Radiation Therapy FAQs

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Prostate cancer radiation therapy is another form of treatment for prostate cancer. It includes external beam radiation therapy (EBRT) and brachytherapy. EBRT is usually done after other surgery, to manage high-risk recurring cancer. It has a very good success record. It provides long-term disease control and survival rates equivalent to treatments like surgery.

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Radiation can be delivered in two ways:

  • External-beam radiation therapy – The beam of radiation is aimed in the specific spot of the cancer, with the help of an ink tattoo that helps locate the same spot for each day of treatment. Radiation of healthy tissue will, thus, be avoided. External radiation therapy is typically performed 5 days a week for a period of 4-8 weeks. In cases where the cancer spreads to the bones, radiation might be applied to these specific areas.
  • Brachytherapy, or internal radiation therapy – tiny seeds of radioactive material are inserted into the prostate through needles. These are guided towards the prostate by the surgeon, using ultrasound. The radioactive material can be applied in high-dosage rates, in several occurrences for brief periods of time, or in low-dosage rates, in which case the radioactive material is permanently set in place.

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Prostate cancer radiation therapy can cause many side effects. Some are minor and diminish after therapy is stopped. The side effects include fatigue, skin inflammation in the treated areas, frequent or uncomfortable urination and rectal bleeding or irritation. Some prostate cancer radiation therapy side effects, however, are permanent. Bowel function may never become normal even after treatment is stopped. Impotence can occur up to 2 years after prostate cancer radiation therapy in some patients.

 

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There are several cases when radiation therapy might be considered a good option:

  • Early stage cancer in men that are younger than 70;
  • In returning cancer that has been previously treated with surgery;
  • In cancer that has spread to the bones and that isn’t responding well to hormonal treatment;
  • In cancer cells that couldn’t be removed with surgery.

There are studies that attest that surgery for prostate cancer is a better option over radiation therapy. Choosing between Surgery vs Radiation vs CyberKnife requires thorough information and discussions with your doctor.

 

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EBRT is similar to having a routine X-ray. Radiation is not seen, smelled or felt and side effects don’t occur until 2 or 3 weeks into treatment. Prostate cancer radiation therapy is a local treatment so only the areas of the body where it is administered will experience side effects.

Most patients experience some or all of the following prostate cancer radiation therapy side effects:

  • Burning or tingling with urination
  • Difficulty starting urination or weak urinary stream
  • Hemorrhoids or rectal irritation with some blood
  • Increase in urination frequency and urgency
  • Infrequent, softer and smaller volume bowel movements
  • Occasional diarrhea

Depending on the severity of these side effects, patients will be given anti-diarrheal medications or a medication to decrease the frequency of urination. Most symptoms are short-lived and diminish after the prostate cancer radiation therapy ends. Otherwise, patients typically continue with their normal daily activities during treatment.

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Patients are given detailed written instructions about the following:

Prostate Cancer Radiation Therapy – Radiation does not remain in the body once treatment is done and it is completely safe to be in contact with other people. With permanent seed brachytherapy, the tissues absorb the radiation from the implant. Any items which are touched, including bodily waste, are radioactive. However, during the first couple of months after permanent seed brachytherapy, patients should maintain a distance of 6 feet or more from pregnant women or those trying to conceive. Avoid close physical contact with young children and pets for long periods of time.

Sexual function – Sexual intercourse can be resumed after the seed implant but condoms should be worn during the first week after the procedure. Most men experience erectile dysfunction after prostate cancer radiation therapy. The likelihood of prolonged impotence is determined by age, the use and duration of prostate cancer radiation therapy, smoking and other medical conditions, such as hypertension and diabetes, as well as certain medications. For most men, erectile dysfunction diminishes slowly over the first 2 years post-treatment. Men who are not on medications containing nitrate can use oral medications that improve erectile quality with great success.

Patients may experience a longer time to reach orgasm after prostate cancer radiation therapy. Some notice change in the nature of their ejaculate, such as thicker or less fluid or a decrease in the quantity or an absence of ejaculate after treatment, more so with EBRT than brachytherapy. After brachytherapy, the ejaculate may be discolored, dark-brown or even black. This is due to “old” blood from the procedure. It is harmless and will eventually clear.

Sperm production – Prostate cancer radiation therapy affecting the testicles may lead to a temporary reduction in sperm count and, in some cases, lead to a permanent reduction in sperm count or sterility. Patients who are considering conceiving should seek medical advice regarding fertility and sperm banking.

Testosterone production – The dosage of prostate cancer radiation therapy reaching the testicles is not high enough to impair normal functioning.

On a final note, in a study by Dr. Mark S. Soloway, professor and chairman of urology at the University of Miami, it was found that prostate cancer radiation therapy created a statistically significant higher risk of developing bladder or rectal cancer as compared to those who had undergone radical prostatectomy.

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Following EBRT, follow-up appointments with the doctor will help monitor the patient’s recovery and ensure any side effects are diminishing. The frequency of follow-ups will depend on the risk of cancer recurrence. PSA blood tests will start around the third month after treatment and are repeated every 3 to 4 months during the first 2 to 3 years and then every 6 months. Brachytherapy patients will have a CT scan of the prostate 3 to 4 weeks after the procedure. This scan will evaluate the “quality” of the implant.

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PSA blood tests are used to monitor progress after treatment. Following prostate cancer radiation therapy, the PSA will be low but will not reach its lowest point for couple of years. Also, PSA results often vacillate up and down during the first 3 years after EBRT or brachytherapy; this does not mean treatment failed. After prostate cancer hormone therapy, as testosterone recovers, the PSA may rise and the period of eventual decline may be prolonged;  this is also not a sign of treatment failure. The PSA remains a vital monitoring tool and testing at regular intervals is crucial. In addition to the PSA, the doctor will evaluate other data to monitor treatment outcomes.

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Usually, no additional treatment is needed after prostate cancer radiation therapy. It’s important to note that patients can have radiation after surgery but surgery after radiation is almost impossible. If the prostate is removed, the follow-up is easier because the PSA would always be at zero. With prostate cancer radiation therapy, however, the PSA fluctuates as it had prior to surgery. Regularly scheduled PSA testing is important in evaluating the need for future treatment. Should the cancer return, treatment will, in part, depend upon the initial treatment choice. Additional or alternative forms of radiation therapy may be recommended. Doctors, including a radiation oncologist, urologist, and medical oncologist, will discuss treatment options at that time.

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