Prostate Surgery

Intensity-Modulated Radiotherapy For Prostate Cancer

Prostate cancer is the most common cancer in men, with more than a million global cases and thousands of deaths per year.

Treatment for the disease aims to remove or kill the cancer cells before they overwhelm the body. Many procedures are available to achieve this aim based on the cancer stage and other clinical factors.

Radiation is one such approach that involves using high-energy rays to destroy cancer cells or slow cancer cells’ growth. Advances in radiation technologies have led to multiple delivery modes, such as intensity modulated radiotherapy (IMRT) and proton beam therapy.

Clinical utilization of these technologies improves patient outcomes by reducing side effects, morbidity, and disease recurrence. Here, we explore the use of imrt for prostate cancer which is a form of external beam radiotherapy used to treat prostate cancer. We offer answers to common questions to help you consider the best treatment for your cancer.

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What Is IMRT (Intensity Modulated Radiation Therapy)?

There are two main types of radiation therapy for prostate cancer: internal radiation (brachytherapy) and external beam radiation. However, external beam radiation therapy is the most common way of giving radiation treatment for prostate cancer. IMRT is a type of external beam radiation therapy that uses a computer to plan and target specific radiation doses for your prostate cancer.

In IMRT, a computer analyses your prostate cancer’s size, shape, and location to generate an exact treatment plan. Then the radiotherapy machine delivers beams of radiation that match the tumor shape and size.

Unlike conventional radiotherapy, this approach allows the radiation oncologist to better control the radiation dose to different areas and reduce damage to nearby healthy tissues (Al-Mamgani et al., 2009). IMRT has increased the survival rates of prostate cancer patients, with reduced risk of side effects (Fischer-Valuck et al., 2018).

What Do I Need To Do To Get Ready For My IMRT Treatment?

It is now possible to rapidly generate and evaluate IMRT treatment plans through recent developments in computer technology. Before your first treatment, your doctor, in conjunction with other specialists (for example, radiologist and oncologist), will carefully plan the delivery process and advise you on specific steps to get you ready for your treatments.

You may be required to attend a simulation appointment, whereby the doctors perform a practice run, show you the equipment, and mark the spot where the radiation will go through.

Generally, you should expect to receive additional clinical examinations to ensure you are still suitable for IMRT and that the right amount of radiation goes to the tumor. Your care team will take three-dimensional pictures of your tumor to help with this process. Further, your doctor might tell you to make some dietary changes to get your digestive and urinary system ready before the procedure. You may also need to not eat for a given amount of time before you arrive.

It is critical to follow the advice given by your doctor to avoid the risk of severe complications during and after the procedure. Moreover, prepare your home for recovery and arrange for extra support while you recover. It is important to talk to your care team if you take any medications or supplements, as they might protect cancer cells against radiotherapy.

How Long Does IMRT Treatment Last?

The exact duration and treatment sessions of your IMRT will depend on the size of your prostate cancer, your overall health, and other clinical factors. Usually, daily IMRT treatment takes about 30 minutes to complete.

You will get daily treatment for five days a week over several weeks, depending on your particular care plan as determined by the factors mentioned above. You can go home after each treatment.

IMRT usually lasts for 20 sessions over four weeks at some hospitals, while others use 37 sessions over more weeks. Though the latter usually results in a larger overall dose, you will receive lower amounts of radiation per session than the first option. Clinical trials have shown that the two approaches work equally well with similar levels of side effects (Dearnaley et al., 2016).

What Will Happen During My Daily IMRT Treatments?

You and your doctors will take several preparatory steps at each treatment session. You may get medication to ensure your bowel is empty before the actual treatment. Your radiographer will help you position before starting the machine. Although post-treatment effects of radiation defer across individuals, most men can continue with their daily activities. You may need to take time off work if the treatment is making you tired.

What Will Happen After My Daily IMRT Treatments?

The response to IMRT can vary across individuals. Your care team will have regular check-ups to monitor how your cancer is responding to treatment. Further, radiation will cause both short- and long-term side effects, including urinary, digestive, and sexual complications. Therefore, after your IMRT treatments, your doctor will monitor and help you manage side effects. 

Are there Side Effects With IMRT?

Like all treatments for prostate cancer, IMRT can cause side effects. Usually, radiation will reach and damage some healthy cells and tissues. However, the risk of damaging healthy tissues is much lower in IMRT compared to conventional radiotherapy. Moreover, some of these side effects are common treatments for prostate cancer, while others are unique to radiation.

The extent of IMRT side effects is different for each prostate cancer patient. It often depends on the radiation dose, your general health, and other clinical factors. Fortunately, most of the damaged tissues will recover quickly, reducing the duration of the side effects. However, some side effects can start many months or even years after treatment. 

Some of the common side effects are detailed below:

Urinary problems

IMRT and other forms of radiotherapy for prostate cancer can irritate or damage the lining of urinary organs (bladder and urethra), which leads to urinary problems. Difficulty urinating, sudden urge to empty your bladder, and frequent urination are common radiation-induced urinary problems. These problems tend to improve over time, with most men making a full recovery some weeks after treatment.

Bowel problems

The bowel and the rectum’s neck are close to the prostate gland, which can be irritated or damaged by radiation during IMRT and, in turn, cause bowel problems. These problems are usually temporary, but some men develop permanent bowel complications. 

Previous bowel problems also increase the risk of bowel complications. It is essential to inform your doctor about previous or current bowel problems before you start IMRT. This early risk assessment will allow your care team to better plan for potential side effects.

You can help improve the severity of both short- and long-term bowel complications through strict adherence to your doctor’s dietary advice.

Bone problems

Rarely can radiation damage the bone cells and blood supply to the bones leading to pain and hip and bone problems in the future. Additionally, combination treatment involving IMRT and hormone therapy can further weaken your bones, increasing the risk of hip and bone problems.

Skin problems

During IMRT, the skin between your legs may become sore, and it may cause some of your hair to fall out. These skin side effects will usually resolve after your treatment. Ask your care team about how to look after your skin during and treatment.

Tiredness and fatigue 

Radiation therapy can cause months of tiredness and fatigue. IMRT is more targeted, thereby reducing the risk of severe tiredness. Further, some men experience less severe tiredness, or none compared to others. Tiredness will usually improve several weeks after treatment, but some men could have the symptom for up to a year.

Erectile dysfunction

IMRT may cause problems with erection and could lead to impotence. These complications usually develop over time, contrary to the presentation after surgery, where erection problems occur immediately and improve over time. 

Erectile dysfunction caused by radiotherapy can take up to two years to appear and can get worse over time if left unmanaged. Your doctor may recommend additional treatments to manage the symptom. The typical prostate cancer treatment includes drugs, implants, and corrective surgeries, which work best if you start them early.

Other cancers

Radiotherapy could increase the risk of other cancers by damaging the DNA of normal cells. This is a small chance that IMRT could increase your risk of bladder and bowel cancer, but this will usually take years to appear.

Many of the above side effects can be managed effectively with your doctor’s help. Therefore, before you start treatment, talk to your care team about the side effects. Discussing your concerns and knowing what to expect can help you deal with the side effects.

What Can I Do To Take Care of Myself During IMRT?

Before your treatment, your doctor, in conjunction with radiation specialists, will carefully plan your care and advise you on specific steps to get you ready for IMRT. Additionally, they will give you information about the potential side effects of the treatment and details for what to do if you notice any changes.

Importantly, IMRT to treat prostate cancer can be physically and psychologically draining. Some of the actions below can help you manage the impact of IMRT on your daily life.

  • Get ample amounts of sleep to help manage the impact of radiation-induced fatigue and tiredness.

  • Eat a healthy and balanced diet to help heal and repair damaged tissues. Your doctor will help you make changes to your diet, especially if you have appetite-related side effects.

  • Clean the skin affected by radiation with products approved by your doctor.

  • Talk to your doctor before initiating any new medications or supplements.

Will I Be Able To Have Sex During And After IMRT?

In most cases, you can have sex if you wish, and most men do not have a problem having sex during or immediately after IMRT. Further, there is no risk of radiation to your pattern. Rarely your doctor may recommend that you limit sexual activities to avoid irritating the treated area.

Your sexual activity during this period and in the long run will depend on potential treatment side effects and how severe they are. IMRT and other forms of radiotherapy can cause problems with getting and keeping an erection. Other aspects of your diagnosis and treatment, including certain medicines, tiredness, and anxiety, can also impair your sexual function and libido.

Conclusion 

IMRT is an effective treatment for both low and high-grade prostate cancer. And it is also an option for treating residual cancer after surgery or disease relapse.

Unfortunately, IMRT, like other treatments, has side effects, such as tiredness, urinary problems, bowel complications, and erectile dysfunction. Therefore, speak to your doctor about the benefits and complications of IMRT to help you make an informed decision. Your healthcare provider may implement an alternative treatment option that is suitable for the stage of your cancer. 

Sources

  1. Al-Mamgani, A., Heemsbergen, W.D., Peeters, S.T., Lebesque, J.V., 2009. Role of intensity- modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 73, 685–691.
  2. Dearnaley, D., Syndikus, I., Mossop, H., Khoo, V., Birtle, A., Bloomfield, D., Graham, J., Kirkbride, P., Logue, J., Malik, Z., 2016. Conventional versus hypofractionated high- dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 17, 1047–1060.
  3. Fischer-Valuck, B.W., Rao, Y.J., Michalski, J.M., 2018. Intensity-modulated radiotherapy for prostate cancer. Transl. Androl. Urol. 7, 297.
  4. Kagan, A.R., Schulz, R.J., 2010. Proton-beam therapy for prostate cancer. Cancer J. 16, 405–409.
  5. Pinkawa, M., 2010. External beam radiotherapy for prostate cancer. Panminerva Med. 52, 195–207.

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