What Happens Before Radiation Therapy Treatment
Each treatment plan is created to meet a patientâs individual needs, but there are some general steps. You can expect these steps before beginning treatment:
Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.
Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an âinformed consentâ form. Signing the document means:
Your team gave you information about your treatment options.
You choose to have radiation therapy.
You give permission for the health care professionals to deliver the treatment.
You understand the treatment is not guaranteed to give the intended results.
Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:
Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.
You may also be fitted for an immobilization device. This could include using:
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What To Know About Radiation Therapy For Prostate Cancer
As treatment options for prostate cancer get better, it can be tough for men to understand what to expect, especially when it comes to radiation therapy.
Its critical that men find a care location that not only offers the latest clinical advancements, but has an experienced and diverse team that treats all aspects of cancer, including the physical, functional and emotional aspects of the disease, shares Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Healths John Theurer Cancer Center.
Dr. Gejerman, as well as radiation oncologists Prashant Desai, M.D., medical director of radiation oncology at Ocean Medical Center and Priti Patel, M.D., medical director of radiation oncology at Riverview Medical Center, helped answer some of the most commonly asked questions about radiation therapy for prostate cancer below.
Q: What are the different types of radiation therapy for prostate cancer?
There are several forms of radiation therapy, but they can be broken down into two main categories:
External Beam Radiation â This form of therapy is more common, and delivers radiation from outside your body to treat cancer. This type of therapy can be used on its own or in combination with brachytherapy, depending on how aggressive your cancer is. There are three main techniques of delivering EBRT for prostate cancer:
Q: Is radiation therapy painful?
Q: Is radiation therapy safe?
Q: When is radiation therapy the right choice?
How Long Does It Take To Recover From Radiation Treatment
Everything from your age at the time of radiation to the type of cancer treated can influence your path to radiation recovery. Even though most radiation treatments only target specific collections of cancer cells, the effects of radiation can easily spread to nearby cells. Most recover within a few weeks, but some injuries develop later or require a longer recovery process.
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Survival By Tumor Grade
One way cancer is staged is by looking at the grade of cancer. Grade refers to how cancer cells look like under a microscope.
Traditionally for prostate cancer, this has been done using the Gleason Score, which was developed in the 1960s. Under this system, cancerous cells are categorized on a scale from 1 to 5. Grade 1 cells are considered normal prostate tissues, while cells in the grade 5 range have mutated to such an extent they no longer resemble normal cells.
In determining a Gleason score, a pathologist will examine a biopsy sample under a microscope and give a Gleason grade using the above scale to the most predominant pattern displayed, then a second grade to the pattern that is the second most predominant. Those two grades are then added to form the overall Gleason score .
In theory, Gleason scores could range from 2 to 10, but pathologists today rarely give a score between 2 and 5 and are more likely to be in the range of 6 to 10 with 6 being the lowest grade of prostate cancer.
Under the Gleason Score system, a 6 is considered low grade, 7 is intermediate and scores of 8, 9, or 10 are considered high-grade cancers.
The higher the Gleason score, the more likely it is the prostate cancer will grow and spread quickly.
However, there have been some issues with the Gleason system, and a new grading system, to act as an extension of the Gleason system, has been developed.
Under this system Gleason scores are now categorized into grade groups:
What Is Radiation Therapy
Radiation is the strategic use of ionizing radiation or photons to kill cancer cells. It works by damaging the cancer cells DNA .The targeted cells die without growing or replicating themselves. Radiation therapy, like surgery, is very effective at killing localized or locally advanced prostate cancer and has the same cure rate as surgery.
Just as surgical skill can play an important role in determining outcomes from prostatectomy, the technical skill of your radiation oncologist can play an important role in radiation outcomes. When choosing a radiation oncologist, look for a physicians who has broad experience with an assortment of approaches and can objectively help you decide on the best course of treatment.
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Sexual And Reproductive Health
You can be sexually active during your radiation therapy, unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else.
If youre sexually active with someone whos able to get pregnant, its important to use birth control during and for 1 year after your radiation therapy. During your radiation therapy, your sperm may be damaged by the radiation. If you conceive a baby with this sperm, the baby might have birth defects. Using birth control helps prevent this.
For more information about your sexual health during cancer treatment, read Sex and Your Cancer Treatment. The American Cancer Society also has resources about sexual health issues during cancer treatment. The one for men is called Sex and the Adult Male with Cancer. You can search for it at www.cancer.org or call for a copy.
Male Sexual and Reproductive Medicine Program
MSKs Male Sexual and Reproductive Medicine Program helps people address the impact of their disease and treatment on sexual health. You can meet with a specialist before, during, or after your treatment. We can give you a referral, or you can call for an appointment.
Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
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Advantages And Disadvantages Of External Beam Radiotherapy
- You dont need a general anaesthetic and you dont need to stay overnight in hospital.
- You may be able to work and carry on normal activities during the treatment.
- You are not radioactive during or after the treatment so you can be in close contact with others.
- Each treatment is relatively short. It usually takes about 15 minutes, although you may be in the radiotherapy department for up to an hour.
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.
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Radiopharmaceuticals That Target Psma
Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.
Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.
This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.
This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.
Possible side effects
Some of the more common side effects of this drug include:
This drug can lower blood cell counts:
- A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
- A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
- A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.
This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.
What Side Effects Will I Have
During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation. Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice a loss of hair or decreased perspiration within the treated area.
These skin reactions are common and temporary. They will subside gradually within four to six weeks of completing treatment. If skin changes appear outside the treated area, inform your doctor or primary nurse.
Long-term side effects, which can last up to a year or longer after treatment, may include a slight darkening of the skin, enlarged pores, increased or decreased sensitivity of the skin, and a thickening of tissue or skin.
Another possible side effect is erectile dysfunction and urinary symptoms such as frequency, bleeding, or, rarely, incontinence. Keep these side effects in mind when considering your treatment options. If you have any concerns, donÃ¢t hesitate to talk to your doctor about them.
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What Happens During External
What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive. External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.
Each session is generally quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine.
Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.
This type of radiation therapy only targets the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until after the treatment period is complete. Let your health care team know if you are experiencing any side effects so they can help relieve them. Read more about the side effects of radiation therapy.
Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. âItâs more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,â Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. âIt slowly sets in after radiation treatment,â Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
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Focal Therapy For Prostate Cancer
With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer. Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function
Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer. Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.
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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.
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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.
Possible Risks And Side Effects Of Brachytherapy
Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.
These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.
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