Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
Who Can Have Radiotherapy
External beam radiotherapy can be suitable for you if:
- your cancer hasnt spread outside the prostate
- your cancer hasnt spread to the area just outside the prostate
- your cancer has come back after treatment that aimed to cure it .
If your prostate cancer is localised or locally advanced, or if you have recurrent prostate cancer, radiotherapy will aim to get rid of the cancer completely.
If you have some types of inflammatory bowel disease , external beam radiotherapy may not be suitable for you as it could make your bowel problems worse. Talk to your doctor or nurse to discuss if radiotherapy is suitable for you.
Radiotherapy for localised and locally advanced prostate cancer
If youre having radiotherapy for localised or locally advanced prostate cancer you might also have hormone therapy for six months before, during or after treatment. Hormone therapy can shrink the prostate and the cancer inside it, and make the treatment more effective. Your doctor will let you know if you need hormone therapy and for how long you should have it. If there is a risk of the cancer spreading outside your prostate, you may continue to have hormone therapy for up to three years after radiotherapy. Read more about hormone therapy.
- high-intensity focused ultrasound or cryotherapy, but these are less common and only available as part of a clinical trial.
If you have advanced prostate cancer
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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.
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.
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Radiation Therapy: What It Is
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.
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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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.
Side Effects To Be Considered
Erectile dysfunction , urinary symptoms and bowel symptoms are side effects that need to be considered when treating prostate cancer, with ED often considered an important factor by patients. Perhaps the main advantage of LDR brachytherapy is the low risk of permanent side-effects.13
In the two months following LDR brachytherapy, men may experience temporary but significant urinary irritation and bother, however this can often be successfully managed. Late urinary bother occurs in 10% of men, urethral strictures in 2-3%, with urinary incontinence not commonly seen. Bowel toxicity is also rare, with low occurrence of significant rectal bleeding or ulceration.10,11,13,14
Evidence suggests LDR brachytherapy offers the lowest risk to erectile function compared to many other prostate cancer treatments, with Ong et al reporting 60% of men preserved excellent erectile function in the five years following treatment.15 In younger men, the erectile preservation rate was 70%.
In New Zealand, LDR brachytherapy is a combined procedure performed by both a radiation oncologist and urologist. However, the procedure also requires a multidisciplinary team including radiation therapists, medical physicists, as well as the theatre staff. The procedure is performed under general anesthetic and usually takes about an hour, with patients able to return home on the same or following day.
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Will I Need To See My Doctor After My Imrt Treatment Is Over
Once your IMRT is finished, it is important for you to have regular visits with your doctor to check how well your treatment is working and to deal with any side effects that you may have. Your doctor will want to see you every three to four months for two to three years. Your doctor will schedule your appointments and order any tests you need to make sure you have the best follow-up care possible. Dont be afraid to ask about any tests or treatments that your doctor orders. Use these appointments to learn about the things you need to do to take good care of yourself following your prostate cancer treatment. .
Helping Yourself After Your IMRT Treatments.
- When do you need to see your doctor or health care team?
- How can you reach your doctor or health care team?
Prostate Cancer Risk Groups
Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .
Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.
The risk group of the cancer will help determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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What To Expect After Radiation Therapy For Prostate Cancer
Patients who receive radiation therapy for prostate cancer may experience a wide range of short-term and long-term side effects. And side effects may vary widely from patient to patient depending on a variety of factors, including the extent of the disease and the patients overall health. For instance, some patients may need a urinary catheter to help empty the bladder. Other patients may experience sexual side effects.
At CTCA, our trained supportive care providers work closely with you and your doctors to determine how best to address radiation therapy side effects. Services may include:
- Pelvic floor therapy
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.
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Are There Side Effects Of The Combination Approach
There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.
In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.
How To Handle Sexual And Reproductive Side Effects
Some men experience erectile dysfunction after prostate cancer treatment. Depending on your specific needs, a combination of medications, mechanical devices or surgical procedures may be used to help you get and maintain erections if treatment has interfered with your sexual function.
While many men are able to have active and enjoyable sex lives after prostate cancer treatment, it can be difficult to father children through intercourse. As a result, some men choose to bank their sperm so that it can be used for artificial insemination in the future. Other men have their sperm harvested from their testicles so that it can be injected into an egg and potentially form an embryo.
At Moffitt Cancer Center, we understand that there are many things to think about when undergoing prostate cancer treatment. Our oncologists and supportive care providers can help you determine which options are most appropriate for your unique needs, and no referral is required to make an appointment. If youd like to request a consultation with an oncologist from our Genitourinary Oncology Program, call or submit a new patient registration form online.
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Permissions And Ethical Aspects
The Ministry of Social Affairs and Health in Finland provided permission to obtain the Finnish Cancer Registry patient data. Experts in health psychology revised the questionnaire, and it was mailed to the patients from the National Public Health Institute . The Ethics Committee of Helsinki University Hospital approved the research protocol.
Coping With The Side Effects Of Radiation Therapy
Everyones experience with radiation therapy is different. Side effects vary from person to person, even when given the same type of treatment. Before your treatment, ask your health care team which physical side effects are possible and what to watch for. You may also experience emotional side effects. Seeking out mental health support to help with anxiety and stress is important.
Ask your health care team about ways to take care of yourself during the treatment period, including getting enough rest, eating well, and staying hydrated. Ask whether there are any restrictions on your regular exercise schedule or other physical activities. If so, talk with them about another way to get regular exercise.
Continue to talk to your health care team throughout your treatment. Tell them when side effects first appear, worsen, or continue despite treatment. That will help your health care team provide ways to help you feel better during and after treatment.
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Side Effects Of Prostate Cancer Treatment
The side effects of treatment vary depending on several factors, and they can be distressing. You should talk through options and concerns with your doctor before deciding which treatment to use for your prostate cancer.
Some common side effects of types of treatment include:
- Surgery many men will have temporary urinary incontinence . Almost all men will have a change to their sexual function and most men will have erectile dysfunction .
- Radiotherapy a small number of men will have bowel problems. Between 40 and 80 per cent of men who have radiotherapy will experience immediate or delayed erectile dysfunction.
- Brachytherapy erectile dysfunction and bowel problems can occur. Some men may experience painful urination and irritation of the bladder for several months after therapy. Urinary incontinence is not usually a problem.
- Hormone therapy side effects may include erectile dysfunction, tiredness, mood changes, hot flushes and loss of sex drive.
Coping with some of these side effects can be very difficult. It is important that you discuss possible side effects with your specialist before treatment.
Reducing Side Effects During Radiotherapy For Prostate Cancer
Radiation is a very effective treatment for prostate cancer, but in a small percentage of patients it also can cause toxicities to nearby organs, particularly the rectum. Side effects are usually minor and can include hemorrhoidal type bleeding and rectal incontinence. But for a very small subset of patients, the side effects can be more serious.
Patients who take blood thinners or who have Crohns disease or ulcerative colitis, for example, are at greater risk for complications from radiation therapy for prostate cancer than are other patients. For these patients, sparing the rectum is a significant concern.
Serious complications are rare, but as Dr. Greg Cooley, Department of Human Oncology clinical associate professor and radiation oncologist at UW Health East, says, If they happen to one patient, thats one too many.
For patients who are susceptible to complications, Cooley uses a relatively new technique to move the rectum away from the treatment area to reduce the likelihood that the rectum will be exposed to radiation during treatment. He injects a substance called SpaceOAR into the space between the patients prostate and rectum, which pushes these two organs apart by about 1 cm and solidifies into a soft hydrogel that remains stable for three months.
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