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Treatments – Chemotherapy
Radiation Therapy or Radiotherapy
What is Chemotherapy?
Chemotherapy concerns the use of special cytotoxic
drugs to treat cancers by either killing
the cancer cells or slowing their growth. Chemotherapy drugs travel
round the body and
attack rapidly growing cells, which may also include healthy cells
in the body as well as
cancer cells. However the breaks between bouts of chemo allow the
bodies normal cells
to recover before the next course of chemo.
To travel the body, chemotherapy needs to enter the bloodstream and
the quickest way to do
this is intravenously – through a vein or artery. Other methods of
administering chemotherapy may also take the form of intra-muscular
injections, tablets or creams. The way you have chemotherapy depends
on a number of factors including the type of cancer you have and the
drugs that you are taking. Talk with your doctor if you have any questions
Some cancers can be treated or cured by chemotherapy alone, while
some treatments may combine chemotherapy with other procedures such
as surgery or radiotherapy – this is known
as adjuvant therapy. Adjuvant chemotherapy can be used before the
main treatment to help make the tumour smaller, or after treatment
to kill residual cancer cells that may cause
problems later in treatment.
In some instances chemotherapy may not be able to control the cancer
but may be used to relieve symptoms such as pain and help you lead
as normal a life as is possible.
There are many different combinations of chemotherapy used to treat
various cancers, and
these may have different affects on different people.
Side Effects of Chemotherapy
While chemotherapy is useful for the killing of cancer cells in the
body, as with most other treatments patients may experience side effects
from the chemotherapy. These side effects
vary from treatment to treatment and from person to person but fortunately
may disappear with time or be managed to reduce the impact that they
The most common side effects are nausea and vomiting, fatigue (tiredness),
(hair loss), muscular, nerve and blood effects as well as bowel (constipation
and oral problems.
It is important that you tell the doctors and nurses if you are experiencing
any side effects
from your treatment so that they can discuss an appropriate course
of action with you.
Hormone Therapy is another option for treating Prostate Cancer. It
is most commonly used
in the treatment of malignancies that have spread beyond the prostate.
The body produces hormones to control the growth and activity of healthy
cells, but some of
these hormones may stimulate the growth of the prostate cancer. The
male hormone Testosterone, which is produced by the testicles, appears
to have a direct affect on the growth
of prostate cancer.
Hormone therapy aims to limit the cancers access to testosterone,
thereby ‘starving’ the
cancer, thus reducing the growth of, or actually shrinking, the tumour.
This means that
patients receiving hormone therapy may experience a reduction in their
possibly a reduction of their tumour that may last for a number of
years. Reducing the
size of the tumour is also useful when planning radiation therapy
of the surgical removal
of the prostate.
Testosterone is produced mainly in the testicles and the rate of production
by the pituitary gland in the brain. There are two main methods of
reducing the production
of these hormones, through surgery method or through medication.
Surgical Hormone Therapy
Because testosterone is produced by the testicles, the quickest method
of reducing its
production is by removing part of the testicles; this procedure is
known as an ‘Orchidectomy’.
The surgeon does this by making a small incision in the groin or scrotum
while the patient is
under general anaesthetic.
While this is a simple procedure that only requires one night in hospital,
the recovery period
may be painful and there are a number of possible side effects. Most
of these symptoms can
be treated with medication but there are also the psychological aspects
related to the
non-reversibility of the procedure to consider.
Medical Hormone Therapy
Hormone treatment using medication aims to produce the same result
as the surgical method, which is to reduce the amount of testosterone
available to the cancer. Although this process
may take longer than the surgical method, results have shown that
the efficacy of this
treatment process is the same as the surgical method.
The medications work by suppressing the hormones produced by the pituitary
gland in the
brain, which stimulate the testes to create testosterone. The hormone
drugs can be
administered either as tablets or injections that can be done at home
or in hospital either
monthly, quarterly or every 4 months.
What are the Side Effects of Hormone Therapy?
Hormone therapies may have a number of side effects, whether performed
through medication. Both procedures share common side effects, while
there may also be additional side effects related to the medications
that you are taking.
Common side effects include a decreased libido, erectile dysfunction
(impotence), infertility, gynaecomastia (the development of swollen
breast tissue), hot flushes and nausea.
Most of these side effects can be treated or will pass with time.
It is important to realise that Hormone Therapy is not a cure and
that some cancers can
become Hormone Resistant. It is not known how this happens, but has
been noted with
both the medical and surgical methods.
However, it is also vital to discuss treatment alternatives
and possible side effects with your doctor so that you can make an
informed decision about which treatment options are best for
What is Radiation Therapy?
Radiation therapy, also called radiotherapy
uses powerful x-rays and other high-energy
rays to kill cancer cells using a machine called a ‘Linear Accelerator’.
Damaging the cancer cells means that they cannot grow or multiply
and so they die. Normal cells are also damaged in this procedure
but usually recover.
Which patients get Radiation Therapy?
In general, radiotherapy is suitable if the cancer is still
in the prostate gland and has not spread
to other areas of the body.
A number of tests will be carried out
to see if radiation therapy will help, including:
Doing a PSA
of abdomen and pelvis
There are a three steps before you start Radiation Therapy,
these help the radiation therapy
team plan and work out the best way to deliver the treatment
to your prostate while limiting radiation to the bowel and bladder.
1.Simulator Planning Session
is placed into the penis and rectum and small amounts of dye
are put into these
to help find the exact position of your prostate
gland (which varied slightly between men).
face down on a couch, measurements will be done by taking x-rays
from the front
and side. 4 small tattoos will be used to mark the
areas to be treated, while other marks will
also be drawn on your skin with ink.
requires no special preparation
and is not painful
2.Planning CT Scan
place about a week after your simulator session and is similar
catheters will not be used. You will lie on a couch
as a CT scanner takes pictures of the
these sessions it is important to try not to empty your bladder
Therapy team will use the information collected during your
and CT scan to work out the best way to deliver
What are the side effects?
The bowel and bladder lie next to the prostate gland and during
radiotherapy some of the
normal cells of the bowel or bladder may be damaged due to their
proximity to the prostate.
Although care is taken so that radiation does not affect these
areas, sometimes it is
Short-term side effects may include:
feeling when urinating or the need to urinate more often;
may become looser and more frequent, and there may be spots
and discomfort when emptying the bowel.
may also feel a loss of energy and increased lethargy during
but this should remedy soon after treatment.
For most people side effects will settle within about a month
treatment, although it may other people longer.
Long-term side effects may include:
A small number of men may develop long term complications from
radiation therapy such as frequent rectal bleeding or other
bowel problems. Some men may find that treatment affects
their sexual function, including erectile dysfunction and discomfort
or a lack of fluid during ejaculation.
Side effects of Radiation Therapy will differ between men and
so it is impossible to determine
who will have other side effects
If you suffer any side effects it is important you let your
doctor know as soon as possible so
that appropriate help can be given.
The Cancer Council's booklet Understanding Radiotherapytalks
about ways to manage side effects. Phone 13 11 20 for a copy
Prostate brachytherapy involves the placement of radioactive material
directly into the
prostate gland. These implants can be in the form or wires or radioactive
The seeds are about the size of a grain of rice and are inserted into
the prostate through
hollow needles placed through the skin bellow the scrotum. This procedure
performed under a general anaesthetic and is called animplant.
Slowly over a few months the seeds deliver a dose of radiation to
the prostate cancer.
Who can be treated using Prostate Brachytherapy?
There are strict guidelines that determine
whether you are suitable for brachytherapy.
These criteria include:
Your level of fitness
The size of the prostate gland
The local extent of the cancer within
the prostate– the cancer must be confined to the gland
The aggressiveness of your cancer cells
If Brachytherapy is not suitable there are other options for managing
your malignancy including external beam radiotherapy and hormone therapy
that may be more suitable.Discuss these options with your doctor.
What are the advantages of Brachytherapy?
Compared to radical prostate surgery, brachytherapy is simple, less
invasive, has a shorter recovery time and is less likely to affect
Compared to external beam radiotherapy, brachytherapy is less likely
to cause long term
rectal problems or erectile dysfunction and involves fewer visits
What is the Brachytherapy Procedure?
If your Urologist and Radiation Oncologist have decided that you are
suitable for brachytherapy, they will first need to plan your treatment.
Firstly you will need an ultrasound examination of the prostate. By
showing the size and
position of the prostate gland, the ultrasound shows precisely where
to put the radioactive
You will then need to return to hospital about six weeks after your
ultrasound to have the
seeds implanted. You will be admitted to hospital for at least one
night after the procedure
to ensure that there are no problems with urination.
About three weeks after the implant you will need a CT scan of the
prostate; the scan allows doctors to determine the exact doe of radiation
given to the prostate.
You will then be followed up every few months when examinations and
PSA tests will be
done to assess how effective the treatment has been.
What are the side effects of Prostate Brachytherapy?
It is important to realise that side effects may occur from all treatments.
When undergoing the procedure you will need to undergo at least one
and stay in hospital at least one night.
The level of radiation emitted by the seeds is very low, but as a
precaution it is advised that pregnant women and young children maintain
a distance of a metre from you (except for
short periods – hugs and cuddles) for the first month after the procedure.
Initially you may have slight bleeding from the needle puncture sites
and have swelling or
bruising around the scrotum. Applying an ice pack can assist in bringing
relief and reducing
There may be some blood in your urine after your implant, but this
generally settles down
within a few days. Some men may develop short or long term urinary
problems such as obstruction or incontinence. This is more common
in men who already have severe urinary difficulties and is why these
men are excluded from brachytherapy.
For a few weeks after treatments you may experience some bowel irritation,
this may include frequent or loose motions and/or alight bleeding
from the rectum. These symptoms nearly
Also, follow up tests may indicate that the brachytherapy implant
has not adequately treated
the gland, thus additional external beam radiation therapy would be