1. What radiation reactions, functional consequences and complications of RT may have patients with prostate cancer most often?
Some consequences and complications may appear a year or several years after therapy, and radiation reactions can sometimes occur during treatment. The earliest may appear nearly 3-4 weeks after the start of therapy. For example, bladder inflammation, less often rectum inflammation may occur. Sometimes there may be cystitis, tenesmus, frequent urination and slight pain at the same time, rarely the blood may appear in the urine. As a rule, such adverse reactions can occur in the second half of treatment. Sometimes these symptoms may appear during 1-3 weeks after the course: the tissues have late reaction to RT. The rectum and bladder are in close proximity to the prostate gland, where the tumor is located. Unfortunately, it is impossible to completely exclude these organs from the irradiation zone even with the most advanced equipment. Such a risk is always may be: no special treatment can be safe in 100%, including chemotherapy or surgery.
2. What late complications can occur and when it may be?
It can occur in 3 months after the start of treatment for prostate cancer and later, even after a few years. Urethral strictures and urinary incontinence may appear as like as the bladder volume may decrease. These complications often occur in people after surgery and radiation therapy on outdated linear accelerators. As for the modern equipment used to treat prostate cancer in TomoClinic, such “side effects” appear only in 2-5% of cases.
3. Why is this happening at all?
Even tolerant RT are high for the sensitive bladder, and the rectum is even more susceptible to radiation. The manifestation of complications depends on how easily the tissues of the body can recover. By the way, scientists conduct clinical trials why some people have radiation reactions, while others do not have, and how this can be foreseen. But not a single analysis can guarantee 100% accuracy of the result, even tests for the sensitivity of the body to chemotherapy drugs that we often work with. The clinic can guarantee accurate dose adjustment to the tumor, but we do not know how a specific organism will respond to RT. When receiving the same dose, two people can have a completely different reaction.
4. What we do in the clinic to reduce radiation reactions?
We are able to minimize the amount of radiation for nearby organs, and this is what the IMRT method helps in. The smaller the dose to critical organs (bladder and rectum), the less the radiation reaction will be. We prescribe special anti-inflammatory drugs during the course of treatment. As a rule, radiation reactions subside within 3 months after completion of a course of radiation therapy. When discharging a patient, we always give expert advice for taking certain medications.
5. Is the patient informed about the possible consequences of radiotherapy for prostate cancer?
If complications happen, this must be dealt with. We always find out whether the dose was exceeded or if the cause was an individual feature of the human body. But initially, the patient signs an agreement with the clinic that he knows about possible consequences. Doctors explain what can occur. We read the instructions for medications and see a whole “sheet” of possible side effects. Take this pill to stop the headache. So the doctor must stop the oncological process, achieve remission and cure, although the patient may encounter some possible complications. Therefore, the doctor and the patient make a decision together. On one side of the scale are your fears, and on the other is the price of your own life. It is important to understand: when treating with old linear accelerators, the patient could expect a much larger set of side effects. After completing treatment we monitor and ask our patients about changes it their quality of life. TomoClinic assesses the situation on the IPSS scale and concludes: statistics say that the majority of patients tolerate treatment safely and have a good quality of life after it. Radiation reactions often appear in those patients whose problems were not solved by proctologist and urologist before treating the cancer.
6. Are there situations where the patient should not start a course of treatment with radiotherapy for prostate cancer?
Of course, we always evaluate how healthy the patient is before starting the course: is there dysuric syndrome, frequent and painful urination, rectum inflammation. After all, radiation therapy can aggravate these symptoms, although at the same time it will be directed to the tumor. An RT course cannot be started if the patient is diagnosed with acute (chronic) urinary retention. It is advisable to eliminate this problem surgically or medically in order to begin the fight against a tumor of the prostate gland.
7. Does it happen that the patient is in a hurry& Knowing out about prostate cancer he is ready to rush into battle with oncology…
Some men recklessly run to the surgeon, discarding all alternatives and believing that excision of the tumor will bring greater success. Surgery is preferable for young men and a localized tumor, although prostate surgery is quite difficult and requires high professionalism. However, if cancer is found in a man older than 50 years, it is more rational to choose radiation therapy. Sometimes a complex of different methods is important. We should inform patients about this, as well as about the opportunity to choose, because many do not even know that there are other effective tactics besides the surgical method for treating this diagnosis.
8. How do each of these treatments for prostate cancer affect men’s health?
First of all, it is a hormone-dependent tumor, so sometimes radiation is “delayed” for 3-6 months for hormone therapy. During this period chemotherapy also helps to reduce the volume of the tumor mass. The doctor must take into account inflamed lymph nodes and metastases in the pelvic bones, which often happens with prostate cancer. The treatment strategy depends on this.
The type of tumor, its aggressiveness, the degree of spread of the process and the risks are determined. In some cases, treatment can be started immediately after diagnosis, especially if the patient with the doctor decided avoiding surgery. Any case, the patient must understand: if the hormone therapy indicated, the production of male hormones is suppressed, and therefore decrease in potency may appear.
Sometimes drugs must be taken for a month or even six months, and male potency is often restored after it (we should take into account the age of the man). It is important to note another convincing fact: the percentage of impotence after radiation therapy is much lower than after surgical treatment. Of course, the question about this may not even be in front of a man, because sometimes making such sacrifices is nothing to do with getting rid of the underlying cancer. The specialists of our clinic are seeking for a victory, but mention the price of such a victory while maintaining the quality of life. And it should be at least the same as before treatment!