I've chosen radiation as my treatment option for prostate cancer. What’s next?

Receiving a prostate cancer diagnosis can be overwhelming, and understanding treatment options is crucial for making informed decisions. Radiation therapy for prostate cancer is a common choice for treatment and discussing it thoroughly with your healthcare provider is essential. Additional common treatment options for prostate cancer are surgery with a urologist or active surveillance, the process of closely monitoring the prostate cancer in low-risk cases. However, when treatment is necessary, many men choose radiation treatment for prostate cancer due to the less invasive nature of the treatment.

To help guide you through this conversation, here are 10 important questions to ask your radiation oncologist about radiation therapy for prostate cancer.

1. What is radiation therapy, and how does it work in treating prostate cancer?

   Understanding the basics of radiation therapy will provide a foundation for discussing its potential benefits and risks in your specific case. Radiation damages cancer cells by breaking the DNA strands of the cells, removing the ability for the cells to continue reproducing and the cancer from growing. Radiation oncologists can control the radiation to deposit the required dose to effectively kill the cancer cells. The challenge for radiation oncologists is to deliver a high enough dose to the prostate, while minimizing damage to healthy tissue surrounding the prostate. Radiation is usually delivered to the whole prostate to ensure that all cancer cells are targeted.

2. Is radiation therapy the most suitable treatment option for my specific case?

   Your doctor will consider various factors like cancer stage, your overall health, and your preferences before recommending a treatment plan. The information from your PSA (prostate specific antigen) blood tests, your Gleason score from the biopsy, images from any scans such as MRI and CT scans, and any additional tests such as the PSMA scan and genetic testing will all be used to get an accurate picture of your specific case. This information, in addition to data from the most recent prostate cancer research should be considered.

3. What are the different types of radiation therapy available for prostate cancer, and how do they differ in approach and effectiveness?

   There are various forms of prostate cancer radiation therapy, including external beam radiation and brachytherapy (internal radiation therapy). Understanding these options will help you make an informed choice. Here are some great resources for you:

   • Article discussing the different types of radiation treatments for prostate cancer.
   • Article reviewing the results of IMRT vs. proton therapy for prostate cancer.
   • Article discussing the outcomes of radiation therapy for prostate cancer.

4. What are the potential side effects of radiation therapy for prostate cancer, and how can they be managed?

   It's important to be aware of the potential side effects, both short-term and long-term, and discuss strategies for managing them. The most common side effects of prostate cancer radiation treatment can include fatigue, urinary frequency, urinary burning, bowel issues and mild redness at the site of the radiation. The rates of these vary for each person and are discussed in more depth in one of our Blog Spot articles. If you experience any side effects during treatment, bring them immediately to the attention of your care team. Often, physicians may recommend simple treatments such as cranberry pills and Advil to help mitigate these side effects.

5. How will the treatment schedule be structured, and how many radiation treatments for prostate cancer are required?

   Knowing the duration and frequency of treatment sessions will help you plan your schedule and make necessary arrangements. Radiation treatments are usually delivered every day, Monday through Friday for 4-8 weeks. Each daily treatment will only take about 20 minutes. In addition, once a week, you will meet with your physician to review your progress and address any side effects or concerns you have. Each day you only need to plan to be at the treatment center for one hour or less.

6. Are there any lifestyle changes or special precautions I should take during radiation therapy?

   Your doctor may recommend specific adjustments in diet, exercise, or daily activities to support your overall well-being during treatment.

   • Antioxidant supplementation is often recommended to be avoided during radiation treatment as it may protect cancer cells against radiation damage and then reduce the efficacy of treatment¹. You may be asked to suspend your use of antioxidants such as vitamins A, C and E, as well as melatonin, zinc and any other similar supplements you regularly take. A standard multivitamin is acceptable to be taken during radiation treatment.
   • Your prostate cancer radiation treatment plan is precisely created for your specific cancer and anatomy. Therefore, it is important to maintain the weight you were at during your treatment planning simulation to ensure accuracy of your treatments.
   • Patients are encouraged to exercise regularly to help fight fatigue and improve circulation. Walking and other moderate activities are ideal. It is not recommended to start a new, intense exercise program during radiation treatments. In addition, since treatment is being delivered to the pelvic area of the body, cycling is not recommended.

7. What are the chances of recurrence after radiation therapy, and what follow-up care will be necessary?

   Understanding the likelihood of recurrence and the importance of regular follow-up appointments is crucial for long-term management. While recurrence of prostate cancer after radiation therapy is low, the five-year survival rates for low, intermediate, and high-risk prostate cancer are 99%, 94%, and 74%² respectively with proton therapy and 98%, 86%, and 68%³ respectively with traditional radiation therapy.

   Follow-up care for prostate cancer includes PSA tests every few months for the first year, and bi-annual or annual tests after that. Your PSA levels will begin to slowly decrease in the two years after radiation therapy and should level out to a low number consistently over the years. Any consistent increases in PSA levels will be monitored by your physician and additional testing will be ordered if necessary.

8. Are there any potential interactions between radiation therapy and other medications or treatments I may be receiving?

   It's important to discuss any existing medications or treatments to ensure they won't interfere with the effectiveness of radiation therapy. As mentioned above, the use of antioxidants is recommended to be suspended during radiation treatment but may be resumed shortly following treatments. Your radiation care team will ask for an in-depth medical history to ascertain if any other medications you are on may affect your radiation treatment.

9. Can you provide information about the success rates and outcomes of radiation therapy for patients with similar profiles to mine?

   Understanding the success rates for patients with similar characteristics can help set realistic expectations. We put together a lot of the data and recent research related to the outcomes of prostate cancer radiation therapy, including proton therapy here. It may also be a good idea to ask your specific radiation oncologist for a list of patients who are willing to share their outcomes and experiences with their treatment. At UF Health Proton Therapy Institute, there is a program called the Ambassador Program, where patients may sign up to be a resource for those newly diagnosed with prostate cancer. Find out more about this program and how to connect with these ambassadors here. It may also help to read or view stories of prior patients like Reid Tillery who shared his experience with proton radiation therapy treatment.

10. What are the alternatives or complementary treatments that can be considered alongside radiation therapy?

    Your doctor may suggest additional treatments or therapies that can enhance the effectiveness of radiation therapy or address specific aspects of your health. Alternatives to prostate cancer radiation therapy may be active surveillance if you have a low-risk stage of prostate cancer. During active surveillance (or watchful waiting), your PSA levels will be monitored every couple of months for changes to ascertain whether treatment should be strongly considered in the near future.

Having an open and informative discussion with your radiation oncologist about radiation therapy for prostate cancer is crucial in making the best decisions for your health. By asking these important and common questions about radiation therapy, you'll gain a deeper understanding of the treatment process, potential outcomes, and how to best navigate this phase of your cancer journey. Remember, your doctor is there to support you and provide the necessary information to make the best choices for your unique situation.