after your final radiation treatment. Many people who get radiation have some fatigue and skin reactions. Based on the area of your body being treated, you may also have some:
Most side effects go away within 12 months after you have finished radiation therapy.
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What Is A Radiation Oncologist
If a patient is undergoing radiation, the cancer treatment plan may be managed by a radiation oncologist who carefully monitors the persons overall health and well-being through the process.
With advanced cancer, a patient may also be referred to a medical oncologist. This specialized doctor uses medicines such as chemotherapy and hormone therapy to treat cancers. Its common for several medical specialists to work together on a treatment plantheyre known as a cancer care team.
Problems Passing Urine And Leakage Of Urine
You might be able to have a short operation to widen the urethra if this happens. Speake to your doctor if you find it hard to pass urine.
A small number of men find they cant pass urine at all. Tell your doctor straight away if this happens.
Almost 50 out of every 100 men who have radical radiotherapy have some problem with leaking urine after 6 years. Your doctor or nurse can refer you to a specialist incontinence clinic if this becomes a problem. They can help you with muscle exercises, bladder training and medicines.
Some men find that they cant control their urine at all. This is very uncommon. If it happens you need to have a tube called a catheter into your bladder. The tube drains the urine into a bag.
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What Is Prostate Radiation
Radiation for prostate cancer is a special treatment of the cancer cells with the help of high-energy rays or particles. Radiation has the power to make small breaks through our DNA cells. This breakage stop the growth and spread of cancer further. Depending on the stage of prostate cancer, radiation treatment can be used in the following situations:
- To cure or shrink early-stage cancer.
- To stop cancer from coming back somewhere else.
- To treat symptoms caused by advanced cancer.
- To treat cancer that has returned .
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.
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Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiotherapy
This type of therapy is used to deliver high doses of radiation to a precise area in the prostate using specialized techniques not achievable by standard conventional radiation therapy. This allows the total dose of radiation to be given in a shorter amount of time, usually 4 -5 treatments over 1 2 weeks rather than the several weeks used for other types of external radiation therapy.
The radiation beam needs to be extremely accurate in order to limit the side effects on healthy tissue. During treatment, the body immobilization used is often more restrictive than with IMRT due to the high doses of radiation. Fiducials, or internal prostate markers, are often used in this type of treatment.
Cyberknife and Truebeam are two types of LINACs used for SBRT treatment of prostate cancer.
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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.