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Comprehensive Radiation Treatment For Prostate Cancer

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Smiling Man Prostate Cancer

What is prostate cancer?

Prostate cancer radiation treatment is an option recommended for patients diagnosed with prostate cancer. It uses high-energy X-rays generated from a radiation therapy machine called a LINAC to destroy cancer cells. Prostate cancer radiation treatment has long been used to kill tumours without the need for surgical operations. It inhibits cancer cells from multiplying by delivering ionising radiation to destroy cancer cells, whilst minimising radiation damage to normal tissues. When these cancer cells die, the body naturally eliminates them. Healthy normal tissues are then able to repair themselves in a way that cancer cells cannot, leading to a much higher proportion of tumour cell death compared to normal cells.

Overview

Prostate cancer refers to a malignant tumour that develops in the prostate, a small walnut-shaped gland below the bladder that produces sperm. This disease is one of the most common types of cancer among men in Singapore. This disease is one of the most common types of cancer among men in Singapore.

 

Some cases of prostate cancer grow slowly and are confined to the prostate gland, while others are aggressive and can spread quickly. Therefore, early detection – while the cancer cells are still confined to the prostate gland – is crucial to ensure successful treatment.

 

Signs and symptoms of prostate cancer

 

During the disease’s early stages, patients often show little to no signs or symptoms. However, as their condition progresses, they may experience the following signs and symptoms such as:

  • Frequent urination (especially at night)
  • Weak urinary stream
  • Inability to urinate Interruption of urinary stream
  • Pain or burning sensation during urination
  • Blood in the urine
  • Back pain
  • Weight loss
  • Loss of appetite
  • High PSA level

 

Prostate cancer – the risk factors

 

Like many forms of cancer, the exact cause of prostate cancer is unknown. However, there are several risk factors that can increase one’s risk of prostate cancer. They include:

 

Age

Your risk of prostate cancer increases as you age. Prostate cancer is most often diagnosed in adults over the age of 50.

 

Family history

 

If you have a blood relative, like a parent, sibling, or child, who has been diagnosed with prostate cancer, you may be at risk too. This is because certain gene mutations increase one’s risk of prostate cancer. These mutations can be passed from parents to children.

 

Those with a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a strong family history of breast cancer are also at increased risk of developing prostate cancer.

 

Obesity

 

People who are obese have a higher risk of developing prostate cancer compared to those who maintain a healthy weight. Obese people also tend to develop more aggressive forms of prostate cancer, with a higher chance of recurrence.

 

Prevention

 

While there is no guaranteed way to prevent prostate cancer, you can reduce your risk by changing your lifestyle and dietary habits. Let us share how to minimise your risk of prostate cancer.

 

Choose a healthy diet full of fruits and vegetables

 

Adopt a diet consisting of vegetables, fruits, and whole grains, especially food rich in vitamins and minerals, to maintain a healthy level of vitamins and nutrients in your body.

 

Maintain a healthy weight

 

It is advisable to maintain a healthy weight by choosing a well-balanced and nutritious diet and exercising regularly. If you are overweight, we recommend reducing your calorie intake and exercising more frequently. Exercise not only improves your overall health but also improves your mood.

 

Undergo regular cancer screenings

 

Early detection is key to ensuring successful prostate cancer treatment. Therefore, it is advisable for you to undergo regular cancer screenings. If you notice you possess a high risk of prostate cancer, you can speak to your doctor, who can provide tips to manage and reduce your risks. 

 

What are the common signs and symptoms

  • Prostate cancer may cause no signs or symptoms in its early stages. Prostate cancer that's more advanced may cause signs and symptoms such as:

    • Frequent urination (especially at night)
    • Weak urinary stream
    • Inability to urinate
    • Interruption of urinary stream
    • Pain or burning sensation during urination
    • Blood in the urine
    • Bone pain
    • Weight loss
    • Loss of appetite

How is prostate cancer diagnosed?

  • Digital rectal examination
  • Prostate-Specific Antigen (PSA) test
  • Transrectal Ultrasound Guidance (TRUS) and Biopsy

What are the different types of treatment?

There are various prostate cancer treatment options available in Singapore. An oncology doctor will assess a patient’s condition, and depending on the stage of the disease, recommend the ideal treatment plan.

 

Because prostate cancer may take years to develop, and specific treatment options carry significant risks, an oncology doctor may opt to observe the tumour rather than treat the condition immediately. The indication for treatment will depend on the severity of the condition, the age and health of the patient, and the symptoms displayed.

 

Localised prostate cancer

 

Patients with localised prostate cancer – the cancer cells are limited to the prostate – who require immediate medical attention may be offered the following treatment options depending on their condition.

 

1) Radiation therapy

 

There are various forms of radiation therapy available to treat prostate cancer. Common radiation treatment for prostate cancer involves:

 

External beam radiation.

 

During external beam radiation treatment, a machine is used to direct high-powered energy beams, such as photons or X-rays, to eradicate the cancer cells. Patients typically undergo external beam radiation treatments five days a week for several weeks. This treatment can also be used after surgery to eliminate any cancer cells that might remain to prevent a recurrence. 

 

Brachytherapy. 

 

Brachytherapy involves placing radioactive sources in the patient’s prostate tissue. Usually, the radiation is contained in radioactive seeds, which are inserted into one’s prostate tissue. These seeds deliver a low dose of radiation over a period of time to eradicate the cancer cells.

 

Proton therapy. 

 

Proton therapy uses a high-energy proton beam to deliver precise radiation to the prostate gland without injuring the surrounding normal tissues.

 

2) Hormonal therapy

 

Hormonal therapy is designed to counter the effects of testosterone, which the cancer cells rely on to grow and spread. This treatment is generally used in conjunction with radiation therapy or surgery in patients with high-risk factors. 

 

3) Surgery

 

In extreme cases, an oncology doctor may recommend radical prostatectomy, which involves the complete removal of the prostate gland, the surrounding tissue, and a few lymph nodes, to prevent the cancer cells from spreading to the other healthy tissues. Chances of successful treatment are high. However, this treatment option carries possible side effects such as impotence and urinary incontinence.

 

Advance prostate cancer

 

If the cancer cells have spread to other areas of the body, an oncology doctor may recommend the following treatment procedures.

 

1) Hormonal therapy

 

Hormonal therapy can also be used to treat advanced stages of prostate cancer. There is an extensive range of approved hormonal treatment options available, with many proving to be effective in controlling the spread of cancer cells. 

 

2) Chemotherapy

 

Though uncommon, chemotherapy helps improve symptoms of prostate cancer if other treatment options prove ineffective. The drug can be administered intravenously or in pill form, or both. Chemotherapy is generally recommended when the cancer cells have spread from the prostate gland to other parts of the body.

 

3) Immunotherapy

 

Immunotherapy can prove to be effective in treating prostate cancer. During treatment, the patient’s immune cells are extracted and exposed to proteins designed to stimulate them to counter the prostate cancer cells. Subsequently, the immune cells are placed back in the patient’s body to treat their prostate cancer.

 

4) Radioactive bone isotope

 

An oncology doctor may recommend radioactive bone isotope if the patient’s prostate cancer cells have spread to their bones. These radioactive isotopes function similarly to calcium and are ingested by the bones. Once the isotopes are within the bones, they release radiation to eradicate cancer cells.

Localised prostate cancer

 

Patients with localised prostate cancer – the cancer cells are limited to the prostate – who require immediate medical attention may be offered the following treatment options depending on their condition.

 

1) Radiation therapy

 

There are various forms of radiation therapy available to treat prostate cancer. All radiation therapy for cancer works on the principle of using high energy radiation to kill cancer cells by damaging the DNA.

Radiation therapy also has to be precisely calibrated to target cancer cells while avoiding exposing normal healthy cells to the radiation dose. Common radiation treatment for prostate cancer involves:

 

External beam radiation.

 

During external beam radiation treatment, a machine is used to direct high-powered energy beams, such as photons or X-rays, to eradicate the cancer cells. Patients typically undergo external beam radiation treatments five days a week for several weeks. This treatment can also be used after surgery to eliminate any cancer cells that might remain to prevent a recurrence.

 

Brachytherapy.

 

Brachytherapy involves placing radioactive sources in the patient’s prostate tissue. Usually, the radiation is contained in radioactive seeds, which are inserted into one’s prostate tissue. These seeds deliver a low dose of radiation over a period of time to eradicate the cancer cells.

 

Proton therapy.

 

Proton therapy uses a high-energy proton beam to deliver precise radiation to the prostate gland without injuring the surrounding normal tissues. The advantage of proton therapy is that the proton particles stop at the tumour and are less likely to damage healthy cells.

 

2) Hormonal therapy

 

Hormonal therapy is designed to counter the effects of testosterone, which the cancer cells rely on to grow and spread. Hormone therapy may rely on medications that either stop your body from producing testosterone or block testosterone from reaching cancer cells in your prostate. Another form of hormone therapy may involve surgery to remove the testicles. However this is a more permanent form of treatment.

 

Hormone therapy can be used in conjunction with radiation therapy or surgery in patients with high-risk factors to make the treatment more effective and reduce the chances of prostate cancer recurrence in patients. If after the initial prostate cancer treatment a patient’s Prostate-specific Antigen (PSA) levels are high or rising, then hormone therapy can also be indicated. For patients with high risk of recurrence after treatment, hormone therapy can help reduce that risk significantly.

 

Side effects of hormone therapy may include loss of muscle mass, increased body fat, erectile dysfunction, loss of sex drive, bone thinning, fatigue, behavioural changes, and metabolism issues. To minimise the effects, your doctor will monitor your dosage carefully during the treatment period and adjust depending on your reaction to the medication and other factors involving your risk of prostate cancer recurrence.

 

3) Surgery

 

In extreme cases, an oncology doctor may recommend radical prostatectomy, which involves the complete removal of the prostate gland, the surrounding tissue, and a few lymph nodes, to prevent the cancer cells from spreading to the other healthy tissues. This is usually an option if the cancer is still localised and not thought to have spread to other parts of the patient’s body.

 

The two main approaches to radical prostatectomy are open and laparoscopic prostatectomy. Open prostatectomy is more traditional and involves a long incision, under general anaesthesia, to remove the prostate and other tissues. In contrast, in a laparoscopic radical prostatectomy several smaller incisions are made and specialised surgical tools are used to remove the prostate. This type of surgery can either be done manually or using a robotic controller.

 

The main advantages of laparoscopic prostatectomy are reduced hospital stay, faster healing and recovery, less pain post operatively, less scaring, and a more rapid return to normal everyday activities. As such laparoscopic surgeries are becoming increasingly popular and may be preferred over open prostatectomy in many scenarios.

 

Chances of successful treatment are high with a radical prostatectomy. However, this treatment option carries possible side effects such as impotence and urinary incontinence.

 

Advance prostate cancer

 

If the cancer cells have spread to other areas of the body, an oncology doctor may recommend the following treatment procedures.

 

1) Hormonal therapy

 

Hormonal therapy can also be used to treat advanced stages of prostate cancer. There is an extensive range of approved hormonal treatment options available, with many proving to be effective in controlling the spread of cancer cells.

 

For advanced prostate cancer, hormone therapy will be a lifelong treatment for most patients. While it cannot cure the cancer, it can shrink it and decrease its growth, no matter where the cancer has spread in the body. This treatment can be effective for years and has also been shown to ease symptoms of advanced cancer including bone pain.

 

How well hormonal therapy can work as a form of advanced prostate cancer treatment will vary from patient to patient. It is also dependent on other factors such as the aggressiveness of the cancer and how far it has already spread. Hormone therapy is also often used for recurrent prostate cancers.

 

2) Chemotherapy

 

Though uncommon, chemotherapy helps improve symptoms of prostate cancer if other treatment options prove ineffective. Chemotherapy generally refers to any kind of therapy that uses chemicals to kill or slow the growth of cancer cells.

 

While it may not be able to cure prostate cancer, it can have many beneficial effects such as relieving symptoms, improving quality of life for the patient, improving the success rate of prostate cancer surgery, and prolonging the lives of prostate cancer patients who no longer respond to hormone therapy. Chemotherapy is also often used in conjunction with hormone therapy to improve outcomes.

 

The chemotherapy drugs can be administered intravenously or in pill form, or both. Chemotherapy is generally recommended when the cancer cells have spread from the prostate gland to other parts of the body in the more advanced stages of the cancer. It is not a standard treatment for early stage prostate cancer.

 

Side effects of chemotherapy include hair loss, mouth sores, appetite loss, nausea, fatigue, easy bruising, and increased risk of infections. Patients undergoing chemotherapy are generally advised to take measures to help manage the side effects. Talk to your cancer doctor today to understand more about chemotherapy and how best it may be used for your condition.

 

3) Immunotherapy

 

Immunotherapy can prove to be effective in treating prostate cancer. It works on the principle of using a patient’s own immune system to fight back against the cancer cells. To achieve this, a vaccine has to be tailored to precisely match a patient’s immune system.

 

During immunotherapy treatment, the patient’s immune cells are extracted via a special machine over the course of a few hours and exposed to proteins designed to stimulate them to counter the prostate cancer cells. This exposure ensures that the patient’s immune cells are able to identify and attack prostate cancer cells. Subsequently, the immune cells are placed back in the patient’s body to treat their prostate cancer.

 

While immunotherapy may not stop a patient’s tumour from growing it does seem to positively influence outcomes and prolong lifespans. It can be an alternate option for patients who have tried other treatment modalities like hormone therapy with limited success.

 

Potential side effects of immunotherapy include minor symptoms like fever, chills, fatigue, joint and back pain, nausea, and headache. Some more serious symptoms like breathing problems and increased blood pressure are rare and usually improve with timely medical treatment. Some new immunotherapy drugs are still being researched and show good promise, Talk to your doctor about the treatment options available to you.

 

4) Radioactive bone isotope

 

An oncology doctor may recommend radioactive bone isotope if the patient’s prostate cancer cells have spread to their bones. These radioactive isotopes function similarly to calcium and are ingested by the bones. Once the isotopes are within the bones, they release radiation to eradicate cancer cells.

 

This treatment can shrink portions of cancer cells that have spread to the bone which reduces symptoms of bone pain and increases comfort levels. When prostate cancer spreads, bones are often the first places to be affected. There is no treatment for metastatic bone cancer, but options like radioactive bone isotopes are important for alleviating symptoms of pain.

 

Metastatic bone cancer occurs in more than 60% of patients who have advanced prostate cancer. It is difficult to predict life expectancy in these patients, but those who have more than one site of cancer are likely to have a lower life expectancy. Early detection and intervention may help improve prognosis.

 

Early detection can catch prostate cancer before any symptoms surface. Talk to your cancer doctor today about scheduling regular health screenings. Men above the age of 50 should go for screenings once every 3-5 years. If you are at a higher risk of getting prostate cancer, you can begin as early as 45.

What is Radiation Therapy?

Prostate cancer radiation treatment is an option recommended for patients diagnosed with prostate cancer. It uses high-energy X-rays generated from a radiation therapy machine called a LINAC to destroy cancer cells. Prostate cancer radiation treatment has long been used to kill tumours without the need for surgical operations. It inhibits cancer cells from multiplying by delivering ionising radiation to destroy cancer cells while minimising radiation damage to normal tissues. When these cancer cells die, the body naturally eliminates them. Healthy, normal tissues are then able to repair themselves in a way that cancer cells cannot, leading to a much higher proportion of tumour cell death compared to normal cells.

How is Radiation Therapy done?

Consultation

The Radiation Oncologist determines the most appropriate method and discusses with you the treatment intent, schedule, risks and side-effects.

Mark-Up and Simulation

A CT scan of the treatment area will be obtained, while three small full-stop size marks are made to ensure accurate positioning during your daily treatment.

Treatment Planning

A multidisciplinary team produces a customised treatment plan for you.

Treatment

Radiation therapy for prostate cancer is delivered daily (Mondays to Fridays) for about eight weeks. Each treatment session lasts 20 minutes.

Follow-Up

Your first follow-up appointment varies depending on how you do during treatment, and is usually about four to twelve weeks after you have completed the course of radiation therapy.

What are the types of radiation therapy available for prostate cancer?

3-Dimensional Conformal Radiation Therapy (3DCRT)

3DCRT delivers very precise doses of radiation to the prostate and spares surrounding normal tissue through a machine called a linear accelerator.

Intensity Modulated Radiation Therapy (IMRT)

IMRT involves varying (or modulating) the intensity of the radiation being delivered during treatment. Compared to 3DCRT, this technique can deliver more tightly focused radiation beams to cancerous tumours while reducing the amount n of radiation to surrounding healthy tissues.

High Dose Rate (HDR) Brachytherapy

HDR Brachytherapy is able to deliver extremely high doses of radiation therapy to tumours with minimal normal tissue effects through the use of Iridium-192 sources placed directly at the tumour site through the use of specialised applications.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

What are the potential side effects?

Although generally safe and clinically tested in Singapore and overseas, prostate cancer radiation treatment does have some side effects that may or may not manifest in some patients. You may experience minimal side effects in the first one or two weeks following your radiation therapy session, which usually improves over time and can be controlled with medication. Inform your doctor or nurse if you are experiencing any discomfort so they can help to alleviate your side effects and improve your wellbeing.

  • Frequent urination
  • Difficult or painful urination
  • Blood in the urine
  • Urinary leakage
  • Abdominal cramping
  • Diarrhoea
  • Painful bowel movements
  • Rectal bleeding
  • Rectal leaking
  • Fatigue
  • Sexual dysfunction, including diminished erectile function or decrease in the volume of semen
  • Skin reactions
  • Secondary cancers in the region of the radiation

Caring for yourself during and after Radiation therapy

  • Stop smoking

    Immediate benefits of less airway irritation with less cough and shortness of breath.

  • Stay active

    Even gently short bouts of activity helps! Improves mood, reduces fatigue, and helps with appetite.

  • Check your medications

    Inform your doctor if you are taking medications, to make sure that they are safe to use during radiation therapy.

  • Be careful caring for the affected area

    Avoid hot or cold packs and only use lotions and ointments after checking with your doctor or nurse. Clean the affected area with lukewarm water and mild soap

  • Enlist support

    Mental and emotional health is as important as physical health. It might be helpful to talk to counsellors or join a cancer support group.

  • Have a caregiver who can manage your care

    It is good to have someone who can help to keep track of hospital appointments and medications prescribed.

  • Rest well

    Get plenty of rest during treatment.

  • Eat well

    Makes you feel better, have fewer side effects, and allows you to fight infections better.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

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ME Novena Specialist Group
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