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Treating prostate cancer

Treating Prostate Cancer
In this video, we will illustrate the different aspects of radiation therapy treatment for prostate cancer. Please note that in order to show these aspects clearly, we are focusing solely on the pelvis of the patient therefore, the entire patient is not visible in this video. For prostate cancer radiation therapy, you may be asked to carry out some pretreatment procedures. These can include emptying your bladder and drinking a number of glasses of water and/or emptying your rectum either using dietary advice or a prescribed enema. In some radiation therapy departments, a balloon-type device can be used to maintain a standard rectal size.
The reason for these procedures is because the prostate gland lies in between the bladder and the rectum and its position can change depending on how full or empty the bladder and rectum are. Therefore, to ensure that the prostate remains in a similar position each day for treatment, you may be asked to carry out these instructions. Another way of verifying the position of the prostate gland for treatment is the use of small markers that are implanted into the prostate before your pretreatment CT scan. These are known as fiducial markers and are typically made from gold or a similar density material. These are placed in the prostate gland using a surgical technique approximately one week before your pretreatment CT scan.
Other organs that are in close proximity to the prostate gland are the hip bones, or femoral heads, and the penile bulb, which is the bottom portion or base of the penis.
When you enter the treatment room, you will be aligned with the laser positioning system.
Images to check the position of the prostate gland will be taken before treatment is delivered on certain days using an imaging panel. In this case, fiducial markers can be seen here to check the position of the prostate gland on the image. If your bladder or rectum size are different from your personalised treatment plan, you may be asked to repeat the pretreatment procedures above. While this may seem inconvenient, it is important that the prostate gland is receiving the prescribed dose.
Prostate radiation therapy can be delivered using many treatment techniques. In this example, we will show the Intensity Modulated Radiation Therapy, or IMRT, technique. In IMRT, five, seven, or nine beams are typically used for treatment. The number used depends on the anatomy of the prostate which is different from one patient to another.
In this example, we are using a seven-field IMRT technique. These seven beams are delivered from different angles around the patient, which means the gantry will move from one angle to another. This movement is controlled by the radiation therapist both inside and outside the treatment room. You will see that in order to reach the prostate gland, the beams will deliver some dose to the normal tissues. For prostate cancer, these are the bladder, rectum, femoral heads, and penile bulb. This means that you may experience some side effects during your treatment.

In this video using VERT, we give an example of the Intensity Modulated Radiation Therapy or IMRT technique for prostate cancer.

Side effects

You may experience some side effects during your treatment. Urinary side effects can include having to empty your bladder more often than usual – either during the day or at night, or both.

  • These are called increased frequency and increased nocturia. You may also experience some pain when urinating (dysuria).
  • If you pass blood in your urine (haematuria), or if you are unable to pass urine (obstruction), you must notify your expert treatment team immediately.
  • Rectal side-effects can include bleeding when using the toilet, a feeling of fullness in the rectum or a feeling that you may need to empty your rectum very regularly, even though this is not the case (tenesmus).
  • You may also experience diarrhoea or constipation. All of these side-effects can be effectively managed by your expert treatment team.
  • As the penile bulb is receiving some dose, you may experience some sexual dysfunction, particularly erectile dysfunction. Again, this is treatable using medication that can be prescribed by your radiation oncologist.

It is understandable that patients may be embarrassed by some or all of these side effects and may be reluctant to discuss them with their expert treatment team. However, these side effects are perfectly normal and expected by the team who are trained to manage them.

Your quality of life while receiving radiation therapy is of the utmost importance to your treatment team and assisting you in managing these side effects is an important part of your care.
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