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23.10.2014 Feature Article

What Ghanaian Men Needs To Know About External Beam Radiotherapy For Prostate Cancer

What Ghanaian Men Needs To Know About External Beam Radiotherapy For Prostate Cancer
23.10.2014 LISTEN

This paper focuses on external beam radiotherapy for prostate cancer to give Ghanaian men a clear understanding of the patient cancer journey.

External beam radiation for prostate cancer uses high-energy X-rays to kill cancer cells. During external beam radiation for prostate cancer, the high-energy beams are generated by a machine called a linear accelerator that aims the beams at your prostate gland.

External beam radiation for prostate cancer kills cancer cells by destroying the genetic material that controls how cells grow and divide. Healthy cells in the beam's path also are affected by external beam radiation therapy, resulting in side effects. The goal of external beam radiation for prostate cancer is to destroy the cancerous cells while sparing as much of the normal surrounding tissue as possible.

External beam radiation for prostate cancer is one of the standard treatment options to treat prostate cancer. It may also be used for men who have prostate cancer that comes back after surgery.

External beam radiotherapy uses high energy X-ray beams to treat prostate cancer. The X-ray beams are directed at the prostate gland from outside the body. They damage cancer cells and stop them growing.

Radiotherapy treats the whole prostate, and sometimes the area around it. The treatment is painless but it can cause side effects.

You are eligible to have radiotherapy if your cancer is contained inside the prostate (localised prostate cancer). Radiotherapy may also be suitable for you if your cancer has spread to the area just outside the prostate (locally advanced prostate cancer).

Radiotherapy can also be used after surgery if your PSA level starts to rise or if tests suggest that not all the cancer was removed with surgery.

Types of external beam radiotherapy
There are two types of external beam radiotherapy, 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT).

There is also image guided radiotherapy (IGRT). This is used as part of all radiotherapy treatments. Your radiographer will take an X-ray or a scan just before your treatment to pinpoint the exact position of your prostate, as well as its size and shape.

At some hospitals, you may have three to four gold seeds, called fiducial markers, put inside your prostate. These are about the size of a grain of rice. The seeds show up on scans and help the radiographer see the exact position of the prostate.

3D conformal radiotherapy (3D-CRT)
With 3D-CRT, the radiation beams match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue surrounding it, reducing the risk of side effects.

Intensity modulated radiotherapy (IMRT)
With IMRT, the radiation beams are matched precisely to the size, shape and position of the prostate. The strength of the radiation beams can also be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate, without causing too much damage to the surrounding tissue. The risk of side effects is usually lower with IMRT than with 3D-CRT.

Some hospitals offer 3D-CRT and others IMRT. You must ask your doctor or radiographer which type of radiotherapy you're being offered.

Advantages and disadvantages
Remember that what may be an advantage for one person might not be for someone else. So talk to your doctor, nurse or radiographer before deciding whether to have radiotherapy – they'll be able to help you decide if it's right for you or come to us at Men's Health Foundation Ghana support group.

Advantages
Many men are able to carry on with their normal day-to-day activities during treatment.

Radiotherapy can be an option even if you're not fit or well enough for surgery.

Radiotherapy is painless, but you might find the treatment position slightly uncomfortable.

Daily sessions only last 10 to 20 minutes, including the time it takes to get you into position.

You don't need to stay in hospital.
Disadvantages
You will need to go to hospital five days a week for several weeks. This might be difficult if you need to travel far.

And as with all prostate cancer treatment you may get side effects such as bowel, urinary and erection problems, as well as tiredness and fatigue.

It may be some time before you know whether the treatment has been successful.

If you have radiotherapy as your first treatment and your cancer comes back or spreads, surgery might not be possible.

Treatment Pathway
You would be offered hormone therapy for three to six months before you begin radiotherapy. This shrinks the prostate and makes the cancer easier to treat. Men who have a higher risk of their cancer spreading may continue to have hormone therapy for up to three years after radiotherapy.

A week or two before starting radiotherapy you will usually have a planning session, where you will have scans of your prostate. This is to make sure the treatment is accurate and the surrounding areas don't get more radiation than necessary. In most hospitals, three very small permanent marks (tiny tattoos) are made on your skin. This helps the radiographers get you into the right position.

You will have one treatment (known as a fraction) at the hospital five days a week with a rest over the weekend. You can go home after each treatment.

Radiotherapy usually continues for seven to eight weeks. Some hospitals may offer a shorter course of about four weeks, with higher doses at each session – but a slightly lower total dose.

At the start of each session, the radiographer will help you get into the right position – using the marks made on your body as a guide.

The machine will take an X-ray or a scan to make sure that you are in exactly the right position. The treatment then starts and the machine moves around your body. It doesn't touch you and you won't feel anything. You'll need to keep very still, but the treatment only takes a few minutes. The whole session lasts 10 to 20 minutes, including the time it takes to get you into position.

It's safe for you to be around other people, including children and pregnant women, during your radiotherapy. The radiation doesn't stay in your body so you won't give off any radiation.

Eating and drinking
Your prostate sits close to your bladder and bowel. Most hospitals will tell you how full or empty your bladder and bowel should be during treatment. This helps the radiographers to make sure they treat the right area each time and can also help reduce side effects.

Some hospitals will give you advice about your diet, and you may be given a laxative to help empty your bowels. You will usually be asked to drink water while you're waiting for treatment so that your bladder is comfortably full.

Anti-oxidants and radiotherapy
Some people take anti-oxidants such as vitamin C and E, lycopene and selenium for their cancer – although there's no clear evidence that they help. Some research suggests that anti-oxidants might protect the cancer cells from radiotherapy, and make radiotherapy less effective so have an open conversation with your doctor and inform him on any complementary therapies you are using.

What goes on after radiotherapy?
You will have regular check-ups after your radiotherapy.

Your first check-up is usually between six weeks and three months after treatment.

You may then have a check-up every six months.
After two years, you might have a check-up once a year.

Check with your doctor or nurse how often you will have check-ups.

PSA test
You will usually have a PSA test a week before your check-up. PSA tests are a very effective way of checking how well your treatment has worked.

After radiotherapy, your PSA should start to drop. Some PSA will still show up in tests because healthy prostate tissue will continue to produce PSA. How quickly your PSA level drops, and how low it falls, will depend on whether you had hormone therapy alongside radiotherapy. If you had radiotherapy on its own, it may take up to two years for your PSA level to fall to its lowest level (nadir). If you had hormone therapy as well as radiotherapy, your PSA level may fall more quickly.

You may see a rise and fall in your PSA level around one to two years after treatment. This is called 'PSA bounce'. It is normal, and doesn't mean your cancer has come back. A sign that your cancer may have come back is if your PSA level has risen by 2ng/ml or more above its lowest level, or if it has risen for three or four PSA tests in a row.

If your PSA level does rise, your doctor may check your PSA level for at least six months before deciding on further treatment.

Treatment options after radiotherapy
If the cancer does come back, there are further treatments that you may be able to have:

Hormone therapy or newer ones like
High intensity focused ultrasound (HIFU)
cryotherapy.
Surgery is very rarely an option because radiotherapy makes it difficult to remove the prostate.

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