Life After Cancer Treatment
After you finish treatment for cancer, give yourself time to adjust to the physical and emotional changes. We are still here to support you after your treatment finishes.
You will need regular check-ups with your treatment team. These may include some blood tests or physical examinations. Speak with your treatment team about the plan for you.
Why It Is Done
Radiation therapy is used for:
- Cancer that has not spread in generally healthy men.
- Cancer that has spread to the bones, and is causing pain or other symptoms.
- Cancer that has come back in the prostate after surgery.
- Cancer cells that may remain after surgery, especially if all the cancer cannot be removed.
Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
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What Are The Different Types Of Radiation Treatments
Radiation therapy uses concentrated doses of radiation to kill cancer cells and reduce the size of tumors. Depending on the type of cancer present in the body, one of two types of radiation therapy may be used.
External beam radiation therapy uses a large machine to send radiation into the specific area containing cancer. The radiation machine never touches the body, but it does move around to deliver radiation into precise parts of the body. External beam radiation is the most common type of treatment for many cancers.
Internal radiation therapy, on the other hand, uses a solid or liquid radiation source to physically deliver radiation inside the body. If a solid source of radiation is used, it only targets a specific part of the body for localized treatment, especially for cancers of the head, neck, breast, cervix, prostate, and eye. If a liquid source of radiation is used, its considered a systemic therapy that travels through the blood into tissues throughout the entire body.
Radiation therapy is often used in conjunction with other treatments or surgeries to target cancer in the most strategic way possible. Its often used to make surgery easier by shrinking the size of the tumor beforehand. Radiation therapy is even used during surgery to go straight into cancer cells without passing through the skin.
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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How Long Will Hormone Therapy Keep My Cancer In Check
Hormone therapy typically is effective for only a few years, but this period can range from several months to many decades. For many men who were using an antiandrogen in combination with an LHRH agonist or antagonist, stopping the antiandrogen, or antiandrogen withdrawal, is the most common first step in secondary hormone therapy. Between 10%30% of men will respond to anti-androgen withdrawal, which lasts on average 3 to 5 months. However, inevitably, additional therapies will need to be added even if this withdrawal response occurs. Continuing the LHRH agonist or antagonist and adding a new therapy in combination can improve survival and maintain or improve quality of life.
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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What Symptoms Should I Look Out For
If your cancer does come back, the first sign is likely to be a rise in your PSA level, rather than any symptoms. And problems will often be side effects of treatment rather than a sign that your cancer has come back.
However, its important to let your doctor or nurse know if you do get any new symptoms or side effects, or are worried that your cancer might have come back. If your cancer has come back and has spread from the prostate to other parts of the body, it can cause symptoms, such as extreme tiredness ” rel=”nofollow”> fatigue), bone pain and problems urinating.
Your doctor or nurse can help find out what might be causing your symptoms and help you manage any side effects. They can also look at your PSA level and do other tests to see whether or not your cancer might have come back.
What other tests might I have?
If your doctor or nurse is concerned about your PSA level or if you have new symptoms that suggest your cancer might have come back, they may recommend that you have some other tests, such as a prostate biopsy, MRI scan, CT scan, bone scan or PET scan.
Your doctor or nurse will explain these tests to you if you need them, or you can get in touch with our Specialist Nurses for more information.
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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Early And Late Effects Of Radiation Therapy
- Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
- Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.
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An Inclusive Clinical Trial
The team designed the phase 3 trial to be as inclusive as possible to capture a population that looks like people commonly treated in the community, Dr. Buyyounouski explained. The participants included both people getting radiation immediately after surgery and those who waited until they had rising PSA levels.
Participants who had some invasion of their cancer into nearby tissue were eligible, although those whose cancer had spread to their lymph nodes were excluded. They could also receive up to 6 months of androgen deprivation therapy, a type of hormone therapy, if recommended by their doctor.
Participants were randomly assigned to treatment with HYPORT, consisting of a higher dose of radiation every weekday for 5 weeks or the commonly used, lower dose every weekday for 7 weeks. They were asked about urinary and bowel symptoms before radiation and 6, 12, and 24 months after treatment, using the Expanded Prostate Cancer Index Composite questionnaire.
After prostate cancer treatments, common urinary symptoms can include urine leakage or pain or burning when urinating. Common bowel symptoms can include bowel leakage or urgency. The trial did not measure sexual side effects, such as erectile dysfunction, since these can also be affected by hormone therapy.
About three-quarters of the participants completed all questionnaires. At the end of treatment, people who received HYPORT reported more bowel side effects, although urinary side effects were equivalent between groups.
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Even When Prostate Cancer Returns Most Survive
By Anne Harding, Reuters Health
5 Min Read
NEW YORK Men who show signs that their disease has returned after prostate cancer treatment are still more likely to die of other causes, a new study in US veterans shows.
Nevertheless, researchers say the study underscores the need to find a better way to identify the minority of men who will die of prostate cancer after disease recurrence.
We often dont know what to tell these men in terms of their risk of dying of prostate cancer, Dr. Timothy Daskivich of the University of California, Los Angeles, told Reuters Health.
Detecting prostate cancer is most often done with a blood test that measures concentrations of prostate-specific antigen, or PSA, a protein made in the prostate that becomes elevated in men with prostate cancer.
After treating prostate cancer with surgery or radiation, PSA levels are monitored. If PSA levels begin to increase, this can serve as an early indicator of disease recurrence. But the effect of a rising PSA after treatment also known as biochemical recurrence on mens subsequent risk of dying from prostate cancer is not clear.
To investigate, Dr. Edward M. Uchio of the VA Connecticut Healthcare System in West Haven and Yale University School of Medicine in New Haven and his colleagues looked at 623 men who had been diagnosed with prostate cancer between 1991 and 1995 and were followed for up to 16 years after treatment.
During follow up, 420 men died, but only 86 died of prostate cancer.
What Types Of Radiotherapy Are There
There are different types of external beam radiotherapy used to treat prostate cancer. Ask your doctor, nurse or therapeutic radiographer which type of radiotherapy you are being offered, and for how long.
Intensity-modulated radiotherapy
This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location of your prostate and the organs near it to work out the precise radiation dose and create a plan for your radiotherapy treatment.
The radiotherapy machine gives out beams of radiation that match the shape of the area to be treated as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects. It also allows the treatment area to get the right doses of radiotherapy to get rid of the cancer. Most radiotherapy centres use a type of IMRT technique called VMAT . It is also sometimes called RapidArc.
Stereotactic radiotherapy
Stereotactic radiotherapy, also known as stereotactic ablative radiotherapy , is another type of external beam radiotherapy that is offered in some hospitals. SABR gives a much higher dose of radiation to the treatment area at each treatment session compared to IMRT, but a lower dose overall. You will have fewer treatment sessions with this technique. It is a very precise treatment that can be delivered on a standard Linac machine.
Proton beam therapy
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Management Of Urinary Dysfunction
Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow and treat irritative bladder symptoms are commonly prescribed to all men following radiation therapy for at least a few weeks. They are gradually withdrawn as symptoms improve.In cases of persistent urinary incontinence, surgical procedures, including a sling that relieves pressure buildup in the abdomen or artificial sphincters provide long lasting results.
Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.
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Side Effects Of Treatment
Treatments for prostate cancer can cause side effects, which might carry on after your treatment has finished. Some side effects can even start several months or years after treatment finishes.
Side effects will affect each man differently you may not get all the possible side effects from your treatment.
Read more about:
Managing side effects
Side effects can affect your day-to-day life, but there are treatments for them, as well as things you can do to manage them yourself. Its important to speak to your doctor, nurse or GP about them.
If youre having problems with a side effect, you might have a meeting with your doctor or nurse to work out what support you need. They may refer you to someone who can give you more advice and support.
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How Is A Recurrence Detected
After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.
When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.
Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.
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Who Can Have Radiotherapy
The treatment is suitable if your prostate cancer is found only within your prostate gland or has spread just outside it to the pelvic lymph nodes.
Radiotherapy and hormone therapy are often used together to treat locally advanced prostate cancer. This helps to make the radiotherapy work better at controlling your prostate cancer.
It may not be the best option if you have urinary symptoms, as it may make them worse.
What Happens Between Appointments
Contact your doctor or nurse if you have any concerns or get any new symptoms or side effects between your follow-up appointments.
Its important to speak to them if youre concerned about anything dont worry about them being too busy.
You can get support or advice over the telephone, or they might bring forward the date of your nextfollow-up appointment.
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