What are the consequences of radiation therapy for prostate cancer?
Prostate cancer is currently one of the most common malignant neoplasms in men. Diseases at first develop asymptomatically, then the signs resemble chronic prostatitis, which is already present in most older men.
Treatment of prostate cancer is carried out with the help of surgery, chemotherapy, hormonal and radiation therapy. The latter method is one of the most effective and is often prescribed both as a monotherapy for stage 2 cancer and in complex treatment for more advanced forms of the disease.
The effectiveness of radiation therapy for prostate cancer
Radiation therapy is currently one of the most effective treatments for prostate cancer. The procedure can be carried out as the main therapy, and also be used as an addition to other methods of treating a malignant tumor. For example, if a tumor requires removal, then radiation therapy can be prescribed after a prostatectomy to completely get rid of the remaining tumor cells.
Despite the great effectiveness, the technique can cause serious consequences. Therefore, the course of treatment is selected by the doctor individually. The specialist evaluates the general health of the man, the presence of concomitant diseases, and collects an anamnesis.
As the main method of treatment, exposure to rays in prostate cancer is effective only at stages 1 and 2. Stage 3 and 4 prostate cancer requires a prostatectomy followed by radiation and chemotherapy.
It is also worth noting that radiation therapy should be carried out with caution if metastases have spread to bone tissue, since the procedure can cause serious harm to the body.
How is radiation therapy performed for prostate cancer?
Currently, there are 2 types of exposure to rays carried out with prostate cancer:
- contact or brachytherapy,
Contact radiation therapy involves placing a radiation source inside the human body, in the immediate vicinity of the tumor, or inside it. With this technique, radiation acts locally, the surrounding tissue does not suffer. Brachytherapy is used for small tumors that have not yet metastasized.
Implantation of the radiation source is carried out under general anesthesia or spinal anesthesia. It is believed that this method is the most gentle, complications from treatment occur quite rarely.
Remote radiation therapy is a method in which irradiation is carried out externally through the skin. Using a computer, the exact location of the tumor is calculated. A variation of the procedure is modern 3D conformal radiation therapy, in which the irradiation area ideally coincides with the area of the neoplasm.
With this procedure, the patient is fixed to ensure complete immobility. Then conduct a study to determine the contour of the tumor. Then the apparatus is installed and treated. During the procedure, the patient lies on the couch in a comfortable position, but he is completely motionless.
The number of radiation sessions for prostate cancer is determined by the attending physician. Depending on the methodology of the therapy and stage of the disease, the number of procedures may be different.
For example, 3D conformal radiation therapy requires a long course of treatment, 1.5-2 months. In this case, the procedure must be visited 4-5 days a week. And stereotactic radiation therapy requires only 5-6 sessions. Treatment can be carried out both in the hospital and on an outpatient basis. Again, it all depends on the stage of the disease and the well-being of the patient.
The consequences of radiation therapy for prostate cancer
Irradiation in prostate cancer of 1-2 degrees usually does not cause serious complications, since it does not require large doses of radiation, and can be carried out as monotherapy. With the advanced stage of cancer, chemotherapy and prostatectomy will be required, respectively, much more complications can occur.
The most common complication after prostate cancer is a violation of urination. Radiation exposure can cause irritation and edema of healthy tissue surrounding the tumor. As a result, the swollen prostate creates pressure on the urethra, which leads to difficult discharge of urine, the stream becomes weak. As a result, there is frequent urge to urinate.
If radiation therapy causes irritation of the bladder, then the patient is worried about burning sensation during urination. This condition is called radiation cystitis. To avoid such a complication or reduce the manifestations of cystitis, you need to drink a lot of water during the treatment period. It is also recommended to be examined for infections in the bladder.
If radiation enters the intestines, diarrhea and abdominal pain occurs. To avoid such a complication, the bladder must be filled before the procedure. He will slightly move the intestine from the prostate so that it does not fall into the irradiation zone. It will also be useful to observe the principles of proper nutrition, to exclude gas-forming foods from the diet.
Remote radiation therapy often provokes a feeling of weakness. Symptom may manifest itself to varying degrees in each patient. In most cases, a feeling of overwork is associated with nervous strain, fatigue from constant going to hospitals, but radiation, if it gets on healthy tissues, can provoke this symptom.
Another frequent complication of radiation therapy is impotence. With monotherapy, erectile dysfunction is quite rare, when exposed to large doses of radiation. Most often, impotence is associated with prostatectomy, which was performed before exposure to the rays.
If impotence occurs after radiation therapy, there is a chance to restore male strength with the help of herbs and medicines. But before starting treatment, you must definitely consult a doctor, because drugs for potency can provoke a relapse of the disease.
Cancer relapse after radiation therapy
If after radiation therapy, the PSA study showed the absence of cancer cells, then they talk about remission. Relapse of prostate cancer is not excluded. The fact is that no method of therapy can guarantee that cancer cells will not remain in the body at all.
At the time of treatment, the tumor could already begin to metastasize, but the metastasis may be so small that during the study they were not detected. In this case, after a few months, there will be a relapse of cancer. Unfortunately, it is quite difficult to predict relapse, so the patient must constantly visit a doctor for the first 2 years and take tests for prevention.
To prevent relapse of prostate cancer, the patient is recommended to lead a healthy lifestyle. Alcohol, smoking and saturated fats increase the risk of developing oncology. The risk group includes obese men. Therefore, it is recommended to lose weight and eat properly and balanced.
Prostate cancer is a very common fatal disease, which is more susceptible to older patients after 50-60 years, especially with a history of chronic prostatitis and prostatic hyperplasia.
Therefore, men are recommended to undergo an annual examination with an andrologist. If you detect cancer on time, you can get rid of it with radiation therapy and avoid serious side effects. According to statistics, more than 93% of patients with prostate cancer of stage 2 are successfully cured and live 5 years and longer.
The effectiveness of radiation therapy for prostate cancer
To cure a tumor of any localization, it is first necessary to destroy the tumor itself. When using surgical methods of treatment, it is removed from the body. When using radiation therapy, the tumor remains in the body and it is necessary to confirm its complete disappearance.
At the International Conference of Urologists, Oncologists and Radiologists in 2016, research data were presented, during which long-term monitoring of the quality of life of patients undergoing radiation therapy was carried out.
Prostate tissue was taken from those men who were monitored 3–8 years after irradiation to confirm the absence of tumor cells. The following correlation was noted: with an increase in the radiation dose, the number of fully recovered patients increased.
If, when applying the IMRT method, the dose exceeded 80 gray (exactly 81 gray), it was possible to achieve 88-90% survival for 8 years after irradiation. This is an important clinical achievement. But in addition to the percentage of cure, it is necessary to pay attention to the side effects associated with radiation therapy for prostate cancer.
The consequences of radiation therapy
Currently, there are several methods of radiation therapy used to treat prostate cancer. Accordingly, several types of equipment are used to destroy a malignant tumor.
The frequency and severity of toxic effects after radiation therapy directly depend on the treatment method used. Today they work on IMRT, CRT methods. An innovative method, put into practice in 2013, is based on the principles of GPS using prostate immobilization. All of these methods have different survival rates and incidence of side effects.
When irradiating the prostate gland, nearby tissues and organs are affected primarily: the rectum and the bladder. After a course of radiation therapy, the following effects may be observed:
- Leakage of urine
- The presence of blood in the feces,
- Radiation fibrosis (narrowing of the lumen of blood vessels due to the formation of different sizes of seals on their walls),
- Urethral stricture (narrowing of the lumen),
- Renal hydronephrosis,
- Rectitis (inflammation of the rectal mucosa),
Distinguish between early and late complications. Among the early ones that appear in the first days and weeks after a course of radiation therapy:
- Bowel disorders
- Leakage of urine and impaired urination.
Using the IMRT technique, good results were achieved from the side effects of radiation therapy. With a 2nd degree malignant tumor, the number of toxic effects was:
- From the urinary tract 10%,
- 0.5% of the gastrointestinal tract and rectum.
In addition to the frequency and severity of side effects, the quality criteria for the treatment are:
- Local tumor control
- Lack of distant metastases.
Today, there is reliable data confirming the comparability of the effectiveness of surgery (radical prostatectomy) and high-dose radiation.
The same can be said for the analysis of total mortality.
Unfortunately, each of the methods is not without drawbacks. Surgical intervention can be technically difficult, and not all surgeons have sufficient experience with such operations. The same is true for high-dose radiation therapy.
Causes of side effects from radiation therapy
One of the important factors that reduce the effectiveness of radiation therapy and increase the incidence of side effects is prostatic motility.
The displacement of the prostate is associated with the movement of feces in the rectum. In this area of the small pelvis, a small amount of free space. With the promotion of feces, the rectum begins to put pressure on the prostate gland. This causes its displacement.
In order to understand why prostate movements are the cause of the side effects of radiation therapy, you need to familiarize yourself with how the radiation process goes.
How was radiation therapy performed before?
In the 50s of the last century, a method was used in which, in addition to irradiating the prostate gland itself, a dose was given to surrounding tissues in order to ensure the reliability of destruction of malignant cells. 20 mm was added to the contour of the prostate, and this entire area was irradiated. Created the so-called "safety belt", covering nearby healthy tissue. And this method worked. But it has critical flaws.
There is a problem: these healthy tissues surrounding the prostate are the bladder and rectum. Coverage of healthy tissues required the need to reduce the dose to 70 gray. As a result, there was a decrease in the cure rate for prostate cancer by up to 50%.
To complete the picture, the situation can be considered in the following example. If the volume of the prostate gland reaches 35 cm3, and in order to ensure reliable therapy, increase this safety margin around the gland by 20 mm, this will lead to irradiation of tissues with a volume of at least 235 cm3.
CRT conformal radiotherapy method and its consequences
With the introduction of new technologies into practice, significant changes were achieved in the method of radiation therapy. Today, oncologists have equipment equipped with multi-leaf collimators, which allow you to completely restore the relief of the tissues and apply radiation in a fairly accurate accordance with the contours of the prostate gland.
It became possible to manipulate the radiation dose taking into account all the anatomical features against the background of a high radiation dose to the prostate gland. This is a CRT or conformal radiotherapy technique.
When using this method, the prostate gland is irradiated from 5 sides with a certain shape of the beam. Thus, the equipment allows a more targeted effect on the tumor. And also reduce the size of the "safety belt" around the prostate gland from 20 mm to 6 mm, which leads to a significant reduction in radiation exposure to surrounding tissues.
In connection with these, it became possible to increase the dose of radiation directly to the prostate gland. To date, a dose of 86 gray is used. To achieve the result, the course of radiation therapy is divided into 48 sessions. In total, radiation therapy lasts 10 weeks. At each session, the radiation dose is up to 1.8 -1.9 gray.
Radiation therapy IMRT and its consequences
Currently, the most commonly used radiation therapy with modulated (changing) intensity - IMRT. This method is based on a deep understanding of the processes occurring in the tumor with the use of radiation therapy. It is aimed at reducing the number of radiation sessions (up to 25, 20 or less) with a parallel increase in the radiation dose.
The main problem of the method: with a decrease in the number of sessions, the dose given at each of them should increase. If you reduce the number of sessions to 12, during each of them you need to submit a dose reaching 7.9 gray. Therefore, the main problem of this method is that the risk of side effects associated with exposure increases significantly. Ensure that there is no coverage of surrounding tissues.
A new milestone in the field of radiation therapy for prostate cancer was reached in early 2010 with the introduction of a method that allows visual control based on computer analysis of the images obtained. The method allows to identify errors that were made during the planning of exposure.
IMRT uses devices that are a hybrid of a computed tomography scanner and a linear accelerator. This equipment, in particular, was installed in the clinic "Medicine" in Moscow.
Two modules are used, one of which allows you to get a beam in the shape of a cone and is necessary for marking radiation therapy. The second module produces a beam whose profile can be changed in real time. This eliminates the exposure of surrounding tissues.
How is the therapy session going
The patient is placed in a special chamber, the apparatus begins to rotate around him. At this time, a 3-dimensional reconstruction of the internal organs is carried out, planning errors are detected and their automatic correction is carried out.
Thus, two new stages were added to the radiation therapy process:
- Real-time error correction,
- Minimizing radiation exposure to surrounding tissue.
Currently, the accuracy of planning radiation exposure reaches 2 mm or less. Now this method is available and used in many clinics around the world. But side effects when using IMRT are not excluded.
IMRT Performance and Consequences
Today, the following data are used as the gold standard of treatment:
- 5-year survival at low risk 94%
- In the intermediate risk group 84%,
- In the high-risk group, 81%.
This is the best shown, compared with surgical intervention, including robotic methods of performing surgical interventions.
Side effects with IMRT:
- Bladder lesions 10%,
- Rectal lesions 5%.
An innovative method of radiation therapy for prostate cancer
The main attention of oncologists and radiologists was focused on finding opportunities to minimize the displacement of the prostate gland in order to exclude irradiation of nearby tissues. The solution was found: the use of a system similar to car GPS. But there is a significant difference.
Car GPS receives a satellite signal. And with the new method of radiation therapy, these "spunniks" are placed directly in the prostate gland. The operator presses a button, the signal is transmitted to the prostate, transponders placed in the gland are activated and send back the reflected signal in the form of an echo.
At the top of the patient is a block similar to a car GPS, which allows you to quickly and accurately determine the location of the prostate gland. 10 scans are made every minute, which allows you to take into account all the displacements of the prostate gland. And they no longer have any effect on the aiming of radiation. But, given these movements, it is possible to reduce the possibility of side effects from the mucous membrane of the bladder and rectum.
In all clinics where this method is practiced, irradiation is stopped with a significant displacement of the prostate gland in the anteroposterior direction. In this case, accordingly, the irradiation of the surrounding cells is also stopped.
Thus, we have reached the minimum number of negative consequences of radiation therapy for prostate cancer. To date, this method is the most expensive.
The way to eliminate prostate displacements
The solution to the problem was the transfer of the prostate from a mobile state to a motionless one. Doctors went the following way: a balloon filled with air was injected into the lumen of the rectum. In the lumen of the prostate gland - a catheter. This allows you to fix the prostate in a stationary position.
So a low level of variability was achieved: less than 1 mm. And these minor displacements are associated with the movements of the balloon in the lumen of the rectum. If we are talking about fractions of a millimeter, such an error can be neglected. On average, when using this method of treating prostate cancer, 5 fractions (5 sessions) are carried out with a radiation dose of 9.9 gray.
When is prostate irradiation necessary?
In cancer, prostate irradiation is a treatment based on the use of ionizing radiation. In modern medical practice, methods are applied that act directionally, that is, only on the tumor.
It is worth knowing: radiation purposefully destroys cancer cells, while it practically does not affect healthy tissues. The effectiveness of manipulation can be compared with abdominal surgery to excise a tumor.
Radiation therapy for prostate cancer is carried out in the following cases:
- At an early stage of the oncological process, when cancer of the first or second stage is diagnosed. Irradiation can act as a single agent, or combined with surgical intervention.
- Exposure to radiation is carried out at stages 3-4 of the cancer process, when for a number of reasons the patient cannot be operated on.
- Treatment of elderly patients who have a history of serious chronic diseases - pathologies of the heart and blood vessels, respiratory system, etc. In this case, the risk from surgery is greater than from the tumor itself.
- It is advisable to carry out radiation at the last stage of cancer along with chemotherapy and hormonal treatment. In the presence of metastasis, the procedure helps to reduce pain.
- Conducting radiation after surgery, during which the prostate gland was removed, helps to prevent recurrence of the disease and the appearance of metastases.
Before treatment, the doctor must identify the stage of prostate cancer. Radiation therapy in the absence of medical contraindications is prescribed immediately.
Types of radiation therapy for prostate cancer
The first experiments with radioactive radiation were carried out in the middle of the twentieth century. They showed a high result, but certain disadvantages were revealed. In particular, this is a serious damage to healthy cells, which led to a range of negative symptoms.
Modern techniques have little to do with past samples. A breakthrough in cancer therapy has been the use of narrowly targeted radiation. In other words, it became possible to act exclusively on a diseased organ, which significantly increases the chances of recovery.
It is worth knowing: all the used methods of radiation exposure are classified into two large groups - the remote method (external use of radiation) and the ionizing option (the effect on the tumor from the inside). None of the methods used guarantees 100% healing of the patient. To increase the effectiveness of therapy, combined radiation is recommended - 2 or more radiotherapy methods are combined.
Radiation therapy of prostate adenoma is not carried out, since prostatic hyperplasia is a benign process. It is advisable to apply this technique if the disease is malignant, which is unlikely.
Remote therapy involves exposure to a tumor outside the patient’s body. There are several methods of conducting:
- The conventional method is used most often. In the process of manipulating the apparatus, certain settings are set, as a result of which the tumor is exposed at a given angle,
- 3D-conformal treatment is characterized by extreme accuracy of influence on a tumor neoplasm. The advantages of the method include a small list of side effects, targeted exposure, a weak effect on healthy tissues. High-precision equipment is used for manipulation,
- The IMRT method stands for Intensive Radiation Modulated Prostate Treatment. This option helps to reduce the negative impact on other internal organs,
- SBRT is a stereotactic method of therapy, which involves radiation directly to the focus. The duration of the treatment course is less than seven days,
- IGRT - irradiation with image correction. During the manipulation, it is possible to obtain a picture of the tumor neoplasm or immediately after it. In this case, the dose of radiation received by normal cells is reduced to zero.
It is noted that an external effect on prostate cancer often leads to a burn at the site of entry, fragility of blood vessels, hemorrhages often appear.
Brachytherapy or contact treatment has an undeniable advantage - it affects the focus. All manipulation is controlled by an ultrasound apparatus. Radioactive grains are injected with a special needle through the perineum.
Brachytherapy is of several types depending on the time of exposure:
- Long. Rods, which are enriched with radioactive iodine, are introduced into the focus of formation. The severity of radiation is small, but the therapeutic result is due to the constant influence.
- Temporary. The procedure involves the introduction into the prostate of a radioactive element with a large dose of radiation. It is left inside the body for a short period of time, then it is removed. This leads to the death of pathological tissues, as a result of which the size of the prostate decreases.
The dosage of radiation is calculated in accordance with radiological schemes, tables and established international standards.
Another treatment option is proton exposure. The therapeutic effect is achieved due to the effect at the cellular level. Protons destroy cancer cells, while the dosage of radiation is very small, respectively, the harm to healthy tissue is minimized. The likelihood that prostate cancer will return after proton irradiation is 10% less than other methods.
Reducing the negative effects of radiotherapy
Despite numerous early and delayed complications, radiation therapy is used quite often, because it helps to destroy malignant cells and prevents them from multiplying, it helps to clog the blood vessels, as a result of which the tumor does not grow, since it does not receive nutrients.
Doctors have developed measures to help reduce the harmful effects on the body:
- Exclude alcoholic drinks from the menu, give up bad habits. The patient needs to eat properly and balanced, paying particular attention to fruits, vegetables, and fiber.
- Careful hygiene of the perineum.
- Before therapy, it is necessary to check the patient for the presence of infectious pathologies of the genitourinary system. If the patient has cystitis or pyelonephritis, antibacterial treatment is required before irradiation.
- If a man has problems with urination, then oncology treatment begins with hormonal drugs, after which radiation is added, which begins with a minimum dosage.
- Before manipulation, it is required to abandon any mechanical effect on the urethral canal.
- When the patient is in serious condition, a break of 14-21 days must be maintained between the stages of irradiation.
- At the first symptoms of rectitis as a consequence of medical manipulation, rectal suppositories with belladonna, methyluracil suppositories should be used, enemas should be performed based on medicated oils.
Tip: in order to minimize the complications of radiation therapy in the first 2 months it is impossible to lift objects heavier than 4 kg, it is not recommended to sit for more than two hours in a row, you must constantly monitor that the intestines and bladder are not full.
What are the contraindications to the procedure?
Radiotherapy cannot be prescribed to all patients who have been diagnosed with prostate cancer. The manipulation has direct contraindications. When prescribing radiation, the general condition of the patient must be taken into account.
- If the patient has a urine drainage catheter,
- The presence of an inflammatory process in the body. Especially when a patient has exacerbation of cystitis or rectitis,
- History of exposure to pelvic organs,
- Obesity of the third and fourth degree,
- Chronic diarrhea
- High blood creatinine
- Severe condition of the patient.
Before prescribing radiation therapy, the probable negative consequences after it must be taken into account. A patient who is in critical condition will not be able to cope with complications, which ends in death.
The use of radiotherapy significantly increases the chance of a patient with cancer for life, especially at an early stage of the pathological process. When the disease is started, radiation treatment allows you to extend life for a long time and improve its quality.
What is radiation therapy?
It is also called radiotherapy, radiation therapy. This is one way of treating malignant tumors with ionizing radiation. Radiation is formed thanks to special devices. The mechanism of radiotherapy is that a powerful radiation flux acts on the affected organ, in which pathological cells die, the malignant course of the disease stops.
If oncology is not treated with radiotherapy or other alternative methods, then pathological cells will grow, grow, divide, and spread to healthy cells.
Types of prostate radiotherapy
- Remote - when the radiation source is located far from the patient, not close. Such therapy can be used alone or in combination with surgical treatment or chemotherapy. This is a classic treatment for prostate cancer.
- Brachytherapy - the introduction of a dose of radiation into the pathological organ, that is, into the prostate. Patients tolerate such a therapeutic session. Its advantage is that the radiation source acts locally, so the risk of negative consequences is minimal. If necessary, brachytherapy can be repeated, the recovery time after this method is minimal, so patients do not stay long in the hospital. The effectiveness of treatment with brachytherapy is high, the number of relapses does not exceed 20%.
- Combined radiation therapy - irradiation of a prostate cancer affected by the contact method. It is used together with interstitial and in-band exposure. Used as an alternative to surgery.
- Palliative radiation therapy - It is aimed at stabilizing tumor growth, it is used when radiation therapy is contraindicated in the general scheme to the patient.
- Stereotactic Radiosurgery - single exposure of the affected organ in high doses. Despite its name, stereotactic radiosurgery has nothing to do with surgery. The difference between this irradiation technique and the standard one is that the radiation directly hits a pathological tumor.
Mechanism of action
An idea of the effect of treatment can be obtained by understanding what radiation is in case of prostate cancer. Before radiation therapy, an MRI (magnetic resonance imaging) scan is required and the volume of tissue that will account for the main radiation impact is determined.
The mechanism of action of ionizing radiation on the prostate is caused by the formation of free radicals and hydrogen peroxide. The destruction of nucleic acids (DNA) and the integrity of cell membranes. The action is not only on atypical cells, but also healthy ones. This is the main cause of the unpleasant effects of prostate irradiation.
The duration of an irradiation session for prostate cancer is 10 minutes, with an intensity modulation of 20 minutes. The course is from 5 to 8 weeks, 5 procedures, 2 days break.
Irradiation is performed in a wave and corpuscular manner. The dose of radiation is selected individually to minimize negative effects on nearby tissues.
Radiation therapy options for prostate cancer
Remote irradiation is a commonly used method for the treatment of cancer. Photon, corpuscular and interstitial radiotherapy are distinguished. The exposure is carried out using the apparatus, a concentrated stream of radio emission is directed to the area as close as possible to the prostate.
• acute inflammation in the intestines,
• history of pelvic irradiation in the anamnesis,
• severe obesity,
• functioning urethral catheter.
With microcysts (a decrease in the volume of the bladder), diarrhea, ulcerative colitis in remission and infravesical obstruction, the question of conducting is decided on an individual basis.
The positive aspects include:
• relative low injury rate,
• quick rehabilitation,
• lack of need for prolonged hospitalization,
• less risk of complications.
• duration (up to 2 months),
• the inability to accurately establish the stage of the oncological process,
• possible complications,
• lack of effect in some patients.
As an external method, radiologists can use conformal radiation therapy, with a 3D survey of the prostate, bladder and rectum.
The clinical volume of radiation corresponds to the borders and shape of the prostate.
Exposure to 3D conformal irradiation of the bladder and rectum is significantly less.
Brachytherapy (contact therapy, internal radiation therapy) is one of the new developments, the negative impact on neighboring structures is minimized. Special sources of radio emission are introduced into the prostate gland. For the treatment of prostate cancer, a low-dose permanent and high-dose temporary brachytherapy are used.
Suitable as an alternative treatment for prostate cancer in the initial stages, without metastasis. In addition, the PSA level should not exceed 10 ng / ml, differentiation on the Gleason scale is less than 7 points, and the prostate volume should be no more than 50 cm3.
After brachytherapy, more than 80% of patients live longer than 10 years.
The positive aspects include:
• single outpatient procedure,
• nice results,
• less risk of complications,
• the ability to maintain erectile function.
In patients with locally advanced prostate cancer, remote irradiation is performed before brachytherapy.
Radiotherapy may vary in form of exposure:
• with intensity modulation (particle flow is divided into several multidirectional beams using a computer),
• proton therapy with a gentle effect (small doses) on surrounding tissues, since irradiation of atypical cells occurs at the molecular level,
• neutron therapy - the most traumatic, it is carried out if there is no effect from exposure to protons or gamma rays.
In large oncology centers, all types of radiotherapy are available.
Adverse effects of radiation therapy for prostate cancer
When irradiated, not only the organs of the urogenital tract that border the prostate suffer, but also the intestines and skin integuments.
Patients come with the following complaints:
• dysuric disorders: cramps, pain during urination, weakening of the stream of urine, nocturia, peremptory urge, urinary incontinence / incontinence,
• debilitating itching in the urethra, increased discharge,
• violation of erectile function,
• constipation or frequent loose stools when part of the intestine is involved in the irradiation zone,
• pain in the lower abdomen,
• dry mucous membranes, thirst,
• exacerbation of hemorrhoids,
• skin manifestations at the site of exposure to the rays: redness, maceration, ulceration,
• weakness, asthenic syndrome,
• nausea, loss of appetite,
• urinary retention,
• the appearance of blood in urine, stool,
• hair loss.
Each patient has individual reactions, the condition may improve within a few days after the end of the course, but may take a longer period.
To ensure that there will be no complications after radiation therapy, not a single technique is able to.
The most common complications of radiation therapy:
General recommendations for the patient receiving radiation treatment
Sometimes the negative consequences of radiation therapy pass on their own, but more often, coordinated actions of both the patient and the doctor are necessary to achieve the effect.
After irradiation, the body is weakened, and it requires strength not only to recover, but also to fight a cancerous tumor. If you follow simple tips, rehabilitation processes will go faster.
At first it’s worth give up significant physical exertionbut you should not completely exclude motor activity: walking in the fresh air, without direct exposure to sunlight, is useful.
It is important to eat right. According to the dietary guidelines for prostate cancer, daily caloric intake is limited to 2800 calories. The exception is chemo- or radiation therapy, the average calorie intake of 3800 cal.
In the menu you need to enable more fruits and vegetables. Red meat (beef, pork, lamb) is not the best choice, instead, a fish rich in selenium, protein and omega fatty acids is useful.
Quite allowed diet meat: rabbit, turkey, chicken breasts.
All substances with irritating effects are excluded.
Useful decoctions of herbs with a diuretic effect (lingonberry leaf, horsetail, bearberry, dill seeds, etc.). All dishes are prepared with the most gentle processing.
Refusing bad habits is a step towards recovery or remission of prostate cancer.
All problems must be immediately discussed with a doctor, timely tested and take medication. As a rule, for the prevention of negative effects on urinary organs, uroseptics, herbal remedies, and an enhanced drinking regimen are prescribed. This measure helps prevent inflammation and changes in urinalysis: severe leukocyturia, proteinuria may require a suspension of radiation therapy.
To normalize the stream of urine use alpha blockers.
When radiation rectitis is recommended as much as possible sparing diet, antihistamines, with severe inflammation - antibiotics and hormones.
Pain and discomfort relieve oil microclysters and suppositories with methyluracilbaths with a solution of weak pink potassium permanganate.
Accept vitamin complexes it is possible in reasonable quantities, from food additives with an incomprehensible composition that guarantees a full recovery, it is better to refuse.
Some effects of radiation therapy for prostate cancer can be reduced with folk ways: clover and sea buckthorn oil contribute to the healing of radiation proctitis, and with post-radiation cystitis, regular intake of cranberry juice helps to reduce inflammation.
Indications and contraindications
Radiation therapy is an alternative. radical prostatectomywhen it comes to early stage prostate cancer. Irradiation of the tumor allows you to control its proliferation when surgery is not possible. With metastatic cancer, the method is used to improve the quality of life, often combined with hormonal therapy.
Radiation therapy is used before and after prostatectomy. In the first case, irradiation helps to reduce the size of the tumor, in the second - to "finish off" the remaining cancer cells. Radiation therapy is carried out a few weeks after surgery to allow tissues to recover.
If the tumor is very large, then its decay after cell death will lead to severe intoxication of the body, therefore, radiation in such cases is combined with surgical methods (prostatectomy).
Histologically unsuccessful tumors respond best to radiation therapy - low-grade tumors, whose cells are very different from normal and divide quickly. Highly differentiated slowly growing cancer lends itself to such treatment much worse. The sensitivity of such cells can be increased with the help of medications, saturating the tumor with oxygen, increasing its temperature (local hyperthermia), lowering the pH level. All these measures are considered at the planning stage.
Contraindications to radiation therapy:
- Pyelonephritis, chronic renal failure.
- Large volume of residual urine.
- Age after 70 years. In old age, drug palliative treatment methods are preferred.
Thanks to new methods of preliminary planning, radiation therapy is now becoming safer than prostatectomy.
Remote radiation therapy
Remote (external) radiation therapy is the most common type of exposure. It is indicated for cancer localized in the capsule of the prostate, at the stage T1a-T2cN0M0, as well as locally distributed at the T3-T4 stageN0M0 in conjunction with hormone therapy.
- Previous pelvic irradiation,
- Acute inflammation of the rectum,
- Installed urethral catheter,
- Obesity 4 degrees.
Relative contraindications to external radiation therapy are chronic diarrhea, small bladder volume, urethral obstruction, ulcerative colitis.
Advantages: the possibility of a complete cure without surgical intervention, there is no need to go to hospital. Of the minuses: a long treatment (1.5-2 months), concomitant benign hyperplasia will remain.
With low oncological risk (T1-2b N0M0, Gleason less than 6, PSA less than 10 ng / ml), the total (for the entire course of treatment) exposure to 70-72 Gray (hereinafter referred to as "Gy") is sufficient. For tumors with moderate risk (T2b N0M0, Gleason 7, PSA from 10 to 20 ng / ml), the dose can be increased to 68-81 Gy. Thus, it is possible to increase the percentage of five-year survival without relapse and without late adverse reactions. At high risk (T2c N0M0, Gleason greater than 7, PSA greater than 20), a dose increase is justified in terms of increased survival, but the risks of developing side effects from radiation therapy also increase. Within 6 months, it is advisable to add hormone therapy.
According to the irradiation technique, convection and 3D-conformal are distinguished. The first method involves the use of simple rectangular fields of influence. In the second case, a three-dimensional tumor model is created, it is more accurate, reduces the load on vital organs.
Irradiation unit Radiation Therapy Equipment
The purpose of a radiotherapist during remote radiation therapy is to point the direction of the radiation flux with the capture of a small amount of healthy tissue in order to avoid relapse. This task is simplified by more modern techniques.
Proton therapy involves exposure to protons dispersed to high energies using a cyclotron. The proton beams are distributed in the target in such a way that their dispersion beyond it is completely excluded. The energy of a proton beam is greater than radiation. The duration of exposure is 10-15 minutes. On average, 18 procedures are required per course.
Proton therapy unit ProBeam
IMRT - remote radiation therapy with intensity modulation, possible only on special linear accelerators. The device performs a spatial scan of the tumor (3D) to direct the radiation beam at various angles. In each position, the system selects the optimal radiation intensity and the shape of the beam of irradiating particles. The beam can be divided into several segments. Thus, the main radiation load falls on the center of the tumor, and healthy tissues undergo minimal damage. A 3D model of the prostate is pre-compiled using an MRI or CT scan.
SBRT (stereotactic hypofractional radiotherapy)
If you immediately give a high dose of radiation in high precision mode, then there is a chance to kill cancer without surgery in 1-5 sessions and significantly extend the life of a patient who was previously considered incurable. Such an innovative method of radiation therapy is called stereotactic hypofractional radiotherapy.
Irradiation lasts from 15 seconds to 2 minutes. Tumor cells die, necrotic, a stable scar remains at the site of cancer. This process takes some time, so the result will not be right away. Treatment lasts only 2 weeks: one for preparation, the second for radiation.
This method of radiation therapy is most suitable for the treatment of cancer at the initial stage, as well as in the presence of a small number of medium-sized metastases. If the tumor is large, and the number of metastases is more than 10, then SBRT is not used.
Of the complications, radiation inflammation of the skin most often develops. After 1-3 weeks, the symptom will disappear, but during this time protection from ultraviolet radiation (tissue, cream) is necessary.
IGRT - 3D radiation therapy under visual control. Tumors after each irradiation change their shape, the prostate shifts with different fullness of the bladder, the device records these changes, which makes it possible to have a more accurate effect. The software allows you to compare CT images and the actual image of the tumor. Thanks to this, the position of the patient and the direction of the radiation flux can be adjusted. All tumor parameters are entered into the system. If the beam goes beyond the designated boundaries, the installation will turn off, after the correction, the session continues.
This is an innovative technology of remote radiation therapy, which allows to reduce the treatment session and increase its effectiveness due to the high variability of the patient's position and installation parameters. The device supports 360 positions, in each of which additional options for adjusting the dosage and radiation power are available. The Gated RapidArc technique provides flow adjustment by synchronizing its direction with the patient's breathing. Irradiation itself lasts a couple of minutes, but the exact laying of the patient will require at least half an hour.
VMAT RapidArc irradiation technology
During irradiation, the entire tumor volume is covered, providing an ideal treatment regimen. Today it is the most effective and safe method of radiation therapy.
SDRT is a single-fraction extracranial radiotherapy. During the session, the gland is fixed with rectal cylinders and exposed to 8 Gy. The course lasts 5 days. As during IGRT, the doctor sees the prostate on the screen. Preparation and laying of the patient takes half an hour, and the irradiation itself lasts several minutes.
Fixation helps to avoid complications from the genitourinary system. Basically, the negative consequences are limited to frequent uncomfortable urination, which normalizes within 3 weeks.
Hospitalization is not required. This method of radiation therapy is suitable for the elderly, as well as those suffering from diabetes mellitus, pathologies of the circulatory system. If the tumor has spread beyond the capsule, then SDRT is not used. The inability to insert a urethral catheter and rectal cylinders is also a contraindication.
The prostate gland is an organ located below the bladder. Activity depends on the production of steroid sex hormones - androgens. The normal functioning of the urinary system, reproductive function, and the psychoemotional background of a man depend on the proper functioning of the gland.
The functionality of the gland represents four main areas:
- Isolation of a special enzyme that liquefies seminal fluid and activates sperm movement.
- Monitoring the level of acid-base balance.
- Obstruction of the ingress of microorganisms of a foreign property into the urinary tract from the ureter.
- Gland tissue contracts during ejaculation, ejecting secretory fluid.
The composition of the secretory fluid:
- zinc (provides antimicrobial activity of the seed),
- enzymes that affect the normal functioning of the urogenital system of men.
One of the male hormones - testosterone, is produced due to the proper functioning of the prostate gland.It affects both physical and psycho-emotional well-being.
Indicators of the norm of the prostate gland for an adult male:
|Volume||25 cubic centimeters|
With oncology, the size of the prostate can be increased. Symptom is often the only one at the onset of the cancer process. An enlarged prostate is also characteristic of chronic prostatitis. Therefore, it is supposed to undergo a thorough medical examination when a similar symptom occurs.
If the cause of the pathology was prostate cancer, early diagnosis will avoid serious consequences and save the patient's life.
One type of contact radiotherapy is systemic, in which radioactive substances are injected into the bloodstream (tablets or injections into a vein), after which they are distributed throughout the body. Apply in the case of the spread of metastases in the skeletal system.
Comparison of the effectiveness of various types of radiation therapy
The remote method of radiotherapy is designed to limit the development of cancer on the patient at the initial stage of development of pathology. If there is a significant risk of cancer recurrence, appropriate pharmacological drugs are prescribed to reduce hormonal levels of testosterone. With the simultaneous combination of radiotherapy and drug treatment, survival is increased to 3 years.
To accurately direct the ionizing beam into the lesion, a three-dimensional model of the patient's pelvic region is used. Taking into account the individual characteristics of the body, a treatment plan is selected (number of sessions, time intervals).
The procedure itself does not cause pain in the patient. It lasts about 20 minutes. During this time, the focus of the pathology is irradiated with a dose of radiation at the level of 75 Gray. This is an average measure of the intensity of an ionized beam. The strength of the effect is chosen during preparatory measures, depending on the individual characteristics of the male patient’s body. The level of radiation is lowered or increased.
The duration of therapy is from 4 to 8 weeks, depending on the amount of pathological tissue and the degree of growth of the oncological focus. It also depends on the presence or absence of metastases in the cancer patient.
An important task of physicians is to prevent large damage to healthy tissues surrounding atypical cancer cells. The timing of the procedure is important. For a 20-minute interval, the cells around the damaged tissue do not have time to absorb a sufficient dose of radiation to destroy.
To achieve the highest level of radiation accuracy, special implants implanted into the prostate are used. These guides are clearly visible to the specialist conducting the procedure. A radiation beam is directed there.
Before starting the procedure, the man is placed on a special table next to the device performing the irradiation. The patient’s body is fixed. At the time of the procedure, no unnecessary movements are provided. This will significantly reduce the effectiveness of the procedure and harm healthy cells. The patient is dressed in special hospital clothing.
The settings of the device depend on the information obtained earlier in the diagnosis. The doctor checks the accuracy of the device settings and the position of the patient's body. The device is turned on after leaving the medical staff of the x-ray room. This is a safety measure in order not to harm the area of increased radiation to the health of employees.
During operation, the device does not emit rays in the visible spectrum, the patient does not see the ionized beam. A sign of work is the smell of ionized air.
Remote radiation therapy is divided into three types:
- Intensively modulated - carried out on equipment containing more than 100 sensors for scanning and building a three-dimensional picture of the tumor in the prostate and pelvic area. Due to the constant monitoring of the directivity of the beam, it is possible to timely adjust the power of the directed radiation depending on the localization of the radiation.
- Conformal radiation therapy - a scanning system is used to diagnose the position of the prostate gland, the shape of the gland and its size. The accuracy of the radiation direction depends on the data obtained. A positive point with this type of therapy is the minimization of side effects.
- Visual control - this type of therapy is based on prostate imaging technology. Tumor localization gets clear boundaries and location. Medical staff is entitled to adjust the beam direction in real time, which minimizes the risk of damage to healthy cells and tissues of nearby organs.
The consequences of radiation therapy for the prostate gland
With this type of treatment, not only the prostate, but also other organs can suffer, so the consequences can be both local and general. Local effects include:
- violation of urination: urges, weak outflow of urine,
- the appearance of so-called radiation cystitis,
- rectitis - an inflammatory process in the rectum, manifested by problems with stools, pain in the anus, itching and discomfort,
- loose stools or constipation.
Common consequences include:
- temperature increase to the level of 37.5 degrees,
- nausea, vomiting,
- fluctuations in blood pressure,
- sexual dysfunction (impotence), lack of erection,
- a decrease in immunity, against which the patient can easily catch viral or fungal diseases: patients again have chickenpox, many begin to suffer from tonsillitis, herpes, skin fungus, and even internal organs.
Another name for contact therapy is brachytherapy. It is used in the early stages of the onset of pathology. The principle of application is that the source of radio emission is brought to the directly affected tissues and cells by subcutaneous injection. The effect of maximum irradiation of neoplasm cells is achieved with minimal risk of side effects and radiation damage to neighboring healthy tissues and organs.
There are two options for the implementation of brachytherapy, depending on the condition of the patient and the stage of the oncological process:
- option with a high dose of radiation,
- option with a low dose of radiation.
When choosing the first method, the indicators of a special oncomarker in the patient's blood serum — the prostatic specific antigen — are taken into account. It is used to diagnose and monitor the course of prostate cancer and prostate adenoma - benign prostatic hyperplasia.
The main advantage of using the method with a high level of ionizing radiation is the therapeutic use of a very powerful and short pulse of charged radiation particles. That is why this treatment option is not used when conducting remote therapy. Within a short time of exposure to a radiation pulse, a significant number of cancer cells die. When using such power in remote therapy, surrounding tissues will be severely affected. The duration of exposure should not exceed 20 minutes.
The beginning of the procedure includes examination of the pelvic organs using ultrasound, computed tomography or magnetic resonance imaging. Such preparation for radiation therapy provides the doctor with data on the basis of which a three-dimensional model of the pelvis and organs is created, the exact location of the focus of the pathological formation is calculated. The oncologist determines the dosage of radiation and the time of the procedure.
Under general anesthesia, the patient is injected with guides along which an impulse is supplied to the affected cells. Epidural anesthesia can sometimes be used. All the time of implantation, irradiation and removal of the guides is 3-4 hours. After the procedure, the patient is left for a day in a hospital under the supervision of medical personnel.
The choice of a method with a low radiation dose is used for small tumor sizes and the initial stages of cancer pathology. Implants containing radioactive material are implanted in the area of the prostate. The place of implantation and the process is controlled by the visualized area of the small pelvis.
The implantation procedure takes place under general anesthesia. The placement of isotopes is carried out at the location of the tumor using special needles, which allow faster recovery after surgery if rehabilitation is needed.
In the hospital, the patient is no longer than two days after the procedure. Then the patient is transferred to outpatient treatment. Over the following months, prolonged sunbathing and cycling are prohibited. Do not put children and animals on their knees. Physical activity is sparing.
To quickly return to normal after undergoing radiotherapy, you need to monitor the diet, sit on a strict diet. Smoked, spicy, fatty, pickled foods, sour vegetables and fruits - all this should be strictly prohibited. Food should be steamed or boiled. After radiotherapy, the patient may manifest such an unpleasant symptom as cystitis. To get rid of this negative effect, it is necessary to limit the use of salt, and focus on the use of large quantities of fresh herbs, cereals from whole cereals, fresh fruits, vegetables, berries. It is useful to drink a lot of liquid after radiation treatment (at least 2 liters of purified water without gas), including jelly, tea, birch sap, and a decoction from various herbs.
To maintain the health of the whole organism, it is necessary to eat marine fish and seafood, fresh vegetables and fruits, honey and beekeeping products. These products increase the body's defenses, prevent the occurrence of side effects, and contribute to the rapid rehabilitation of the patient after radiation therapy.
Sex after radiation therapy
In most patients, the intimate life after undergoing prostate radiotherapy is impaired. The blame for this is a weakened erection, constant urination, burning, and other consequences of radiation therapy. Over time, the patient's condition improves, he is even recommended to have sex, because during intimacy the general tone of the body rises. Due to this, important processes are accelerated, tissues are cleansed of toxins, the affected organ receives antibodies that allow it to fight against pathogenic structures.
Sex after radiation therapy of the prostate is useful, safe and effective for the rapid rehabilitation of the male body. If for some reason a man cannot enter into an intimate relationship with a partner (there is no erection or it is insufficient to have sexual intercourse), then it is recommended to massage the penis.
The benefits of radiotherapy
With radiotherapy, pathological cells located in the prostate gland die, stop dividing and multiplying. Regarding chemotherapy, the principle of this method of treating prostate cancer is the same, but Radiotherapy has advantages:
- The radiation flux can be focused specifically on the diseased organ if the tumor does not begin to grow. In the case of chemotherapy, the chemical drug affects the whole body, that is, it is common, and not locally.
- With radiotherapy, healthy cells are not affected or are affected, but to a lesser extent than with chemotherapy.
There is no better or worse treatment for cancer. There is an optimal method of treatment suitable for a particular patient. Someone thinks that it is better to excise a tumor in the prostate than to take a shock dose of radiation. But this is not so. After the operation, a sick person may have serious complications, which can be avoided by agreeing to radiotherapy. A shock dose of radiation will fall specifically on a painful organ - the prostate.
Does radiation therapy hurt?
No, this treatment is not accompanied by pain. Some patients even ask doctors: “Is this method of treating the prostate effective if I don't feel anything?” Someone may feel heat and tingling in the area of impact. But there is no question of any pain or discomfort.
Can the patient get bald?
Hair loss during radiotherapy in patients is not observed. Many patients mistakenly think that a decrease in hairline is due to the effect of radiation. But this is not so.
The fact is that radiation therapy can be part of the complex treatment of the disease. She can complete prostate cancer treatment after chemotherapy. And among the side effects after chemotherapy, hair loss is exactly what it means.
Are nausea and vomiting a priori the consequences of radiotherapy?
No, patients do not always show such symptoms. If the neoplasm was small, it did not affect healthy cells and tissues, the malignant process did not begin to spread to other organs, then the patients did not suffer from nausea and vomiting. But if zones outside the prostate are exposed, then the risk of such unpleasant consequences will increase.
With this method of treatment, the prostate gland remains completely unlike surgery. If the disease was detected at stages 1 and 2, then with the help of radiotherapy doctors are able to completely eliminate the pathological cells of the prostate, to cure the patient from a deadly illness. If a dangerous illness was diagnosed in 3 stages, then treatment with radiation therapy can reduce the progress of the disease, reduce pain, and also increase the patient's chances of further existence.
Prostate cancer is a deadly disease, not only health, but also human life depends on the correct methodology. Radiation therapy with such a widespread disease among the male population, although it carries various negative consequences, but still it is one of the most effective methods of treating a dangerous disease.
Consequences, complications, life expectancy prediction
The likelihood of complications of radiation therapy directly depends on the dose of radiation and the radiosensitivity of the surrounding tissues. Acute reactions occur directly during the course of treatment. Within 2-6 weeks, these symptoms disappear. Later complications develop from a month to a year after completion of irradiation. This is lymphostasis of the lower extremities, erectile dysfunction.
Immediate and long-term complications of radiation therapy (in%) Dependence of three-year disease-free survival on PSA level and radiation dose
Preventive measures will help minimize the effects of radiation therapy:
- Exclude spicy and salty foods, alcohol from the diet.
- Thorough hygiene of the genitals and perineum.
- In the presence of cystitis or pyelonephritis, pre-do urinalysis with a determination of sensitivity to antibiotics, undergo a course of appropriate treatment.
- If there is a pronounced difficulty in urinating, then radiation therapy should be preceded by a hormonal or daily dose of radiation should begin with 0.5 Gy.
- Do not conduct radiation therapy after instrumental interventions on the urethra, not earlier than 4-5 weeks after transurethral resection.
- In weakened patients, the irradiation rate should be divided by pauses of 2-3 weeks, the total dose - not more than 40-45 Gy.
If there are prerequisites for the development of radiation rectitis (inflammation of the rectal mucosa with rejection of the lining fiber), it is necessary to use suppositories with belladonna, methyluracil, anestezin, oil.
PSA after radiation therapy for prostate cancer
After radiation therapy, the PSA level decreases more slowly than after prostatectomy. It may take 3 years or more to reach the minimum level (0.5 ng / ml). There have been cases when it took 5 years to lower the PSA level after radiation therapy. After brachytherapy, the first analysis for PSA is taken no earlier than 3 months, then control is carried out once a quarter.
In 30% of patients after radiation therapy, an insignificant jump in PSA is observed, due to the fact that the gland continues to produce antigen.
Prostate Cancer Relapse After Radiation Therapy
Cancer recurrence after radiation therapy can be predicted by a doubling of PSA levels. If the period is 13 months, then the growth of a single tumor is diagnosed (local recurrence). Systemic relapse (growth of metastatic lesions) is characterized by a fast doubling time of 3 months.
An increase in PSA level is an indication for the appointment of other diagnostic methods: MRI, PET-CT, osteoscintigraphy (to determine bone metastases).
Rehabilitation after radiation therapy
After external radiation therapy, a skin burn may appear, as from the sun.. This place should not be rubbed with a washcloth and subjected to other mechanical influences.
After radiation therapy, it is important to eat well. There is no special diet, but smoked meats, pickles, marinades, alcohol, spicy foods should be excluded. The diet must necessarily include fruits (except sour), vegetables, cereals, fatty fish, lean meat, dairy products. If there is no appetite, then it is recommended in the morning on an empty stomach to dissolve a teaspoon of bee bread (bee pollen) under the tongue. Useful infusion on bee subpestilence.
It is advisable to drink more fluid and move. Radiation therapy entails serious intoxication of the body with the decay products of the tumor, which must be removed.
Sex is not contraindicated. The sooner sexual activity begins, the more chances there are to restore an erection. At the initial stage, one can stimulate libido with the help of dietary supplements, and an erection with the use of PDE-5 inhibitors (sildenafil, tadalafil). It should be noted that after complete irradiation and scarring of the prostate, there will be no ejaculation. If a man plans to have children, then he should pass the sperm to the cryobank in advance.
Prices for radiation therapy vary greatly depending on the type of institution, installation, training program. High-precision systems in the Russian Federation so far in single quantities. Treatment of prostate cancer with radiation therapy on a TrueBeam high-speed unit can be done at the Radiation Therapy Center in Moscow. Proton therapy is available at the ProBeam facility at the Proton Therapy Center (MIBS) in St. Petersburg. Price in MIBS:
- Preparation and planning - 200 thousand rubles.,
- Stereotactic radiation therapy in hypofractionation mode - 180 thousand rubles.,
- Radiotherapist consultation - 2500 rubles.
At the Oncology Research Institute named after Petrova session of remote radiation therapy will cost 3460 rubles., At the Russian Center for Radiology. Granova (St. Petersburg) a session of stereotactic therapy costs 30,000 rubles, conformal irradiation of IMRT - 18,000 rubles.
Egor, 50 years old: “I was diagnosed with stage 2 prostate cancer, did radiation therapy (3D). Prior to this, he underwent chemotherapy for another reason, and so, in comparison with her, radiation seemed to me very easy. I went to work, then from her to the procedure, then home. The main thing is to monitor white blood cells and platelets. Therapy has proven effective. There have been no relapses for 5 years. ”
Dmitry, 64 years old: “After radiation, I felt unwell, but managed. To normalize the level of platelets and leukocytes, the doctor advised nuts, honey, and drugs were given in radiology for nausea. Enterosgel drank to remove toxins and took Heptral to support the liver. Radiation was done on a conventional apparatus in our local clinic. So far without relapse, PSA is constantly falling. ”