Types of Radiation Therapy for Prostate Cancer
External Beam Radiation Therapy (EBRT): A machine outside your body aims radiation at your prostate. It’s like getting an X-ray, but more focused to treat cancer cells.
Brachytherapy (Internal Radiation): Small radioactive seeds are placed inside your prostate to fight the cancer from the inside.
Stereotactic Body Radiotherapy (SBRT): SBRT is a highly precise form of radiation therapy. It delivers a few high-dose treatments to the prostate. SBRT is usually completed in fewer sessions compared to other types of radiation, often in 5 or fewer treatments. It’s very effective at targeting the cancer while minimizing damage to nearby healthy tissue.
Proton Therapy: Proton therapy uses protons instead of traditional X-rays to target prostate cancer. Protons have the potential to reduce radiation exposure to surrounding healthy tissues. However, current studies do not show a significant improvement in outcomes compared to conventional photon therapy.
The Treatment Process
Radiation therapy is a step-by-step journey, and your care team will be with you every step of the way to make sure you feel comfortable and informed.
Step 1: Consultation
Your journey begins with a consultation. During this visit, you will meet with your radiation oncologist who will discuss your diagnosis, explain how radiation therapy can help, and answer any questions you may have. This is a great time to talk about any concerns you might have, including potential side effects and the overall process.
Step 2: Planning and Simulation
Once you decide to proceed, the next step is a planning session, also known as a simulation. During this session, you will lie on a table while the team uses imaging scans like CT or MRI to determine the exact location of your prostate. These scans help the doctor create a detailed plan for your treatment, ensuring that the radiation targets the cancer as precisely as possible while protecting healthy tissue. You may receive small marks on your skin (tattoos or markers) to help guide the machine during treatment.
If your prostate is intact, your doctor may recommend additional steps to improve the safety and effectiveness of your treatment:
SpaceOAR Hydrogel: SpaceOAR is a special gel that is placed between your prostate and rectum to create a space. This helps reduce the radiation dose to your rectum, lowering the risk of side effects. The procedure is done before radiation begins and is minimally invasive.
Fiducial Markers: Small gold markers (fiducial markers) may be placed in your prostate. These markers help guide the radiation precisely to your prostate each time you receive treatment. This ensures the radiation is delivered accurately, especially if the prostate moves slightly due to normal body functions.
Step 3: Treatment Begins
Treatment will start soon after the planning session. You will be scheduled for a series of treatments, typically 5 days a week for several weeks. For SBRT, treatments may be fewer but more intense. During each session, you will lie on the treatment table while a machine moves around you to deliver the radiation. The treatment itself is painless, and each session usually takes about 10 to 20 minutes. Your care team will be nearby, and you will be able to speak to them through an intercom if needed.
Step 4: Monitoring and Follow-Up
Throughout the treatment process, your doctors and nurses will monitor you closely to make sure everything is going smoothly. They will check on any side effects and adjust your treatment if needed. After you complete your radiation therapy, you will have follow-up appointments to track your progress and ensure the cancer is responding well. This is also a time to discuss any long-term side effects or concerns you may have.
Acute Side Effects
Acute side effects happen during treatment and may last for several weeks after radiation ends. Most of these side effects gradually improve over time.
Tiredness (Fatigue): Many people feel more tired than usual during treatment. This fatigue can continue for a few weeks after radiation ends. It’s important to rest when you need to and give your body time to recover.
Skin Changes: The skin in the treatment area may become red or irritated, almost like a sunburn. These changes usually appear within a few weeks of starting treatment and may take a few weeks to heal after treatment is complete. Keeping the area clean and moisturized can help.
Urinary Problems: You might feel like you need to pee more often, or you might have some burning when you pee. These symptoms often develop during treatment and may last for several weeks afterward. You may also experience a slow urinary stream or frequent need to urinate, particularly at night. This is due to irritation of the prostate and surrounding tissues. These symptoms generally improve gradually a few weeks after radiation ends. Drinking plenty of water can help ease these symptoms, but try to avoid caffeine and spicy foods, which may worsen them.
Bowel Changes: Some people notice looser stools or need to go to the bathroom more often. These symptoms usually improve a few weeks after treatment ends.
Late Side Effects
Late side effects may include conditions that develop months or even years after radiation treatment is completed. These can range from mild to more serious, and your care team will discuss these potential risks with you in detail.
Urinary Issues: In some cases, urinary problems like incontinence, difficulty urinating, or a persistent slow urinary stream can develop later. You may also find that you need to urinate more frequently. These side effects are less common but may require additional treatment or lifestyle adjustments.
Cystitis: Radiation cystitis is a rare condition where the bladder becomes inflamed due to radiation. Symptoms may include blood in the urine, bladder pain, or a frequent need to urinate. If you experience any of these symptoms, it’s important to discuss them with your doctor, as they can provide treatments to help manage the symptoms.
Bowel Issues: Some people may have ongoing bowel changes, such as increased frequency or urgency. These effects are usually mild but can be bothersome.
Proctitis: Radiation proctitis is a rare condition where the lining of the rectum becomes inflamed. This can lead to symptoms like rectal bleeding, discomfort, or changes in bowel habits. If these occur, your doctor can help provide treatments to alleviate the symptoms.
Erectile Dysfunction: Radiation can affect the nerves and blood vessels that help with erections, leading to erectile dysfunction. This can develop months or years after treatment and may be managed with medication or other therapies.
Secondary Malignancy: There is a very small risk of developing a secondary malignancy (a new cancer) as a result of radiation exposure. This risk is rare, but it is something that your doctor will discuss with you during the planning process.
Self Care During Radiation
Manage Urinary Symptoms: If you experience a slow or frequent urinary stream, avoid caffeine and spicy foods, as they can irritate the bladder. Talk to your doctor if the symptoms persist or interfere with your daily life.
Prevent Constipation: Radiation can sometimes cause changes in bowel habits. Make sure to stay hydrated and eat fiber-rich foods to help prevent constipation and support bowel health.
Stay Active: Gentle exercises like walking or yoga can help reduce fatigue and improve your mood. Always check with your doctor before starting any new exercise routine.
Stay Hydrated: Drink plenty of water to help manage urinary symptoms and keep your body functioning well. This can help flush out irritants and reduce discomfort, particularly if you are experiencing a slow or frequent urinary stream.
Listen to Your Body: Fatigue is common during radiation therapy for prostate cancer. Make sure to rest when you’re tired and pace yourself throughout the day. Light activities like walking can also help boost your energy.
Skin Care: Keep the treated area clean and dry. Avoid tight clothing that might rub your skin, and use gentle, non-irritating lotions if recommended by your care team to keep the skin moisturized.
Healthy Diet: Eating well is crucial during radiation therapy. A balanced diet rich in fruits, vegetables, lean proteins, and whole grains can help you maintain your energy levels and aid recovery. Foods high in antioxidants, like berries and leafy greens, can also support your body during treatment.