| A Patient's Guide to Prostate Cancer and
Treating it With 3-Dimensional Conformal Radiation Therapy Author
Richard K. Valicenti, MD
Bodine Center For Cancer Treatment
Thomas Jefferson University Hospital
Table of Contents
The Prostate, What it Is, What it Does
The prostate is one of the male sex glands. Together with the testicles and the seminal
vesicles, the prostate produces fluid for semen.
Approximately the size of a walnut, the prostate is located below the urinary bladder.
It surrounds the upper urethra (the tube that carries urine and semen out through the
penis). For this reason, many prostate cancer patients experience difficulty during
urination.
[Back to Top]
What Exactly Is Cancer?
Cancer is a serious concern for a patient of any age. But understanding more about the
disease and how it affects the body can only help a patient cope with his or her
condition. Here is a simple explanation of what having cancer means.
The body is made up of cells that divide and reproduce at a normal rate. This natural
process allows the body to grow and to heal itself. Cancer cells divide and multiply
uncontrollably. When these cells generally reproduce they form masses known as tumors
which can interfere with the body's normal function.
If a tumor is malignant, or cancerous, small portions of it can break off and travel to
other areas of the body where new tumors, called metastases, may develop. This is how
cancer spreads or metastasizes.
The rate at which prostate cancer grows and/or metastasizes varies by patient, age and
cancer type.
[Back to Top]
Prostate Cancer, Who Gets it?
Prostate cancer is the most common cancer occurring in men. It is estimated that one in
every 10 American men will develop prostate cancer at some time in his life. According to
the American Cancer Society, approximately 184,000 new cases will be diagnosed this year
alone.
Although younger men can develop prostate cancer, the risk increases with age. The
average age of the prostate cancer patient is 72. For unknown reasons, African-American
men are at a higher risk than other men.
[Back to Top]
How Does Prostate Cancer Progress and What Are its
Stages?
Prostate cancer is categorized in four stages. In its first stage (Stage A or T1), the
cancer is generally confined to the prostate. The cancer is too small to be felt during a
rectal exam. In the second stage (Stage B or T2), the cancer is large enough to be felt
during the rectal exam.
If prostate cancer progresses to the third stage (Stage C or T2/T3), the tumor has
penetrated the outer covering of the prostate. As it grows, the cancer may spread to the
tissue surrounding the prostate and to the seminal vesicles. In locally advanced cancer,
nearby organs such as the bladder may also be affected.
In the fourth stage (Stage D or T4 or Stage N+ or M+), cancer cells may "break
off" and travel through the body to the lymph nodes in the pelvis (Stage N+). Cancer
cells may also be carried through the bloodstream to other organs in the body (Stage M+),
most commonly to the bones.
For patients with Stage D prostate cancer, treatment options have improved, giving hope
for a more comfortable, longer life and even the possibility of remission, a period when
your disease is not progressing.
[Back to Top]
Treatment
In its earliest stages, prostate cancer is a slow-growing tumor. If diagnosed early it
can be cured with either surgery (radical prostatectomy) or radiation therapy.
Advances in both these methods of treatment have been made in recent years, reducing
the complications or side effects associated with each. For early stage prostate cancer,
surgery and radiation therapy are equally effective in providing cure. Because of these
treatment options, physicians are now asking men seeking treatment for early stage
prostate cancer to actively participate in the decision-making process.
If the cancer is locally advanced, such that it has grown beyond the prostate gland,
and/or has a Gleason grade of 8 to 10 and/or a prostate-specific antigen (PSA) blood test
over 20, radiation therapy is still recommended but usually with the addition of hormonal
therapy.
[Back to Top]
Hormonal Therapy
Hormonal therapy is the most common treatment for patients whose cancer has spread
(also known as metastatic prostate cancer Stage D). It is also now being used to treat
locally advanced prostate cancer (Stage C) when combined with radiation therapy.
Hormonal therapy aims to curb the production of testosterone needed by the cancer cells
to grow. As a result, cancer growth may be slowed.
While hormonal therapy may slow cancer growth and reduce tumor size, it may be
accompanied by side effects. Decreased testosterone level can lead to hot flashes, a loss
of sexual desire or impotence.
[Back to Top]
Radiation Therapy
Radiation therapy is the use of high-energy rays to destroy cancer cells and eliminate
their ability to divide and multiply. Radiation may be delivered either externally or
internally.
External radiation therapy involves a series of brief outpatient treatment sessions,
over the course of several weeks. Internal radiation is delivered by surgically implanting
tiny radioactive seeds inside the tumor itself.
In addition to destroying tumor cells, radiation therapy may affect the normal cells in
the area. Although normal cells are better able to repair the effects of radiation than
cancer cells, side effects may occur (see pages 9-11).
[Back to Top]
3-Dimensional Conformal Radiation Therapy
3-Dimensional Conformal Radiation Therapy (3D-CRT) is the state-of-the-art method of
external radiation therapy used at Thomas Jefferson University Hospital to treat early
stage or locally advanced prostate cancer. The purpose of 3D-CRT is to target the
radiation therapy precisely so that it will cover the entire prostate gland, and at the
same time to reduce the amount of radiation directed to the surrounding normal tissues,
the bladder and bowels.
[Back to Top]
Treatment Planning for 3D-CRT
Before beginning your radiation therapy, we will design a treatment plan uniquely
tailored for you. This requires making one or two visits to the department before your
actual treatment begins.
Your first planning visit begins with a simulation, which takes about two hours.
Radiation therapists, working under the supervision of your radiation oncologist, perform
the simulation. At the beginning of this session the radiation therapist will photograph
you for future reference and identification.
Then, the radiation therapist will ask you to lie on a table to make a styrofoam cast
mold of your lower body. This mold will be used during treatment, to be sure your body
position is the same each day. The therapists will take a set of
X-rays of the area to be treated and mark your skin with small permanent tattoos to
guide them in positioning you during treatment. It is important that you try to maintain
the same body position for the planning session and daily radiation treatments. This will
assure precise 3(D)-CRT.
Next, in preparation for a contrast CT scan of your pelvis, a small amount of contrast
will be inserted into your urethra and bladder. The CT scan will be done in the
department. Your radiation oncologist will use the CT scan and sophisticated computers to
create a 3-dimensional image of your pelvis as seen from all angles. Using this image,
your radiation oncologist will work with physicists and dosimetrists to plan the direction
and shape of the radiation beams used to treat you. This will help to assure that the
entire prostate gland is covered and the amount of radiation directed to the surround-ing
normal structures is minimized. Six or more precisely angled beams (or treatment fields)
will be used.
When you return for the second and final step of the treatment planning process, the
radiation therapists will take beam films (port films). The beam films will be taken at
least once a week for the entire course of treatment. You will be positioned as you were
during simulation under the radiation treatment machine, and X-ray images will be taken
from each of the beams that will be used in your treatment. Your radiation oncologist will
check that each of these is accurate in relation to the plan before your treatment begins.
This second step serves as "a dry run" or check of the 3D-CRT plan. It is never
used to evaluate the cancer.
[Back to Top]
Receiving Your Treatment
Once your treatment planning and simulation is completed and your beam films have been
reviewed, you will begin your treatment. Treatments are given daily, Monday to Friday, for
about seven weeks. You should allow about one hour for each treatment.
After undressing and putting on a hospital gown, you will be asked to come into the
treatment room where the radiation therapists will precisely position you under the
treatment machine. You will be alone in the room during the actual treatment, but the
therapists can see and hear you at all times through a monitoring system. You will not
feel anything during the treatment, but you may hear the machine turn on and off. The
radiation therapists may come in and out of the room to set up each of the planned
positions or the machine may do so automatically. The total time in the room will be 20 to
30 minutes, but the actual treatment time is only two to three minutes. Once you are off
the treatment table you are not "radioactive."
Your radiation oncologist oversees your entire treatment. During the course of
treatment you will have weekly appointments with the attending radiation oncologist,
resident physician and nurse to evaluate your response to treatment and any side effects.
Your stay in the department will be longer on these days, so please plan your time
accordingly. At these appointments, feel free to discuss your concerns and ask any
questions you may have. If you would like to speak with the doctor or nurse any time
between these visits, ask the radiation therapist to contact them.
[Back to Top]
Anticipating Specific Side Effects of
Treatment
The body structures that are near the prostate gland will receive a small amount of
radiation. However, with 3D-CRT the amount they receive is much less than with traditional
methods of treatment. As a result, the side effects are generally mild.
Early side effects begin about two to three weeks into treatment and persist for one to
two months after treatment is over. In rare cases they could persist and become a chronic
problem.
The most common side effects are caused by irritation of the bladder neck and urethra.
Patients have experienced difficulty initiating urination, frequent urination, burning
with urination or a sense of urgency when they have to urinate, but they do not become
incontinent.
Side effects may also be caused by irritation of the rectal wall. Patients have
experienced more frequent bowel movements, worsening of hemorrhoidal symptoms, rectal
discomfort, mucous discharge, increased gas or the increased urge to have a bowel
movement. Diarrhea is rare. For most patients all of these symptoms are mild and require
no medication. However, if you become uncomfortable, your physician can prescribe
medications to decrease or alleviate the symptoms.
Some patients will notice mild fatigue during the last weeks of treatment. Although we
recommend that you rest as needed, you should be able to work full time during treatment
and maintain your usual level of activity.
Late side effects of radiation may occur sometime between four months and two years
after treatment is completed. These may include frequent urination, burning with
urination, rectal bleeding and rectal ulceration, all of which are very rare.
One other possible late side effect is impotence, with either difficulty or inability
to obtain or maintain an erection. It is difficult to predict who will develop impotence
after treatment. Many patients will not develop impotence, but may have a change in the
strength of the erection, the sensation of the orgasm or the amount or consistency of the
ejaculate.
If impotence does develop, it will be permanent, but treatment options are available.
If you would like a referral to a doctor who treats these problems, we can provide one for
you.
If you have any questions about these late side effects of treatment, please discuss
them with your radiation oncologist, resident or nurse.
[Back to Top]
Caring For Yourself During Treatment
You do not have to follow any diet or activity restrictions during your treatment. In
fact, we recommend that you maintain your usual daily routine as much as possible. The
treatments will not make you feel sick. Actually, the more active you are during
treatment, the better you will probably feel.
[Back to Top]
Following Up After Treatment
After your treatment is completed, your doctor and nurse will want to see you in four
to six weeks and then every three months for the first two years. After two years, visits
will become less frequent and the doctor will tell you how often. At each of these visits,
they will evaluate your response to treatment. They will do blood tests (including the
PSA), review any symptoms you may have, and do a physical and rectal examination. You
should use the visit to ask questions and discuss your concerns.
[Back to Top]
Important Telephone Numbers
We hope this patient's guide helps in describing treatment with 3-Dimensional Conformal
Radiation Therapy for prostate cancer. If you have any questions, please discuss them with
a member of your healthcare team.You can reach them Monday through Friday at the numbers
listed below. If you need assistance after 5 p.m. or on weekends, please call our
answering service at 215-955-6702 to be connected with the radiation oncologist on call.
Radiation Oncologist ___________________
Urologist _________________________
Resident ____________________________
Nurse _____________________________
[Back to Top]
Glossary
| Dosimetrist |
Someone who plans and calculates the proper radiation dose
for a particular treatment. |
| External Radiation |
Radiation therapy delivered by a machine that focuses on the cancer site. |
| Gleason Grade |
A commonly used grading system which measures how aggressive a tumor is.
Grading is done in the lab with cells taken from the tumor. The grades range from 2 to 10.
The lower the number the lower the grade. |
| Linear Accelerator |
A machine used to treat cancer. It creates and uses high-energy X-rays. |
| Prostate-Specific Antigen |
A blood test that measures (PSA) Blood Test the level of protein produced
by the prostate. A high PSA could be a sign of an enlarged prostate or it may indicate the
presence of cancer. |
| Radiation Oncologist |
A doctor with specialized training in the use of radiation to treat
tumors, especially cancer. |
| Radiation Physicist |
A scientist with extensive training in measuring and delivering radiation
doses. |
| Radiation Therapist |
A professional trained in the use of radiation treatment equipment and in
the accurate delivery of prescribed treatment. May also be referred to as radiation
therapy technologist. |
| Radiation Therapy |
A medical treatment that uses X-rays, gamma-rays, radioactive isotopes
and other forms of radiation to treat disease. |
Back to Disease Site Map
[Back to Top] |
