Prostate Cancer: Should I Have Radiation Or Surgery For
Radiation therapy is more likely to cause bowel problems, 112 experienced disease progression, and radiation oncologists feel the same way about Prostate Cancer Survival Better With Surgery vs, When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery, in case of prostate cancer, and from what this study is showing, Bowel function was better after surgery than after radiotherapy the difference was statistically but not clinically significant.Prostate Cancer TreatmentThat stage comes with surgery, Prostate cancer that has grown beyond the prostate is called advanced prostate cancer, which was higher than in the surgery and radiation groups .< img src=https://i0.wp.com/grandroundsinurology.com/wp-content/uploads/2017/02/nvfdcamy0wy.jpg alt=Debate: Effectiveness of Surgery vs, the idea of getting the cancer out brings a sense of relief.
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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 person’s 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.
What Is Brachytherapy For Prostate Cancer
In high-dose brachytherapy , a single radioactive source is temporarily placed in the prostate using catheters. Typically, the catheters are inserted in the morning in the operating room under general anesthesia, then a CT scan is obtained for treatment planning, and the 5 to 15 minute treatment takes place in the afternoon. A combination of a long-acting local anesthetic and other medications keep the patient comfortable until treatment delivery. The catheters are removed at the end of the treatment. Patients go home that day and are not radioactive.
The time and position of the radioactive source is carefully controlled to maximize the radiation dose to the prostate and minimize the dose to the urethra, rectum, and bladder.
HDR brachytherapy alone can be used to treat low-risk patients, and can be used as a boost for higher-risk patients receiving external beam radiotherapy. In select patients, HDR brachytherapy can be used to treat failures from LDR brachytherapy or external beam radiotherapy.
Siteman is the first and only medical center in the region to perform HDR brachytherapy for prostate cancer. More than 200 patients have received the treatment since our program opened in 2014.
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Side Effects Of External Beam Radiation Therapy
Each type of external beam radiation therapy causes similar side effects. Some are temporary or self-resolving, but others may be long-lasting or permanent. In some instances, erectile dysfunction may start to occur several months after your treatment is complete.
Short-term side effects may include:
- Urinary symptoms such as urgency, needing to urinate often at night, and a weaker urine stream
- Loose bowel movements
- Redness or bruising at the radiation site
Long-term side effects may include:
- Erectile dysfunction, including difficulty getting and maintaining an erection hard enough for penetration
- Urinary dysfunction, including incontinence
- Rectal inflammation
You may be able to reduce your risk of some long-term side effects before beginning therapy. Before starting radiation, talk to your doctor about using a hydrogel spacer during treatments. This technique reduces exposure of healthy rectal tissue to radiation.
Your surgeon will insert hydrogel in the space between the prostate and rectum, increasing the distance between the rectum and the radiation beam. This technique may help you to avoid proctitis.
Erectile dysfunction affects most prostate cancer patients who have radiation, at least temporarily. When the nerves are left intact, this side effect usually improves.
Talk to your doctor about vessel-sparing radiation, which may preserve erectile function more effectively than some other forms, including standard external beam radiation.
What The Research Shows About Radiation Vs Surgery
The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.
The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year mark for radiation therapy, surgery or active surveillance.
If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 100,000 prostate cancer patients over a 15-year period.
As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.
The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.
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What Are The Advantages And Disadvantages Of External Beam Radiotherapy
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
Is Proton Beam Therapy Safer Than Other Options
Due to the concentrated nature of the radiation in proton therapy, there are usually fewer side effects than in conventional radiation therapy. Thats because theres less damage to healthy tissue around the tumor.
People who have proton therapy may have a significantly lower risk of short- and long-term complications compared with people receiving traditional photon therapy, according to a research study . These findings show a two-thirds reduction of adverse events in the 90 days after treatment, as well as a significantly reduced risk of having difficulties moving and performing daily activities.
However, long-term data is lacking on the safety of proton beam therapy. Furthermore, due to the high cost of treatment, current research has been limited in terms of demographics.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
Cyberknife For Prostate Cancer
With CyberKnife because of its precision, there is less risk of burning the rectum or testicles during treatment. There is also a reduced risk of impotence and urinary incontinence. Sexual function remains the same for most patients after treatment. There are also minimal side effects, which may include tiredness, and urinary and rectal irritation. Over-the-counter medications minimizes these, and they usually dissipate in a few days or weeks.
Here are some other benefits:
- CyberKnife has a 98% cure rate for prostate cancer.
- There is less toxicity than with traditional radiation.
- Its quicker and has a high safety record.
- CyberKnife causes less disruption to patients lives.
- Its noninvasive. So, theres no anesthesia or cutting.
- It doesnt come with the risks of surgery like infection and long periods of downtime.
- CyberKnife treatments can be done infive radiation therapy sessions over 10 days. Thats compared to 42 over three months with other types of radiation treatments.
- The CyberKnife radiation beams, which target the prostate, are extremely precise. That means there is less risk of side effects including impotence and incontinence.
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Prostate Cancer: Radiation Therapy
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.
External Beam Radiation Therapy For Prostate Cancer
External radiation therapy uses a machine outside the body to send high-energy beams toward the area of the body with cancer. Treatment is typically administered five days a week for a period of 6-8 weeks. Many men receive 3-dimensional conformal radiation therapy, which uses a computer to shape the radiation beams to fit the tumor. This makes it possible to target the cancer more closely while lessening the damage to healthy tissue near the prostate.
You will lie down under the linear accelerator for just a few moments at each visit and placed precisely in the same place each time. The actual radiation therapy treatments take only a few minutes. A radiation therapy visit is often only 15-20 minutes in length.
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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.
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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What Is 3d Conformal Radiation Therapy
Itâs a procedure that uses a computer to make a three-dimensional picture of your tumor. It helps your treatment team deliver the highest possible dose of radiation to the tumor while minimizing the damage to normal tissue.
3D conformal radiation therapy uses CT-based treatment combined with three-dimensional images of a prostate tumor. CT is short for computed tomography, which uses X-rays to produce detailed pictures inside the body.
So far, this technique has worked well for localized tumors such as prostate cancer limited to the prostate gland.
Whos Eligible For This Procedure
Permanent implants are relatively low-energy sources, and therefore have limited tissue penetration. A well-done implant treats the prostate and the surrounding few millimeters of adjacent tissue.
The best candidates for this procedure are patients with a cancer within or near the prostate. Patients with prostate cancer thats invading nearby structures like the bladder or rectum arent appropriate for this technique.
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Some Things To Consider When Choosing Among Treatments
Before deciding on treatment, here are some questions you may want to ask yourself:
- Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
- Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
- Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
- Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
- Which potential treatment side effects might be most distressing to you?
- How important for you are issues like the amount of time spent in treatment or recovery?
- If your initial treatment is not successful, what would your options be at that point?
Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.
What Is This Post All About
This is a hard decisionsurgery or radiation?
Now remember, what I am going to talk about here is for prostate cancer that hasnt spreadLOCALIZED prostate cancer.
From a 30,000-foot view, surgery and radiation or both EXCELLENT treatment choices for prostate cancer. In general, you can pick and choose certain studies to support one treatment over the other but by and large they are both EQUAL in terms of cancer control.
Now remember, I am a urologist. I try my hardest to provide as unbiased as an opinion as I can but its impossible to remove the fact that I am urologist when providing this information. This is why I will always have my patients meet with a Radiation Oncologistas well as me to hear from them about what radiation is all about as I talk to them about what surgery is all about.
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What Happens After Radiotherapy
After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:
- check how your cancer has responded to treatment
- help you deal with any side effects of treatment
- give you a chance to raise any concerns or ask any questions.
Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have
follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.
The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.
After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.
Treatment options after radiotherapy
Looking after yourself after radiotherapy