Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
External Beam Radiation Therapy
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.
Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.
How To Manage Urinary And Bowel Dysfunction
Its common to experience urinary dysfunction, bowel dysfunction or both after receiving radiation therapy to the prostate gland. Medication is usually the first treatment recommended for these issues, although there are also injections and surgical procedures that can be used to address these side effects should they persist.
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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.
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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Are There Options To Prevent Or Treat These Side Effects
Yes. Your health care team can help you prevent or relieve many side effects. Preventing and treating side effects is an important part of your overall cancer treatment. This is called palliative care or supportive care. Before treatment begins, ask what side effects are likely from the specific type of treatment you are receiving and when they may happen. And during and after treatment, let your health care team know how you are feeling on a regular basis.
What Side Effects May I Have During Or After My Imrt Treatments
There are several side effects that you may have during or after your IMRT treatments. They are urinary problems, bowel problems, erectile dysfunction or impotence , skin problems, loss of appetite and tiredness. Remember, that IMRT treatments are focused on your prostate cancer. This protects the healthy cells around your prostate, which means you may have fewer side effects and that the side effects you do have wont be as bad.
The urinary problems you may have are:
The bowel problems you may have are:
- Soreness in your rectal areaYou may have soreness in your rectal area. This usually goes away by itself. If you are very sore, let you doctor or health care team know. There are medicines and things that you can do to be more comfortable.
The erectile dysfunction problem you may have is:
- Fewer erectionsMost men do not have problems with erections or intercourse during or right after IMRT. Over time, you may find that you are not having as many erections as you used to. This is because the radiation can harm the nerves near your prostate that help you have erections. Talk to your doctor or health care team if you have a problem like this.
The skin problems you may have are:
Another problem you may have is:
If you have trouble figuring out how to make changes to deal with your tiredness, you may want to talk with your doctor or health care team.
Another problem you may have is:
Managing your side effects.
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Not Sleeping Well Causes Fatigue
Some people with cancer are not able to get enough sleep. The following problems related to sleep may cause fatigue:
- Waking up during the night.
- Going to sleep at different times every night.
- Sleeping duringthe day and less at night.
- Being inactive during the day.
- The time of day that cancer treatment is given.
Poor sleep affects people in different ways. For example, the time of day that fatigue is worse may be different. Some people with cancer who have trouble sleeping may feel more fatigue in the morning. Others may have severe fatigue in both the morning and the evening. People with cancer who are inactive during the day, have restless sleep, or who have obesity may have higher levels of fatigue.
Even in people with cancer who have poor sleep, fixing sleep problems does not always improve fatigue. A lack of sleep may not be the cause of the fatigue. See the PDQ summary on Sleep Disorders for more information.
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How Proton Therapy Effectively Treats Prostate Cancer
Proton therapy treats prostate cancer with high doses of radiation that are more accurate, and potentially more effective, than traditional radiation. Our targeted proton beams focus most of their destructive energy at the tumor site, therefore causing less damage to healthy surrounding tissue as they enter the body. Because of this, proton therapy patients dont have to worry about many of the side effects and additional healthy tissue damage that is commonly associated with X-ray therapy.
an effective cancer treatment alternative
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What Is Radiation Recall
Radiation recall is a rash that looks like a severe sunburn. It is rare and happens when certain types of chemotherapy are given during or soon after external-beam radiation therapy.
The rash appears on the part of the body that received radiation. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.
Typically, these side effects start within days or weeks of radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals before continuing chemotherapy.
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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.
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Help For Bowel Dysfunction
To help with symptoms of bowel dysfunction, your healthcare team may recommend:
Avoiding foods that can irritate your bowels
Taking antidiarrheal medications
Increasing fiber intake from fruits and vegetables
If you have persistent rectal bleeding, your team may recommend laser therapy. Laser therapy will scar the blood vessels in your rectum so they stop bleeding.
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Prostate Radiation Vs Robotic Prostatectomy
It is not possible to decide which treatment is better or more effective radiation or robotic prostatectomy, due to the fact that everybody has different stages of prostate cancer and other health-related issues. Below are enumerated pros and cons for each type of treatment, but every patient needs to take into account what his doctor is telling and suggesting.
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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 treatment’s 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.
Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
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Disabled Toilets And Emergency Access
As some shops, restaurants and leisure venues reopen after COVID-19 restrictions are lifted, its worth remembering that many of these will have customer toilets available.
There are a number of toilet cards you can apply for. The cards discreetly explain that you have a medical condition that means you need to use the toilet urgently. You can order a free toilet card from:
You can also buy a Radar Key from Disability Rights UK. This master key is part of the National Key Scheme . It gives you access to more than 9,000 locked disabled toilets around the country, including in shopping centres, department stores, pubs and cafes.
Changing Places also have a list of accessible toilets and rooms that can be used if you need a more private space. Some of them are free to access and some of them need a Radar Key. You can search for your nearest Changing Places toilet to find out more about it.
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Uf Health Proton Therapy Cancer Experts
As a major non-profit academic medical center, the University of Florida Health Proton Therapy Institute has treated more than 10,000 patients and led the way for innovative cancer care in the Southeast U.S. since 2006. As an academic health center, our published research is setting the standards for proton therapy cancer care worldwide, with dozens of clinical trials and more than 300 published research articles in peer-reviewed journals.
When you become a patient at UF Health Proton Therapy Institute, you are assured of receiving the highest quality cancer care as measured by state and national standards. We are committed to delivering the best possible patient outcomes. Our 125+ employees are dedicated to delivering proton cancer treatment in a way that takes the entire patient into account, so you can keep living life to the fullest.
1 Bryant C, Smith TL, Henderson RH, Hoppe BS, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Su Z, Li Z, Lee D, Mendenhall NP. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose- Escalated Image-Guided Proton Therapy for Prostate Cancer. International Journal of Radiation, Oncology, Biology, Physics. 2016 95:435-43.
Are you a candidate for Proton Therapy?
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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.
Radiation Therapy In Localized Disease:
For men that need treatment for localized prostate cancer, external radiation therapy and brachytherapy can be alternatives to surgery. Modern radiation therapy is as effective as surgery when used to cure prostate cancer.
At this stage of disease, radiation therapy is used to attempt to cure the disease. However, it is also sometimes used if surgery didnt completely remove the cancer, or it came back in the area of the prostate after surgery.
These treatment options may require multiple visits. As always, it is important to consider costs and potential side effects. Scroll down to learn more about the different types of external radiation therapy or brachytherapy.
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Management Of Urinary Dysfunction
Because the urinary symptoms following radiation therapy stem from irritation of the tissues, drugs that improve urinary flow are commonly used. Tamsulosin , terazosin , and other alpha-blockers are typically instituted in all men following radiation therapy for at least a few weeks, and are gradually withdrawn as symptoms improve. Anticholinergic medications like tolterodine or solifenacin can help treat bladder irritation symptoms as well.
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In cases of persistent urinary incontinence, the least invasive procedure consists of an injection of collagen into the urethra. This tightens the passageway, making it more difficult for urine to leak through. Although over 50% of men stay dry with this procedure, the effects only last for a short time.
Longer-lasting results are seen with surgical procedures. In one-type of procedure, a sling made from silicone or, more rarely, human tissue is slipped under the urethra and anchored to the muscle or bone, relieving the urethra from pressure buildup in the abdomen as urine accumulates in the bladder.
The sling results in urinary function improvements in about 70% of men after prostatectomy, although only about half of those reported being completely dry after four years. Following radiation therapy, only 30% of men showed an improvement, with even fewer men reporting being completely dry after four years.
Spaceoar Hydrogel Reduces Side Effects Of Prostate Cancer Radiation Therapy
While radiation treatment for prostate cancer has become much more precise over the years, the organs location immediately next to the rectal wall can expose the rectum to high dose radiation, which can lead to disruption in bowel function for some patients.
A new method for reducing these short- and long-term side effects is SpaceOar hydrogel, now available at Fox Chase.
In a minimally invasive outpatient procedure, the two liquid components of SpaceOAR hydrogel are injected through the peritoneum into the space between the rectal wall and the prostate by a urologist. The procedure is done under anesthesia with ultrasound guidance.
The resulting interaction between the two fluids creates a temporary and absorbable gel spacer that is primarily made of water. Hydrogels have been used in other implants such as surgical sealants used in the eye, brain and spine.
The OAR in SpaceOAR stands for Organ At Risk, referring to the rectum.
The position of the prostate poses particular challenges for the higher doses of radiation treatment required for this type of cancer, Fox Chase radiation oncologist Mark Hallman MD, PhD said. The posterior prostate lies right on top of the interior rectal wall and this puts the rectum at increased risk.
SpaceOAR was approved as a medical device by the FDA in 2015 and Fox Chase is among the first in the Philadelphia area to offer it.
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