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Prostate Cancer Care

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Prostate Cancer Care

If you are suffering from early stage prostate cancer, you may not notice any symptoms. If prostate cancer has progressed to an advanced level, you may experience numbness or weakness in the legs or feet, loss of bladder or bowel control, chronic pain in the hips or back, frequent urination or problems urinating, blood in the semen or urine, erectile dysfunction.

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What is Prostate Cancer?

The prostate is a male sex gland about the size of a walnut. It is just below the bladder and in front of the rectum. Its main purpose is to produce fluid that carries sperm during orgasm. The prostate gland needs male hormones to function. The tube that carries urine, called the urethra, runs through the prostate.

Statistics

These are some statistics from the American Cancer Society:

  • The most common cancer in men, excluding skin cancer
  • American Cancer Society estimates there will be 241,000 new cases in 2011
  • Risks include family history and increases with age
  • African-American men are at more risk than Caucasian men
  • Second leading cause of death in men with about 34,000 estimated deaths in the United States

Grading of Prostate Cancer 

What is “grading”? 

A part of the diagnosis that takes a look at the cancer cells at a microscopic level to determine how fast they grow and spread. The cancer cells are compared to normal cells and given a grade known as a Gleason score. This helps your doctor decide the aggressiveness of the tumor and how it should be treated.

The Gleason system is a grading of the cancer cells and interpreted by numbers on a scale of 2 to 10. A lower number means the cells are slower growing. A higher number means the cells are growing faster and more likely to spread to others areas in the body outside the prostate.

Scores mean:

  • Grades under 4 (low score) mean that the cancer cells look fairly similar to your normal cells, and the cancer is likely to be less aggressive.
  • Grades 5 to 7 (middle range) This means that the cancer cells do not look like normal cells, and are more likely to be aggressive and grow faster.
  • Grades 8 to 10 (high score) indicate that the cancer cells are more likely to be very aggressive in growth.

Prognosis

A prognosis is a statement about the expected survival and recovering from a disease. You may want to ask, “Can I survive this?” Here are some facts that may help answer your questions about this subject. 

Your chance of recovery depends on these things: 

  • Type and location of the cancer
  • Stage of the disease
  • How quickly the cancer is likely to grow and spread
  • Your age
  • Your general health
  • How your cancer responds to treatment

To form a prognosis for you, your doctor will consider all the things that could affect your disease and treatment to make a prediction of what seems likely to happen. To do that, the doctor will look at what researchers have found out over many years about thousands of men with prostate cancer. When possible, the doctor will use statistics for groups of men whose situations are most like yours to make a prediction.

You may find it easier to deal with prostate cancer when you know your prognosis and the statistics for how well a treatment might work. The doctor who is most familiar with your situation is in the best position to discuss your prognosis with you and explain what the statistics may mean for you.

What are the survival rates for prostate cancer?
The prognosis for men diagnosed with prostate cancer before it has spread is excellent. These are the most recent statistics, according to the National Cancer Institute:

  • The five-year relative survival rate for cancer that is still confined to the prostate is nearly 100 percent.
  • The five-year relative survival rate for cancer that has grown just outside the prostate or has reached nearby lymph nodes is nearly 100 percent.
  • The five-year relative survival rate for cancer that has spread to distant parts of the body is about 29 percent. The five-year relative survival rate for prostate cancer for all men combined is higher than 99 percent. This is largely because most prostate cancers are found at an early stage.

(These survival rates are adjusted to account for the fact that some men with prostate cancer will die of other causes.)

  • Step 1: Consult
    On your first day, you will come in for a consult with your doctor. A radiation oncology nurse will take you into an exam room and check your vital signs (Blood Pressure, Temperature, Pulse) and weight. The radiation oncologist will do a quick examination. Once you have had a consultation with your respective doctor and he/she has given you the necessary information about your specific cancer, the basic plan of action on how your treatment will be approached, and discussed possible side-effects of your radiation treatment, you will have a time set up to get a CT scan.
  • Step 2: CT 
    The CT scan will give the treatment team a 3D rendering of the patient’s internal anatomy. This scan will be used by our planning department and doctors to create your specialized treatment plan.

    On the day of your appointment, a therapist will come and get you and show you to the CT room. You will be assisted on the CT table by the therapist and straightened to ensure that your body is aligned on the table.  You will be placed in the same position that you are to be treated in on a daily basis. It is important to be in the same position everyday for your treatments. Achieving this includes making a device called a VacLok. The VacLok originally starts out with the consistency and flexibility of a beanbag chair. The VacLok will be formed around your legs and feet, and then, all of the air will be vacuumed out of it to form a hard mold of your legs. The mold will be used everyday to ensure that you are in the same position.

    After the VacLok is made, you will be scanned once to ensure that your internal anatomy is indeed aligned. When the therapist determines that you are aligned properly you will be ready for the actual CT scan.  Lasers will be used for the therapist to mark crosshairs on your skin, and “BB’s” will be placed over these marks so that their location can be seen on the CT scan.

    Next, the scan will be performed. The CT table will move through the scanner. At this point you will not feel anything and nothing will actually touch you.  The room is mounted with cameras and audio equipment so that the therapist can see and hear you at all times should you need anything.  All you need to do at this point is to remain as still and relaxed as much as possible.

    After the scan is complete, it will be sent to Varian Eclipse Planning System for our dosimetrists and physicians to create your individualized treatment plan. You will be assisted off the CT table and given an appointment time for your first treatment, if one has already been determined, if one has not, the clinic will call you with more information and an appointment time when your plan has been completed.
  • Step 3: Treatment Planning 
    The scanned information is sent to the dosimetry planning department as soon as it is completed so that your site specific radiation therapy treatment plan can be made.  The planning process can take up to a week. When the team has completed your plan, you will be assigned to a treatment room and given an initial “start” appointment. 
  • Step 4: Your Treatment 
    Your first appointment will take a little longer than the rest of your treatments.  You will be taken to a treatment room. Once in the room, you will get in the same position that you were in during your CT scan. The table will be raised, and you will then be aligned to the crosshairs that were marked on your skin.

    While trying to get you aligned, the therapists will be moving you around. You should relax, “lay heavy”, and let the therapist do all the moving.  At this point, shifts will be made from these marks based on what the dosimetry team has planned for you.  Once shifts have been made, radiographic images will be taken to ensure that you are aligned according to your plan and will be checked by your oncology physician before any actual radiation treatment is administered.

    It should be noted that films taken in the treatment room are used for set up and localizing specific anatomy and do not show a progression or digression of your disease. Once these images are approved by the physician, your skin will be remarked and you will then receive your first treatment.

    The machine will rotate to different angles based on your treatment plan. During your treatment, you will not feel the radiation, however, you will hear the machine buzzing. 
  • Step 5: Tattooing 
    After completing your first treatment, permanent marks, or tattoos, will be made on your skin. This involves placing a drop of ink on the skin and using a tiny lancet to make the marks. These tiny permanent marks allow the Radiation Therapists to ensure consistency in your daily set-up. They also allow you, the patient, the freedom to shower or bathe without the worry of maintaining ink marks and tape on your skin. 
  • Step 6: Photograph 
    After the permanent marks have been made, a photograph of your treatment set up will be taken for the clinic’s records. This is to ensure that your treatment set up will be consistent should a different therapist need to treat you at a later date. 
  • Step 7: Scheduling 
    Since this will be the room where you receive your daily treatments, you will discuss a daily treatment time with your radiation therapist. Available time slots will vary depending on your treatment room’s schedule. The decided treatment time will be consistent throughout your treatment regimen. Treatments are given Monday through Friday- you will not have to come for treatment on Saturday or Sunday. 
  • Step 8: Weekly Follow-up 
    After your first week of treatment, every Monday you will visit with a physician. This is a time when you can talk to the doctor about any concerns or side-effects you may be experiencing.

You can receive external beam radiation treatment (EBRT) as an outpatient. Therefore, you will have your treatment at a clinic, where you will you come for your treatment each day and will not stay overnight. Usually you'll get a treatment five days a week for a total of seven to nine weeks, depending on the type and amount of radiation the doctor would like you get.

This type of radiation comes from a machine called a linear accelerator and is commonly used to treat prostate cancer. Treatment time for each treatment varies with the amount of radiation being delivered.

  • Conformal EBRT. This newer type of EBRT directs radiation at your prostate from several directions to help minimize the doses to surrounding healthy tissues. Many doctors now recommend conformal EBRT if it is available. Some types of conformal EBRT use higher doses of radiation for shorter periods of time which reduces the damage to healthy tissue.
  • Intensity-modulated radiation therapy (IMRT). This is a high-precision type of radiation therapy. It uses a computer to control both the shape and strength of the X-rays to precisely deliver radiation to specific places within a tumor, while minimizing the radiation exposure to surrounding normal tissues.

Side Effects: What to expect during and/or after radiation therapy treatment

Radiation therapy affects the normal cells as well as the cancer cells in your body. The side effects you may experience depend on the amount of radiation you receive. Be sure to let your doctor know of any side effects you have during or after treatment.

Here are some possible side effects you may have during or after your treatments:

  • You may have diarrhea, which may or may not have blood in it. You may also have cramping or feel like you need to have a bowel movement. If you have these effects, they are likely to begin to occur in the second or third week of treatment.
  • The skin around the area treated may get irritated, especially under the scrotum or folds of the buttocks. The skin may be red, flake, or drain fluid.
  • You may lose your pubic hair. Some of it may grow back.
  • You may feel like you have to urinate often or all the time. You may have a burning feeling when you’re urinating. You also may have blood in your urine. If you have these kinds of problems, they usually start to occur about 3 to 5 weeks into your radiation treatment.
  • You may feel very tired and this may not stop until you have been finished with your treatments for about a month.
  • You may have swelling in your legs, penis, or scrotum. This is rare but occurs more often in men who have also had a lymph node biopsy.

The following effects may continue after your treatment ends. In some cases, they may not appear until months or years after you treatment ends.

  • Bowel problems, such as diarrhea or cramping
  • Urinary problems, such as needing to go to the bathroom more often or having trouble controlling your urine.
  • Nobility to have an erection, called erectile dysfunction

You can talk with your doctor about ways to deal with these longer-lasting side effects.

 

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Augusta University Medical Center specialists provide care and support throughout your entire healthcare journey.

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