Late Effects After Radiation For Prostate Cancer
Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.
Radiation to the bladder area can cause late effects to the bladder including:
The bowel is sensitive to the effects of radiation. The late effects that may occur after radiation treatment that includes the rectum, colon, or small bowel include:
Surgery to remove lymph nodes or radiation to lymph nodes can cause damage to lymph nodes and lead to lymphedema. Lymphedema is swelling that can happen in the genital area, belly, buttocks, legs or feet after treatment. It can cause pain, be disfiguring, make activity difficult, and increase the risk of infection in the area.
- Talk to your provider if you are having any new swelling. A Certified Lymphedema Therapist should be consulted at the first sign of swelling to try to keep the lymphedema from worsening.
- You are at risk of infection in any area with lymphedema or that is at risk for lymphedema. If you experience any signs of infection, contact your care team right away or go to the emergency room. These signs include a sudden increase in swelling, an increase in pain, redness, the area is warm to the touch, or fever.
Impact on Reproductive Organs, Sexual Function, and Fertility
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.
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, both of which are common with any radiation treatment given to the prostate. But at MSK, we routinely use sophisticated 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.
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 that the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and after a few months dissolves on its own within the body, causing no harm or long-term effects.
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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.
How To Cope With Digestive Issues
Chemotherapy and radiation therapy can both cause nausea, vomiting and diarrhea. There are several medications, however, that can prevent and alleviate these digestive concerns. Additionally, making certain dietary changes can help ensure that you get the nutrients you need when dealing with digestive issues.
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Side Effects Of Radiation Therapy To Your Prostate
Some people have side effects from radiation therapy. The type and severity of side effects varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.
This section explains the most common side effects of radiation therapy to the prostate. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.
Problems Passing Urine And Leakage Of Urine
You might have problems passing urine after the radiotherapy ends. It might gradually get harder to pass urine over a few weeks or months. This is due to the treatment causing a narrowing of the tube from the bladder to the penis . The narrowing is called a urethral stricture.
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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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.
British Columbia Specific Information
Prostate cancer is a cancer of the prostate gland, which is a gland that produces the milky liquid found in semen. Patients with low-risk prostate cancer have a 10-year cancer survival rate of over 99%.
You are considered a low-risk patient if you have a PSA value that is equal or less than 10 nanograms per millilitre , a Gleason score that is equal or less than 6, and your cancer stage is T1c/T2a. PSA is your prostate specific antigen measured by a blood test, the Gleason score indicates how aggressive the cancer is by looking at tissue biopsy results, and the cancer stage describes how much the cancer has spread.
Active surveillance has been developed to allow for careful management of men with low-risk prostate cancer. For more information, visit BC Cancer Agency – Prostate.
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Proton Beam Radiati On Therapy
Proton beam radiation therapy capitalizes on a unique physical property of high energy protons generated from a cyclotron. The accelerated charged particles travel through tissue until reaching a depth determined by their energy. Once they reach that depth, the remainder of the radiation dose is deposited in a sharp Bragg peak with no dose going beyond that point. When multiple proton beams are used, a very sharp and tight radiation dose distribution is created. This modality is especially attractive when tumors are in close proximity to sensitive organs. PCa is one of the more common indications in which proton therapy is utilized.
At Washington University in St. Louis we are collaborating with investigators from Massachusetts General Hospital and the Harvard Medical School conducting a randomized clinical trial of IG-IMRT versus proton beam radiation in men with low and intermediate risk PCa. The PARTIQoL trial is seeking to measure and compare relative the impact of the two modalities on patient quality of life after treatment. Figure 1 provides a comparison of these two treatment modalities.
Axial CT slice showing conformality of intensity modulated radiation therapy. Radio-opaque markers are apparent in the anterior aspect of the prostate gland. Axial CT slice showing conformality of proton beam radiation therapy in the same patient as panel a. More sparing of the anterior-lateral rectal wall and less dose to peripheral tissues is apparent.
Who Should Consider External Beam Radiation Therapy
In most cases, external beam radiation therapy is used for men with localized prostate cancer . The intent of EBRT in this case is to kill the tumor while sparing as much healthy tissue as possible. Sometimes it is used in more advanced cases. For example, it can be used along with hormone therapy, or used to relieve pain from bone metastases.
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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.
Possible Long Term Side Effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later. This includes problems getting an erection.
Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021
Cancer: Principles and Practice of Oncology VT DeVita, TS Lawrence, SA RosenbergWolters Kluwer, 2019
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Inflammation Of The Back Passage
Inflammation of the back passage is a long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Bleeding is usually slight but can be more severe for some people. Talk to your radiographer or nurse if you have proctitis. They might suggest you use treatments such as steroid suppositories for a short time. This might reduce the inflammation.
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.
If Youre Having Radiation Therapy To The Pelvis
Radiation therapy to the pelvis can cause side effects such as:
- Bladder problems
- Fertility problems
- Changes in your sex life
You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.
Radiation to the pelvis can cause problems with urination, including:
- Pain or burning sensations
- Blood in the urine
- An urge to urinate often
Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:
- Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.
- Urinary incontinence. Radiation treatments for certain cancers, such as prostate and bladder cancer, may make you unable to control your urine or have leakage or dribbling. There are different types and degrees of incontinence, but it can be treated. Even if incontinence cant be corrected completely, it can still be helped. See Bladder and Bowel Incontinence to learn more. This side effect is most often a problem for men being treated for prostate cancer, but some of the information might also be helpful for women dealing with treatment-related incontinence.
Side Effects Of Ebrt For Prostate Cancer
Many of the possible side effects of radiation therapy for prostate cancer involve the bladder and bowelthe prostate is very close to both. Although the goal is to target only the prostate with radiation, sometimes small amounts may cause problems to nearby areas of the body.
Some of the potential side effects from EBRT include:
- Bowel problems, including diarrhea, leakage or rectal bleeding
- Urinary symptoms, such as a need to urinate more frequently, incontinence or a burning sensation during urination
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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.
Low Levels Of Vitamin B12
You might have low vitamin B12 after radiotherapy to the pelvis . This is called a vitamin B12 deficiency.
Radiotherapy can stop your digestive system from taking in vitamin B12 from the food you eat. This is called malabsorption. This means you can have a B12 deficiency even if you eat a balanced diet.
A B12 deficiency can be a cause of anaemia. This can lead to weakness, diarrhoea, numbness and tingling.
Its important that you go to your doctor if youre experiencing these symptoms so that they can help you.
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What Happens During Each Treatment Visit
External radiation is a lot like getting a regular x-ray. The treatment itself is painless and takes only a few minutes. But each session can last 15 to 30 minutes because of the time it takes to set up the equipment and put you in the right position.
External radiation therapy is usually given with a machine called a linear accelerator which delivers a beam of radiation. The machine has a wide arm that extends over the treatment table. The radiation comes out of this arm. The machine can move around the table to change the angle of the radiation, if needed, but it wont touch you. The radiation beams are invisible and you will not feel anything, but the machine will make noise.
Depending on the area being treated, you might need to undress, so wear clothes that are easy to take off and put on. Youll be asked to lie on the treatment table next to the radiation machine.
The radiation therapist might put special heavy shields between the machine and parts of your body that arent being treated to help protect normal tissues and organs.
Once youre in the right position, the radiation therapist will go into a nearby room to operate the machine and watch you on a TV screen. The room is shielded, or protected from the radiation so that the therapist isnt exposed to it. You can talk with the therapist over an intercom. Youll be asked to lie still during the treatment, but you wont have to hold your breath.
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Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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