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 Kind Of Treatment Follow
Patients usually return to see the radiation oncologist about two to eight weeks after the last radiation therapy session. The main purpose of this visit is to see if the side effects from treatmentâsuch as bowel or urinary symptomsâhave subsided. In most patients, these symptoms subside in a few weeks. The doctor will check up on you and make sure you make good progress in recovery. After that, you will have regular follow-ups every three to six months. Your doctor may use a digital rectal exam to assess your prostate. A blood test will measure your PSA level and assess your response to treatment. Higher PSA levels can indicate the presence of prostate cancer. During follow-up, your doctor can also monitor any late treatment side effects and help manage them.
You may ask the radiation oncologist, âHow am I doing? Is the cancer all gone? Am I cured?â However, they cannot answer these questions immediately. After radiation therapy, it may take months to see your full treatment response. The body gradually disposes of dead cancer cells. Some cancer cells, even if technically dead , may continue to function for a while before ultimately dying. The rate of PSA level drop for successful radiation therapy is much slower than that of surgery. PSA usually drops by half every three to four months after radiation, and typically to the lowest level in about 12 to 18 months.
Which Approach Is Better: Active Surveillance Surgery Or Radiotherapy
The 10 year outcomes of the Prostate Testing for Cancer and Treatment trial from the United Kingdom has provided valuable insights into the management of localized PCa. The trial recruited 1643 men 50 to 69 years old. Of these 545 men underwent active surveillance, 553 surgery, and 545 radiotherapy. For the participants, the median follow-up was 10 years, the median age was 62 years, the median PSA was 4.6 , 77% were Gleason 6 and 21% were Gleason 7, and 76 % were T1c and the remaining T2. There were 17 prostate-cancerspecific deaths overall: 8 in the active surveillance group, 5 in the surgery group, and 4 in the radiotherapy group. The difference was not statistically significant among groups.
Metastases developed in more men in the active-monitoring group than in the surgery group or the radiotherapy group . Higher rates of disease progression were seen in the active-monitoring group than in the surgery group or the radiotherapy group . In summary, at a median of 10 years, prostate-cancerspecific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring, while 44% of the patients who were assigned to active monitoring did not receive radical treatment and avoided side effects.
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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. 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.
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Radiation Therapy: Effective For Prostate Cancer
Research published in the Journal of Medical Imaging and Radiation Oncology in 2015 shows that external-beam radiation therapy is a highly effective treatment option for prostate cancer.
Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer.
The 5-year survival rate using this treatment is 98.8% overall.
When compared to other common treatment options such as surgery or brachytherapy, external-beam was as effective and in some cases more effective.
A/Prof Tom Shakespeare, Radiation Oncologist at the North Coast Cancer Institute, led the eight year study comparing the effectiveness of external-beam radiation therapy with other common treatment options such as surgery or brachytherapy.
The main outcome that we have seen from this study is that external-beam radiation therapy is one of the most effective treatment options for prostate cancer, he said.
These are great results showing that radiation therapy is as effective, or even better, than other common treatment options such as surgery or brachytherapy.
In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases.
When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.
Unfortunately, this does not always happen.
How To Decide Between Radiation And Surgery For Localized Prostate Cancer
If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options: active surveillance, radiation therapy or surgery. If you arent comfortable with active surveillance, or if its not an advisable option for you, you may have to decide between radiation therapy and surgery to treat your cancer.
Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.
Weve heard of some physicians telling men of their prostate cancer diagnosis and asking them to make a treatment decision at the same appointment. But prostate cancer progresses slowly, so most men have time to think about their options and shouldnt feel pressured into making an immediate decision.
How you feel about the big three possible side effects of treatmenturinary incontinence, sexual dysfunction and bowel healthmay be the deciding factor for you.
To help you through the process of making this decision, this article covers:
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What Is The Success Rate Of Radiation Therapy For Prostate Cancer
Men with localised prostate cancer who are treated with external-beam radiation therapy have a cure rate of 95.5% for intermediate-risk prostate cancer and 91.3% for high-risk prostate cancer. The 5-year survival rate using this treatment is 98.8% overall.
Accordingly, can prostate cancer be cured with radiation?
Treatment for Prostate Cancer: External-Beam Radiation Therapy. If you have localized prostate cancer that needs curative treatment, you have two good options: Radiation and surgery. More than 60,000 American men opt for radiation every year, and the cure rates are excellent.
How long do you need radiation therapy for prostate cancer?
External beam radiation therapy is given to you five days a week for four to eight weeks. The total dose of radiation and the number of treatments you need depends on the size of your prostate cancer, your general health, and other medical treatments you have had or need to have.
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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
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How To Compare Radiation Vs Surgery For Prostate Cancer
Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.
How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.
What Are The Different Types Of External Beam Radiation Therapy
Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a CT scan to map your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.
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How Much Radiation Is Given
Based on the simulation, other tests, and your cancer type, the radiation oncologist will work with the other members of his team to decide how much radiation is needed, how it will be given, and how many treatments you should have. They figure this out based on research that has shown what the minimum and maximum dose of radiation should be for the type of cancer and area of the body being treated.
If the cancer has not completely gone away or if it comes back, more treatment might be needed. In these cases, the radiation team will help decide whether or not radiation therapy is the best option. This decision depends on the type of cancer, where the tumor is, and how much radiation was given to the area before. If the maximum dose has already been reached, radiation might not be the best option and other treatment may be offered. Getting radiation again to the same area is called re-irradiation.
What Are The Side Effects Of External Beam Radiotherapy
Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease.
Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover so side effects may only last a few weeks or months. But some side effects can start months or years after treatment. These can sometimes become long-term problems. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.
If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy. Read more about the side effects of hormone therapy and how you can manage them.
If youre having radiotherapy as a second treatment, and you still have side effects from your first treatment, then radiotherapy can make those side effects worse or last longer. It may also cause other side effects. The most common side effects of radiotherapy are described here.
Short-term side effects of radiotherapy
Radiotherapy can irritate the lining of the bladder and the urethra, which is the tube men urinate and ejaculate through. This can cause urinary problems, such as:
Tiredness and fatigue
Problems with ejaculation
Skin irritation and hair loss
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Next Steps & Resources:
- Learn more about our featured clinical experts:
- Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Healths John Theurer Cancer Center and associate professor of Oncology at the Hackensack Meridian School of Medicine.
- Prashant Desai, M.D., medical director of radiation oncology at Hackensack Meridian Ocean Medical Center.
- Priti Patel, M.D., medical director of radiation oncology at Hackensack Meridian Riverview Medical Center.
- US News & World Report has recognized Hackensack Meridian John Theurer Cancer Center as the best cancer center in New Jersey. To schedule a visit or a second opinion call 551-996-5855.
- We also offer cancer services across Hackensack Meridian Health at several convenient locations near you. To schedule a visit or a second opinion call1-844-HMH-WELL.
Managing Side Effects Of Radiation Therapy
Advances in the precision of radiation therapy have lessened the risk of complications. And our doctors are constantly developing new ways to minimize side effects. For example, we are one of the few hospitals in the United States using an FDA-approved biodegradable gel inserted before treatment to protect the rectum.
Still, radiation can cause short- and long-term side effects, including incontinence , erectile dysfunction, bowel problems, fatigue, and symptoms in other parts of the body .
Any side effects you experience depend on which part of the body receives radiation. In the case of such techniques as image-guided radiation therapy and stereotactic radiosurgery, it also depends on which normal structures are in the path of the radiations beam. In addition, radiation therapy is sometimes delivered in combination with hormonal therapy, which can cause impotence. Our experts will work closely with you and your medical team to manage any treatment-related difficulties you may experience, such as bladder, bowel, or erectile dysfunction. However, because of the sophisticated targeting systems we use, severe long-term bladder and bowel problems are now rare.
During the course of radiation treatments, some men experience diarrhea or frequent and uncomfortable urination. Please tell your treatment team if you have any of these problems. We can recommend medications and other methods that can help alleviate these uncomfortable side effects.
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