The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
You and your doctor may be talking about using radiation therapy to treat your prostate cancer. Deciding on the best treatment for your prostate cancer is a challenge. It is important for you to learn about radiation therapy so that you can choose the type of radiation therapy that will work best for you. In this booklet, you will learn about the following:
It is important to think about these things if you and your doctor decide that radiation therapy is the best way to treat your prostate cancer.
Radiation therapy is a cancer treatment that uses high energy beams, such as xrays, to kill cancer cells in your prostate and stop them from spreading.
Many years ago doctors learned how to use these energy beams to "see" inside your body to find out if you are sick. You may have seen a chest x-ray or xray pictures of your teeth or your bones. These x-rays use small amounts of radiation. At high doses (or amounts), radiation can be used to treat your prostate cancer. The radiation used for your prostate cancer treatment comes from:
Radiation can kill your cancer cells or keep them from growing. Radiation therapy is used to:
Radiation therapy can be given to you by external beam or internal radiation.
Most men who get radiation therapy for their prostate cancer have external beam radiation. With external beam radiation therapy, a machine directs the high-energy rays at your prostate cancer and a small amount of healthy tissue around it. The most common type of machine used to give you external radiation therapy is called a linear (li-neher) accelerator (ak-sel-ah-ra-ter).
External radiation therapy is usually given to you during outpatient visits to a hospital or treatment center. Outpatient visits are when you do not need to stay overnight in the hospital or treatment center. (See IMPACT Brochure, “IMRT and You,” for more information.)
There are many kinds of external radiation therapy:
It may help you to think about radiation therapy as a game of darts. Your prostate cancer is the bull’s eye in the center of the game board. The darts are the beams of radiation used to kill your prostate cancer cells. The area around the bull’s eye stands for the healthy cells surrounding your prostate cancer. With external beam radiation therapy, your doctors carefully plan to have the darts hit the bull’s eye each time you are treated.
Sometimes despite the careful planning, the darts hit the area surrounding the bull’s eye. This can cause you to have side effects. Over the years, external radiation therapy has become more focused. Doctors are now able to plan radiation therapy so that they hit the bull’s eye almost every time. By protecting the area around the bull’s eye, you may have fewer side effects.
When internal radiation therapy is used to treat your prostate cancer, the radiation source is placed inside your body. This method of radiation treatment is called brachytherapy (braykey- thair-a-pee) or seed implant. When you get brachytherapy, small seeds or pellets are placed in your prostate during an operation. These seeds or pellets are smaller than a grain of sand and are made out of a radioactive (ray-de-oh-ak-tiv) material. The seeds give a strong dose of radiation to your prostate cancer. This radiation kills your prostate cancer cells. The radiation from the seeds will get weaker each day and will be gone after one year. Brachytherapy is usually done during an outpatient visit. (See IMPACT Brochure, “Brachytherapy and You” for more information.)
No. Radiation therapy does not hurt when it is given to you. But, the side effects you may have from your radiation therapy, can cause pain or make you feel uncomfortable. The good news is that there are many things you and your health care team can do to help you manage any side effects you have from your prostate cancer treatment.
Yes, radiation therapy can be used with other kinds of prostate cancer treatment. Radiation treatment is a local treatment. This means that the radiation will only kill the cancer cells in your prostate. Using radiation therapy with another prostate cancer treatment is known as adjuvant (add-ju-vent) therapy (or a cancer treatment that is added to, and given after, your first prostate cancer treatment). Radiation therapy is often used with surgery to treat cancer. Radiation therapy may be used after surgery to stop the growth of any prostate cancer cells that may remain.
In some cases, doctors use radiation along with hormone therapy. Hormone therapy works by starving the cancer cells of the male hormones it needs to grow. This may make your radiation therapy treatments work better. Hormone therapy may be used with radiation therapy or before radiation to shrink your prostate cancer.
Radiation therapy can also be used to lower the amount of pain a person has when prostate cancer has spread to the bones. This is called palliative (pal-ee-ah-tiv) radiation therapy. Palliative radiation therapy does not cure prostate cancer but is very helpful as a treatment to make you more comfortable. Palliative radiation therapy can be used to shrink tumors and reduce pressure, pain, and other symptoms (signs of being sick) of your prostate cancer. When prostate cancer cells are killed or made to grow more slowly by radiation, the pain will get better. This can help lower the amount of pain medication you need to take. Many cancer patients find that they have a better quality of life when radiation is used for this purpose (See IMPACT Brochure called, “Palliative Radiation,” for more information).
A radiation oncologist is a doctor who specializes in the treatment of people with cancer. They use radiation as the main way of treating cancer. Radiation oncologists work closely with other doctors, such as urologists and primary care physicians, to make sure that patients with cancer get the most effective treatment. Your radiation oncologist:
After your treatment is over, your radiation oncologist will see you for follow-up visits. At these visits, your radiation oncologist will find out how well the radiation worked to treat your prostate cancer and will help you with any side effects (unwanted changes in your body) you may have.
After giving you a physical exam and reviewing your medical history, your radiation oncologist will plan your treatment. Your radiation oncologist will let you know:
Working with Your Doctor to Plan Your Treatment
It is important for your doctor to know about your urinary function. This will help your doctor to:
Please answer the following questions and take this page with you when you go to your next doctor’s appointment.
Remember, it is important for you to speak with your doctor or health care team about any symptoms you have. This will help them plan the best treatment for you.
The quick doses (or amounts) of radiation that damage or kill your prostate cancer cells may also hurt or kill your healthy cells. When healthy cells are killed by the radiation, you may have side effects. Most side effects of radiation treatment are well known and can be treated by your doctor and health care team.
External Beam Radiation Therapy
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.
Using many small doses (or amounts) of radiation each day rather than a few large doses (or amounts) helps protect the healthy cells in the treatment area (the exact place in your body where radiation will be aimed). Weekend rest breaks let your healthy cells get better.It is very important that you have all of your scheduled radiation treatments. If you miss or put off your radiation treatments, your radiation therapy might not work as well.
Internal Radiation Therapy
If you have internal radiation, your radiation oncologist will choose the best type of seed implant to treat your prostate cancer. Your radiation oncologist may choose a low dose-rate (LDR) or high dose-rate (HDR). Low doserate seed implants are placed in your body in and around your prostate cancer. The seed implants give off a dose (or amount) or radiation. The low-dose-rate seed implants become less radioactive each day. High doserate implants are placed in and around your prostate cancer for only a few minutes. The seed implants are then taken out. The type of seed implant you have and how long it stays in your body will depend on the dose of radiation you need to have the most effective treatment.
All men who get radiation therapy for their prostate cancer need to take special care of themselves during their treatment. There are many easy things you can do to help yourself during radiation therapy. What you do can help you to:
Your doctor and health care team will talk to you about things you can do to take care of yourself during and after your treatment. Things like:
Telling your health care team what medications are you taking.
Getting enough rest and sleep
Planning Before You Start Radiation Therapy
Yes, there can be side effects when you have radiation therapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The side effects that you have depend on:
Before beginning your treatment, your doctor and health care team will talk with you about the side effects you might have, how long they might last, and what you can do to help make them better. Side effects may be acute or chronic. Acute side effects are sometimes called "early side effects." This type of side effect happens soon after the treatment begins and are usually gone a few weeks of you finish your radiation therapy. Chronic side effects, sometimes called "late side effects," may take months or years to show up after your radiation therapy ends. These side effects will not go away.
The most common early side effects of external beam radiation therapy are fatigue (tiredness) and skin changes. Your skin may become red, warm, and sensitive to touch like a sunburn. Other side effects include hair loss in your pubic (groin) area and a loss of appetite. With internal radiation therapy, the most common side effects are fatigue (tiredness) and problems urinating (peeing). You may have burning when you urinate (pee) or have trouble urinating.
The good news is that most early side effects will go away in time. If you do have any side effects, there are ways to make you feel better. If you have a side effect that is really bad, your doctor may stop your radiation therapy for a short time or change your treatment in some way.
Be sure to tell your doctor or health care team about any side effects that you have. They can help you treat the problems and tell you how to lower the chances that the side effects will come back.
What you are able to do will depend on which side effects you have and how bad they are. Many men are able to work, cook meals, and enjoy their usual daily activities while they have radiation therapy for their prostate cancer. Other men find that they need more rest than before they started radiation therapy so they can’t do as much. Your doctor may tell you to limit activities that might irritate your pubic (groin) area. You should try to keep doing the things you enjoy as long as you don't get too tired.
Nearly all men being treated for prostate cancer say that they feel emotionally upset at different times during their radiation therapy. It's not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Radiation therapy may affect your emotions because you are very tired or have other side effects.
Some men find it helps to learn about their disease and treatment because it makes them less afraid of their treatment. Find out as much as you want to know. Do not be afraid to ask questions. Your emotional health is as important as your physical health.
Talking with an understanding friend, relative, minister or another patient may be helpful. Your doctor’s office may be able to give you a list of local prostate cancer support groups. There will be men in the support group who have had radiation therapy. You may also contact the American Cancer Society at 1-800-227-2345 or the National Cancer Institute’s Cancer Information Line at 1-800-422-6237 to find out about cancer resources in your local community.
Many people don't understand prostate cancer or its treatment. They may stay away from you because they're not sure what to say or how to help. Try to be open when you talk to other people about your illness, treatment, needs, and feelings. People will often be willing to lend their support. If you get tired easily, limit your activities and do only the things that mean the most to you.
It is ok if you want to find out about other prostate cancer treatments or ways to help manage the side effects from your treatment besides what your doctor tells you to do. You might like to try new methods to help you deal with treatment and its side effects, such as meditation or relaxation exercises. Make sure that you tell your doctor about other treatments, vitamins or herbal medications you may take.
Remember everyone needs some support during difficult times. Don’t be afraid to ask for help from your doctor or health care team, during or after your treatment.
It is normal for you to worry about your future after your prostate cancer treatment is over. You may be worried about how you feel or what you can do to keep your prostate cancer from recurring (coming back). You will want to know which doctor will take care of you, how often you need to see the doctor for follow-up appointments, and what tests you should have. Understanding what to expect after your prostate cancer treatment can help you and your loved ones plan for follow-up care, make changes to your daily life, and make important health decisions.
Follow-up cancer care means that you will have regular medical checkups. During these checkups your doctor will look at your medical history and give you a physical exam. Follow-up care may include blood tests and additional imaging tests of your pubic (groin) area. Imaging studies are ways used by doctors to take pictures of the inside of your body, such as x-rays or a CT Scan (also known as a CAT Scan).
Follow-up care is important because it helps your doctor find any changes in your health. The main reason for your follow-up care is to check for recurrence (the return of your prostate cancer), or metastasis (muh-tas-tuh-sis), which is when
your prostate cancer moves to another part of your body. Follow-up care visits are also important to help you deal with any side effects from your radiation therapy. All men who have treatment for their prostate cancer should have follow-up care.
Most men see their radiation oncologist for regular follow-up visits. Others are sent back to their urologist or regular doctor. Your follow-up care will depend on other treatments that you had or may need.
During each visit, you should tell your doctor about any:
It is important for you to be look out for changes in your health and to tell your doctor about these changes. Your doctor will let you know whether these changes are caused by your prostate cancer, your radiation therapy, or another health problem.
Just as every patient is different, each man’s follow-up care is also different. Your doctor will schedule your appointments and order any tests you need to make sure you have the best follow-up care possible. Don't be afraid to ask about any tests or treatments that your doctor may order. Try to learn about the things you need to do to take good care of yourself.
The following are some questions that you may want to ask your doctor after you have finished your radiation therapy:
In general, men undergoing radiation therapy for their prostate cancer go back to their doctor for follow-up visits every three to four months for two to three years after their treatment has ended. After that, they go back to their doctor one or two times a year.
Until your side effects are gone, you need to keep following the instructions your doctor and health care team gave you to take care of yourself. For example, you may have skin problems for several weeks after your prostate cancer treatment ends. Keep being gentle with your skin in your pubic (groin) area until it is healed. Don't try to scrub off the marks in your treatment area. Your doctor or health care team can answer any questions you have about skin care and help you with other concerns you may have after your treatment has been completed.
You may find that you still need extra rest after your radiation therapy is over. This is because your healthy tissues are getting better and rebuilding. Try to get as much rest as you can. It may take some time for you to get your strength back. Start doing your normal daily activities slowly. If you feel that you need emotional or social support, ask your doctor or health care team about support groups or other ways to express your feelings and concerns. You may also contact the American Cancer Society at 1-800-227-2345 or the National Cancer Institute’s Cancer Information Line at 1-800-422-6237 to find out about cancer resources in your local community.
These tips may help you keep track of the information you and your doctor talk about during your visits:
It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.
Remember, you have the right to copies of all your medical paperwork and the actual slides, x-rays and any other information about your health care and treatment. A good idea would be to create two copies of your medical information and keep them in folders. Keep one folder at home and take the other one with you to your doctor’s appointments. Whenever you see a new doctor, it is important for you to let them know about your prostate cancer and any treatment that you have had.
You learned about:
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment.
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