Radiation Therapy – During Treatment

What to Expect

Your treatment will begin approximately one to two weeks after your CT simulation. Your radiation oncologist, along with physicists and dosimetrists – specialists who are experts in calculating the physics and the dosage of radiation – use this time to create your customized radiation plan.

The Plan

After your provider and team signs off on your plan, the plan is sent to the schedulers. The duration of treatment will vary depending on your individual situation, ranging from as short as five sessions to several weeks of daily treatments. In general, you can expect to receive radiation therapy five days a week for two to 8 weeks. For those traveling long distances to receive care at the Weiser Prostate Cancer Center, overnight accommodations are available at our onsite hotel in Ann Arbor, the Wilmot at Med Inn. Your patient navigator will help connect you to the Med Inn and other lodging options through our Michigan Medicine Lodging team.

With external beam radiation therapy, you will lie on a table while the machine delivers radiation to the prostate. The radiation technicians will position you carefully on the table to ensure the beams are aimed at precisely the same spot each time. You will not feel anything from the treatment. Each session is relatively quick, usually lasting only a few minutes. If you wear loose, comfortable clothing like athletic pants and a T-shirt, you won’t even need to change into a hospital gown or scrub pants.

The radiation oncology nurse will check your overall health, prepare you for your simulation/s, provide education about side effects of radiation, and discuss any questions or concerns you might have. You will meet with your doctor once a week to monitor your progress and potential side effects.

Radiation therapy is generally well-tolerated, but you may experience these common, short-term side effects:

• Fatigue. Staying active with moderate exercise, such as walking, can help.
• Urinary symptoms, such as frequency, urgency, and a mild burning sensation. These can be treated with ibuprofen, Flomax and Tylenol. Avoid drinking alcohol, caffeine, and citrus drinks, which can irritate the bladder. Be sure to drink plenty of water.
• Loose bowel movements. This may be treated with increased hydration, taking Imodium and following a BRAT (bananas, rice, apples, toast) diet.

If you find yourself feeling unwell overnight or on the weekend between treatment sessions, your care team is on-call and available to help you 24 hours a day, seven days a week.

As with your CT simulation, on treatment days we recommend you have a full bladder and an empty rectum. We also advise you avoid foods that can cause gas, like beans, broccoli, and carbonated beverages. Gas can affect the position of the prostate.

Types of Radiation Treatment

Here is a high-level overview of the types of radiation treatment. All of these are effective options, but some may work better for your specific circumstances. Your radiation oncologist will discuss your options, and together you’ll select the best treatment course for you.

External Beam Radiation Therapy (EBRT)

• Intensity-Modulated Radiation Therapy (IMRT): An advanced form of therapy where the intensity of the high energy X-ray beams is varied, allowing for more precise targeting of the prostate while sparing surrounding tissues.
• Volumetric Modulated Arc Therapy (VMAT): An advanced type of IMRT that delivers radiation in a 360-degree rotation around the patient. It allows for precise and efficient treatment, targeting the tumor from multiple angles while minimizing exposure to surrounding healthy tissues.
• Stereotactic Body Radiation Therapy (SBRT): A focused form of radiation that uses a similar 360-degree rotation around the patient to deliver high doses over a shorter period, often completed in five or fewer sessions.
• Image-Guided Radiation Therapy (IGRT): Incorporates imaging techniques during treatment to enhance the accuracy of radiation delivery. It is used in conjunction with IMRT, VMAT, SBRT, and other techniques.

Brachytherapy

• Low-Dose Rate Brachytherapy: This involves implanting radioactive seeds in the prostate that release radiation over several months. The procedure is usually done in a single session.
• High-Dose Rate Brachytherapy: This is the temporary placement of radioactive material in the prostate for short periods, often in combination with EBRT.

In some cases, radiation therapy may be combined with other treatments like hormone therapy to increase effectiveness, particularly in advanced or high-risk prostate cancers.

Each type of radiation therapy is selected based on various factors, including the stage and grade of the cancer, overall health of the patient, potential side effects, and personal preferences. The goal of each method is to maximize the effectiveness of the treatment while minimizing damage to surrounding healthy tissues.

Combining Radiation with Hormone Therapy

Depending on your specific prostate cancer, your doctor may recommend adding hormone-based therapy along with radiation treatments. Hormone therapy refers to a drug treatment that impacts the levels of certain hormones. Androgen Deprivation Therapy (ADT) is a popular form of hormone therapy that can be combined with radiation therapy to improve outcomes in men with higher-risk, localized prostate cancer

What is ADT?

Androgen Deprivation Therapy (ADT) reduces the levels or effects of androgens (male hormones, primarily testosterone) in the body.

Why is it used?

ADT is effective in treating prostate cancer because prostate cancer cells rely significantly on androgens to grow and proliferate. ADT can make cancer cells more susceptible to the effects of radiation. Combining ADT with radiation therapy can improve outcomes in men with higher-risk cancer that has not spread beyond the prostate.

Who most benefits from ADT?

First, it’s important to know that not all individuals with prostate cancer need ADT. But those with localized prostate cancer, more aggressive cancer, or who have a higher risk of recurrence may benefit from the addition of ADT to radiation. Here are some things to consider with your doctor:

• Your risk group: ADT is more likely to be recommended for higher-grade tumors or those at a more advanced stage. Risk groupings take into account factors such as tumor stage, Gleason score, PSA levels, and imaging findings.
• Your overall health: Having other health conditions can influence your decisions. ADT has its own side effects and risks.
• Your preferences and quality of life considerations: The potential side effects of ADT can significantly impact your quality of life.

When is it given?

The timing of ADT in conjunction with radiation therapy to treat prostate cancer is a strategic decision between you and your oncologists based on the stage and aggressiveness of your disease, as well as your overall health and quality of life preferences.

• Before radiation therapy (neoadjuvant): ADT can shrink the prostate tumor and may be used to improve urinary side effects prior to beginning radiation therapy.
• During radiation therapy (concurrent): ADT and radiation therapy can be used together to enhance the treatment effects on cancer cells.
• After radiation therapy (adjuvant): Additional ADT after radiation can help reduce the risk of cancer recurrence, especially if your tumor has high-risk features.

The total duration of ADT, including neoadjuvant, concurrent, and adjuvant therapy, can range from a short course of six months to long-term treatment of up to two years for more aggressive cancers.

How is it given?

You will take ADT either as injections or oral pills. The most common method involves regular injections of luteinizing hormone-releasing hormone (LHRH) agonists or antagonists, which lower testosterone levels. Another approach is anti-androgens, medications that block the action of androgens on cancer cells.

What are the side effects?

Because ADT significantly lowers your body’s testosterone levels, it can cause a range of side effects that may affect your quality of life. We encourage open discussions with you, your partner, and your care team about your personal preferences and lifestyle with regard to potential side effects when you plan your treatment.

Side effects of ADT therapy include:

• Hot flashes and sweating
• Decreased libido and erectile dysfunction
• Loss of muscle mass and increased body fat
• Mood swings and depression
• Osteoporosis, leading to a higher risk of bone fractures
• Increased risk of heart disease and diabetes

The extent and severity of these side effects varies from person to person. We partner with you and your loved ones in open, respectful, two-way communication about what to expect, and effective ways to manage the side effects of ADT. Our goal is for you to maintain the best possible quality of life while you are going through treatment.

Many men find it helpful to join our peer mentoring group, to hear first-hand the experience of others who have been treated for prostate cancer and understand what you and your partner are going through.