Prostate Cancer
Radiotherapy: External beam radiotherapy
Radiotherapy uses high energy rays to destroy cancer cells while protecting healthy tissue. When it is given outside of the body (externally) it is called external beam radiotherapy, and when it is given from inside the body it is called brachytherapy (see ‘Brachytherapy’).
External beam radiotherapy is used both to treat cancer and to relieve pain when the cancer has spread to the bones (see 'Pain relief'). It can also be used together with other therapies such as hormone therapy and brachytherapy. Radiotherapy as a means of cure is usually given 5 days a week for over 4-7 weeks.
Here we discuss men's experience of radiotherapy as a treatment for prostate cancer.
Some of the men who opted for radiotherapy described their experiences in the waiting room at the hospital while waiting for a diagnosis and for treatment.
Comments that his only inconvenience was radiotherapy required so much time.
Comments that his only inconvenience was radiotherapy required so much time.
The process of radiotherapy... the only inconvenient part of the radiotherapy treatment is you've just got to cut out 6' weeks of your calendar because you've got to report to the hospital Monday to Friday for 6 weeks and then for some reason or other another 3 days, so it ties you in terms of what you can do. But as far as the hospital was concerned you get an appointment, you get a time and I found that you were always taken within 10 to 15 minutes of your time. You went in for the radiotherapy, you were out and that was it, so the actual time spent in the treatment room was probably 20 minutes to half an hour at the most.
Expresses his frustration with the worry caused by delay in the waiting room.
Expresses his frustration with the worry caused by delay in the waiting room.
The delays to see the consultant bothered me, I suppose also the delays in the waiting room bothered me, particularly when you're going for the results of a biopsy and you're there biting fingernails. Because we all feel this you know the word cancer scares the life out of us and you're waiting there for a half past 9 appointment and you see the specialist at quarter to 11 and I've seen them as late as 12 o clock. And all that time you're a bit frustrated with the long delay and you are sort of beginning to worry and worry and worry, well I say you, I'm speaking for my own self because some of us worry more than others. I feel quite anxious those times, what happens I do not know.
It must be awful.
Yes it bothers you because you almost regard this man as God who's going to pronounce a life or death sentence on you when you don't know. So to wait a long time for that sort of pronouncement does get you up a little bit tight. But the frustration as I say of waiting and the worry of what the guy is going to say to you when you go in.
Explains how efficient he found the treatment.
Explains how efficient he found the treatment.
We even got to know the other patients. And because I'm a councillor I took my councillor papers there so I was a bit introverted as regards all the others but because the others only had the usual 1948 magazines on the table you know I mean they built up a chat show between them and discussed everything from the weather to the latest political situation you know that was, it was good for them, they were never on their own and of course they were always together as it were you see. So all that was very harmonious and very nice and very quick and very efficient and I couldn't find a fault with that in any way whatsoever. And I bought them a box of chocolates when we left because it was rather, they were really good, they were a nice team.
Some described delays and frustration, while for others, clinics ran more smoothly. All reported that the radiotherapy treatment itself was well managed, and painless.
Beginning radiotherapy treatment
During a radiotherapy planning session a computed tomography scan (CT scan), MRI scan or PET scan of the prostate is given producing a 3D image of the prostate.
A computer uses the scans to map the location of the prostate and the organs near it to work out the precise radiation dose and create a treatment plan.
Radioactive beams can then be emitted by the radiotherapy machine (a big x-ray machine called a linear accelerator -often called a LINAC) which carefully shapes the radiation beams to the exact size and shape of the prostate gland, reducing damage to the surrounding normal tissue and organs. This method also reduces the side effects and can allow higher doses of radiation to be given, which may be more effective.
There are currently three types of external beam radiotherapy used for prostate cancer treatment:
- intensity modulated radiotherapy (IMRT)
- volumetric modulated arc therapy (VMAT)
- stereotactic ablative radiotherapy (SABR)
Intensity modulated radiotherapy (IMRT)
IMRT is currently the most common radiotherapy treatment type given for prostate cancer. With IMRT, advanced computers calculate and deliver radiation beams from different angles to focus directly on the cancer.
It allows the radiotherapist to vary the dose of radiation given to different parts of the tumour and surrounding tissue and give a higher dose to the cancer and a lower dose to healthy tissue for reduced side effects. IMRT radiotherapy as a means of cure is usually given 5 days a week over 4-7 weeks.
Volumetric modulated arc therapy (VMAT)
VMAT works in a similar way to IMRT, except the radiation dose is given by a radiation machine that rotates to deliver radiation beams more precisely to the cancer and allows the radiotherapist to change the dose more accuracy during treatment. This option is currently only available in some hospitals and is being tested to see how effective it is compared to IMRT.
Stereotactic ablative radiotherapy (SABR)
In SABR therapy, many small, thin beams of radiation are directed from multiple different angles to meet at the point of the cancer. It allows for delivery of larger doses of radiation to the cancer and gives treatment over a few days rather than weeks. SABR is not currently standard treatment for prostate cancer but is currently being provided by several hospitals as treatment.
To make sure the radiotherapy is given in the correct position each time the person who gives the treatment (radiographer) will make some permanent marks (tattoos) the size of a pinpoint on the skin.
See Macmillan Cancer Support for more information about radiotherapy for prostate cancer (‘Resources and Information’).
Describes the process and considers that the treatment is painless.
Describes the process and considers that the treatment is painless.
Explains that the operation is very technical and precise.
Explains that the operation is very technical and precise.
The actual radiotherapy you just lay down, the beam is focussed and they're very precise, they mark you up with an infrared beam as it were, I'm not sure that it's infrared but at least it's a red beam, if it's infrared it would be producing heat. But they mark you up with the beam, they set you in exactly the position, they keep you very still for a period of about 2 minutes and then the radiation takes place in 3 positions. The 3 positions for the prostate to the left hand side, exactly over the middle, just up above the penis, about 3 inches up above the penis and to the right hand side. So it's quite a precise art as it were. The duration is for about 2 minutes and the only thing you do is lay there rather bored and I count the clicks. They explained that the clicks were not seconds because I try and time it but it's just clicking to say that the radiation is on. You're not completely sure whether you should be there because everybody goes outside the room, so you think what is this thing that they want to avoid that I'm having. So they go outside and they monitor you from the outside. But that, once they've set you up then the machine is automatic, it would do its 3 positions automatically, I assume automatically, I don't think they're operating it from outside. So that is a very, very precise, very technical operation that is I think particularly good.
Describes the treatment and considers it is not invasive or painful.
Describes the treatment and considers it is not invasive or painful.
However, others thought that psychological aspects were neglected and they felt as though they were treated like they were ‘on a production line’ while having radiotherapy.
Most of the men we interviewed experienced side effects either during or after treatment (see the 'Side effects of treatments' section).
Compares the treatment to factory-like conveyor belt.
Compares the treatment to factory-like conveyor belt.
Explains the radiotherapy process and gives advice to others.
Explains the radiotherapy process and gives advice to others.
My next effort or result with what was happening was that I was then to have a series of 27 to 30 shots of the radio therapy. This is a horrible thing to go through. First of all you have a little dot put on your tummy so that each time they can set the machine up and they can find this tattoo mark and then the machine sort of lifts itself up, you're steady and it goes round you and then clicks off. You are alone in this room but you haven't got anything to worry about because you can look through a window and see the nurses there.
They are very, very good indeed, they are very helpful. And when you are going through this series of radiotherapy you certainly need somebody, not only with you because you won't be able to drive or anything after it, you'll have a hell of a job to even to walk 100 yards, but it goes, it goes. Also in 97 I then started going to the pain therapy doctor and this is when you start taking your pills of morphine, and other ones which you will come across in time. Another, going back to the radiotherapy it is most difficult really to explain how things are. You will be very down, everything is such an effort to do and if you're not careful you could say 'Damn it all I'm going to give up,' but don't give up, its not worth it because there's plenty left later on.
We have not yet been able to interview anyone who has had volumetric modulated arc therapy (VMAT) or stereotactic ablative radiotherapy (SABR) treatment for prostate cancer. If you have had this type of treatment and you would like us to include your story on this website, please email us at hexi@phc.ox.ac.uk for more information.
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