Radiation Therapy for Prostate Cancer

At Cleveland Urology Associates Cancer Center

Our doctors at Cleveland Urology Associates are experienced in every stage and manifestation of the disease and have a very high success rate in treating prostate cancer. A multi-specialty team from Urology, Radiation and Medical Oncology at our Cancer Center works with the patients to determine the best treatment options available. In addition to Radical Prostatectomy, we perform Brachytherapy (radiation seed implants), Intensity modulated radiation therapy (IMRT), hormonal therapy and chemotherapy.

What Is Radiation Therapy?

Radiation therapy is commonly used in patients with prostate cancer.

• For early stage disease, patients have a choice between radical surgery and radiation, with similar outcomes.
• Radiation therapy can also be combined with hormonal therapy for intermediate risk disease.
• Radiation therapy is also used in advanced stages of prostate cancer to treat painful bone metastases.

There are two types of radiation therapy used for prostate cancer.

1. External beam radiation
2. Brachytherapy

External Beam Radiation Therapy

External beam radiation therapy uses a linear accelerator to produce high energy x-rays which are directed in a beam toward the prostate.

What is radiation therapy and how does it work?

• External beam radiation is a special kind of energy produced electronically by a special machine called linear accelerator.
• This energy is then carried by waves and focused on the cancer site.
• External beam radiation is a completely non-invasive technique. Radiation is invisible, tasteless and odorless.
• No radiation remains with the patient after treatment.
• Radiation therapy works by damaging or destroying cells that are actively reproducing. Tumor cells reproduce more quickly and more often than the normal cells, and are therefore more likely to be affected by radiation. Normal cells at the time of treatment are also affected by the radiation, possible leading to side effects. Unlike cancer cells, however, most normal cells can recover with little or no permanent damage.

What is intensity modulated radiation therapy IMRT?

IMRT is an advanced form of external beam radiation. It is used to further focus radiation beams, with the goal of increasing the dose of to the prostate while sparing normal tissues. IMRT has 80-100 tiny lead “leaves” on each side of the beam that are moved in or out to define the treatment field with pin-point accuracy.

This breakthrough technology for delivering image guided radiotherapy is now available in Cleveland at Cleveland Urology Associates Cancer Center offering new hope to patient who are battling prostate and other urological cancers.

Intensity modulated radiation therapy (IMRT) is the most technologically advanced, most precise method of external beam radiation therapy available.

Recently, we also installed a Dynamic image guided radiotherapy (IGRT). This new technology combines a state-of-the-art treatment machine with sophisticated digital imaging tracking and monitoring tools, enabling us to deliver the most accurate treatment possible.

This new treatment system at Cleveland Urology Associates Cancer Center incorporates a high quality imaging device that enables us to position patients very precisely and to deliver the radiation dose directly to a targeted area.

Our linear accelerator is housed in a special treatment vault and the patients are monitored via closed-circuit television. Sophisticated image matching software shows patient anatomy on computer monitors in a control console outside the treatment room.

IMRT & IGRT is a new form of radiation therapy that uses computer-generated images to plan and then deliver more precisely focused radiation beams to cancer cells than is possible with conventional radiotherapy. With capability at Cleveland Urology Associates Cancer Center we can deliver a precise radiation dose that conforms to the shape of the cancer, while significantly reducing the amount of radiation to surrounding healthy tissues. Consequently, the technique can increase the rate of cancer control while significantly reduce adverse side effects.

Treatment Process

The treatment process consists of several steps:

Consultation with our associate radiation oncologist at Cleveland Urology Associates Cancer Center. Telephone number is (216) 265-4580 We will make this appointment for you as soon as you decide to proceed with radiation therapy for management of your prostate cancer.

Our team will have access to all your medical records including report of your prostate biopsies and any other x-rays we have performed. Our team will review your medical history, pathology reports and all x-ray reports, conduct a physical examination and set an appointment for you to begin the positioning and imaging process.

Treatment preparation

• Special molded devices that will help you maintain the same position everyday during the treatment are developed.
• Colored ink will be used to mark your skin, to assist in positioning for treatment by aligning the radiation equipment with the targeted area.
• A special CAT scan and MRI may be done.

Simulation and treatment planning

The simulation is a specialized radiation planning CT scan, which is performed while you are lying on your back on the simulation table. All of your pelvic organs are delineated and your pelvic anatomy is recreated in the computer in 3-D. Using all of this information, Dr. Field and radiation physicist will then work together to design the best IMRT treatment plan that optimizes the dose to the prostate and minimizes the dose to the bladder and rectum. The planning and quality assurance process may take several weeks to complete.

Treatment Delivery

• After the plan meets the established rigorous standards, you will be notified by our staff and an appointment will be made for verification films and then the daily treatment will start.
• Treatment is usually given five days a week for 9 weeks.
• No treatment will be given on weekends, so that the normal cells will recover.
• The total dose of radiation and the number of treatments you will need – will depend on the size and location of the cancer, the grade of cancer, your general health and other factors.
• Each day, you will arrive for treatment at the designated time, and the radiation therapist will position you on the treatment table.
• The therapist can visualize the prostate, the table position is adjusted based on the prostate location.
• You make notice laser lights in the room, these help the therapist to position you properly on the treatment table.
• The actual treatment is delivered using a linear accelerator.
• The daily treatment sessions usually last about 15-20 minutes.
• You will be monitored by our therapist via a close circuit camera.
• Dose delivery itself takes only few minutes.
• The radiation treatment is invisible and you will not feel it.
• The linear accelerator emits a buzz as it produces the radiation beams.
  It is important to lie as still as possible during this time, so that the radiation dose to delivered to the exact targeted area each time.
• The linear accelerator will move around you.
• After treatment, you can resume normal activity without limitations.

Prostate cancer center at Cleveland Urology Associates is the most comprehensive facility of its kind in North-East Ohio. Specially trained Board Certified Radiation Oncologist and our support staff are skilled in both standard and unique radiation therapies. We are constantly seeking innovative ways to use existing technology and identifying new therapies to help our patients. Our center is also committed to discovering newer and better methods for detecting, treating and preventing prostate cancer. Patient centered care is our philosophy. The cancer centers has easy accessibility and flexible scheduling lets you make appointments that fit into your routine.

We realize that there is more to your cancer treatment than radiation. Our Cancer Center has:

• Easy parking
• Easy access from highways and main roads
• Complimentary rides from and to your home
• Complimentary housing if needed
• Nutritional guidance
• Educational programs

What are the side effects from radiation therapy?

Since external beam radiation therapy in entirely non-invasive, you will not have any side effects or feel anything after treatment in first few weeks. As treatment progresses, you may have side effects:

• Mild fatigue – usually resolve in few months
• Bladder irritation, difficulty voiding, hesitancy, slow urinary stream – usually relieved with medications
• Rectal irritation or diarrhea – usually relieved by diet and medications.
• Mild skin irritation.
• Long-term side effects are very rare.
• We will constantly monitor you and treat any possible side effects.