Patient Information

Treatment Options

Radiation Options

Once your urologist meets with you and reviews your diagnosis, he may refer you for a consultation with the radiation oncologist. A radiation oncologist is a doctor who specializes in the treatment of cancer patients, using radiation therapy as the main modality of treatment. You will be given an appointment to come for a consultation. You will first meet with the nurse who will review your health history and then discuss radiation treatments. Following this, the doctor will meet with you and advise you of his recommendations. Having a consultation does not commit you to this type of treatment. Our goal is to educate you about radiation treatments so you can make an informed decision. You should allow at least one hour for this first meeting. We encourage you to bring a friend or family member along to join the consultation.

Radiation treatments are an important tool in treating many cancers. The DNA in the center of the cell is damaged by radiation so the cell is not able to reproduce or duplicate. The cancer cells do not have the ability to repair themselves, so they die off.

External Beam Radiation Therapy

The most common type of radiation is external beam. A machine called a linear accelerator creaetes a high energy radiation beam that can be focused on the prostate.  Nothing touches your body and you are not enclosed. You are not able to see or feel the radiation.

The full course of external beam radiation takes 43 or 44 treatments. These treatments are given Monday through Friday, with Saturday and Sunday off. The purpose of this is to obtain better results from cancer cells becoming disabled at different stages of their development. The daily treatment takes just 15 minutes. You will be able to select workable appointment times and come at the same time each day. All treatments are performed at our facility and do not require hospitalization.

The most common side effect is fatigue, which occurs toward the end of the radiation period. This often will begin about the sixth week through the end of the treatment. Some other side effects which are common are related to urination. It is not uncommon to have some urgency to urinate along with some mild burning sensation. The stool consistency may change to either more frequent smaller amounts of mushy consistency or more firm and less often. There is a possibility of impact on sexual performance with some compromise presenting even years after treatment.

You may continue to work and continue daily routines while receiving radiation. The more normal you keep your routine, the better you may tolerate your treatments.

Do’s and Don’ts of External Beam Radiation Therapy
  • Use lukewarm water to shower
  • Use a mild soap such as Ivory or Dove
  • Do not use a brush on the skin of the treatment site
  • Gently pat your skin dry
  • Do not sit in hot tubs
  • Do not put heating pad or hot water bottle on lower abdomen
  • Do not apply talcum powder or after-shave below the waist
  • Eat a well balanced diet, avoiding acid juices (orange juice) and tomatoes
  • There are no restrictions on activity
  • Report any blood in urine or stool
  • Report any repeated episodes of diarrhea
  • Avoid bicycles or motorcycles for three weeks after having anything inserted in prostate (seeds or beacons)

The second type of radiation is continuous release of a radioactive source implanted in the prostate. This is referred to as brachytherapy. This is also referred to as seed implantation.

Often times several different types of treatment may be combined. For example, a high grade aggressive cancer may be treated with both external beam and brachytherapy. Androgen deprivation therapy (hormone therapy) may also be added to either treatment to achieve longer survival times than either therapy used alone.

Prostate Seed Implantation (Brachytherapy)


http://en.wikipedia.org/wiki/File:Brachytherapy.jpeg

Prostate seed implants are tiny radioactive pellets which are smaller than a grain of rice. This treatment consists of implanting the seeds into the prostate as close to the cancer as possible. The implants deliver two times the amount of radiation given by external beam radiation. The number of seeds needed to treat your cancer is determined by the size of your prostate. Usually 50 to 80 seeds are placed one at a time. The seeds release radiation slowly over a period of months. Within one to two years the radioactivity is considered gone but the metallic seeds remain in place.

You will need to have a special ultrasound exam prior to your implant. This is called a Volume Study. This test is done to determine the size and shape of your prostate. The radiation oncologist will insert a probe in your rectum to obtain the accurate measurement of your prostate. If your prostate size is within the recommended limits, then the doctor will formulate a play for the placement of seeds. This procedure will be done at the Boardman Cancer Center.

The implantation of the seeds will be done in the operating room at the Boardman Campus of St. Elizabeth. Your urologist will be present along with the radiation oncologist. This procedure will be done on an outpatient basis. You will be totally asleep during the surgery so you must be accompanied by a driver. The procedure takes 45-90 minutes. You will be discharged the same day. You will go home with a catheter in your bladder. This will be removed within a day or two. This treatment does not require a surgical incision so you may resume normal daily activities within a few days after the procedure.

The most common side effects of this type of treatment are:

  • Frequent urination
  • Burning with urination
  • Difficulty with urination
  • Soreness in the perineum

These symptoms may last for several weeks to several months. They will decrease as the seeds lose their strength.

You may need to take some precautions being around small children and pregnant women if you choose this method of treatment.

Not all patients are candidates for seed implantation. This can only be determined by a consultation with a radiation oncologist. Often times this procedure is used in conjunction with another type of treatment.

Surgical Options

For some patients, a good treatment option is surgical removal of the prostate. This involves removing the entire prostate, seminal vesicles and a portion of the bladder neck. When considering surgery many factors are taken into consideration including:

  • Cancer stage
  • Age
  • General medical condition
  • Life expectancy

Surgical techniques include Robotic-Assisted Laparscopic as well as Open Prostatectomy.

A urinary catheter remains in the bladder for at least a week after all surgeries. The main side effects of surgical intervention are erectile dysfunction and urinary incontinence.

Androgen Deprivation Therapy

Prostate cancers can be slowed by medication. This is not a permanent cure, but can add many productive years by causing a remission. The male hormone, testosterone, stimulates the growth of cancer. By eliminating testosterone from the body, the cancer may go into a dormant state. This can be accomplished by the administration of drugs called LHRH agonists. This interrupts the production of testosterone. These drugs may also be added to radiation to augment treatments for a more effective result. Another type of drug is called an antiandrogen which blocks the body’s ability to absorb any testosterone into the cells.

These drugs are given in the form of injections which last over the period of one to six months. There are side effects which accompany these drugs. They range from hot flashes, breast tenderness, impotence, and possible breast enlargement. These medications are prescribed by your urologist and administered in his office.

Watchful Waiting

Watchful waiting may be a choice for some men with lower risk cancers that are confined to the prostate or in elderly men with low risk of cancer progression.

Regular evaluations will be done by your urologist consisting of digital exams, PSA tests, and in some instances, follow-up biopsies. As long as there is no change in these factors, you may continue watchful waiting. Often this can continue for years. Treatment may be considered with evidence of cancer change/progression.