Welcome to the Austin Center for Radiation Oncology!
At the Austin Center for Radiation Oncology (ACFRO), we focus on our strength – the treatment of prostate cancer. Not just a little prostate cancer, but a lot of prostate cancer. We’re considered a high-volume prostate cancer center. This mean that everyone on staff has expertise in the treatment of prostate cancer. When ACFRO opened, we were one of the first facilities in Central Texas to specialize in a type of cancer, not just radiation therapy. We were also one of the first sites to bring image guidance to full use. We continue to be at the forefront by bringing the first Halcyon treatment machine to Central Texas.
We’re passionate about the treatment of prostate cancer. In fact, 99% of what we treat is prostate cancer. From the therapists that bring you into the room to line you up on the machine, identify your prostate and make sure you’re in the perfect spot, to the therapists that actually treat you, all of our technicians are specifically trained to treat prostate cancer.
Patient consultation: What to expect
During an initial consult, we will review what you should expect when being treated at our center. This will include the process of setting up radiation treatments, your daily schedule, short-term and long-term side effects as well as cost. Many patients consider: am I in the right place, do they have the right equipment, do they have an experienced team; what will the treatment be like? We’re here to help answer those questions.
First, we look at where you are in the spectrum of the disease. Is your cancer localized, advanced or metastatic prostate cancer? What stage are you at? Which risk group do you fall into: low, intermediate or high-risk prostate cancer? In reality, each patient is treated differently. They may need radiation therapy as an initial treatment or following surgery if the cancer returns. Some men may need a combination of radiation, surgery and hormonal therapy. During the consultation, we’re going to walk you through the process of what’s involved before you get on the treatment table, what it’s like to be on the treatment table and what happens after you’re done with your treatment.
Patients with prostate cancer typically live for years, so it’s important to pick a treatment with a side effect profile that you’re willing to live with. During your consultation we’re going to go through a detailed chart with you to compare prostatectomy surgery with two different forms of radiation, and we’ll talk about very different end points. Specifically, we’ll talk about sexual function, the effects radiation has on erectile function, urinary control, bowel movements and your vitality score.
People often focus on the technology of treating prostate cancer – typically with the machines, and they’re looking for the latest model. Here at ACFRO we have two machines: the Halcyon and Clinac iX. One of these machines will be best suited for you.
One of our advantages is that we’re deeply tied to Urology Austin. This means we have access to electronic medical records and patient history over a period of time. This really enhances the patient’s experience if we don’t have to repeat exams or testing previously done by their Urologist.
At ACFRO, we customize the radiation to your body by starting off with a CT simulation. Depending on the cancer that you have, we may do some special procedures before the simulation process to increase our accuracy. Our treatment machines are very accurate – down to millimeters – but it all depends on having the patient is in the correct position. Our therapists are trained to have you lined up perfectly, first using skin marks, and then using image guidance to fine tune the process for you. The machines are so sophisticated that they track the prostate. So before each treatment, we use a low dose CT scan to help locate your prostate. There are a few things we can add to your prostate to make sure that we can track more precisely. One of these techniques is the placement of fiducial markers into the prostate. These are small pellets made of gold, that are about the size of a grain of rice. They don’t interfere with medications, MRIs or airport scanners. Placing the markers is a simple procedure that adds an extra level of accuracy that we take advantage of.
The goal of radiation therapy is to decrease the amount of radiation to the normal structures. The ones that are very close are the bladder and the rectum. One of the techniques that we talk about is the benefit of keeping your bladder full and your rectum empty. At ACFRO, we also use a novel approach that actually pushes the rectum out of the way from the radiation field. It’s an injectable hydrogel called SpaceOAR. This gel is inserted through the perineum between the prostate and the rectum to create a buffer zone. This can protect the rectum and decrease side effects such as radiation scar tissue.
One of our most common questions that we hear is “How many treatments will I have to do”? The goal of radiation is to offer a high dose of radiation to a specific area. Depending on where you are in the spectrum of the disease, we may have to increase our radiation field to also cover areas that may potentially hide the cancer. How much normal tissue is in place will help us determine the number of treatments needed. For example, if you have low risk prostate cancer, you’ll need fewer treatments than someone who has high risk prostate cancer. The number of treatments can really vary – they can be as low as 5 treatments, to as many as 45 treatments. It really depends on where you are in the spectrum of the disease and how big the radiation field needs to be.
Radiation treatment at the Austin Center for Radiation Oncology
Getting a radiation treatment is fairly straightforward. Patients prepare by emptying their rectum and drinking 16 ounces of water about an hour before their radiation appointment. Most people get to our center about 10 minutes before their appointment time. This gives them time to change into their scrubs. When called back, they’ll spend about 15 minutes on the treatment machine. During this time, the radiation is effectively on for about three to four minutes total. When on the table, there is no nausea, vomiting, fever, chills or burning sensation. If you drive yourself to the center, you can almost always drive yourself home. However, with all appointments, we recommend that you bring a driver with you. As soon as you’re off the radiation table, you’re no longer radioactive – you will not expose any of your family members or loved ones to radiation.
People remark that the treatment is very easy. However, at about the second or third week inflammation starts to build up. Some patients describe going to the bathroom more frequently during the daytime and night – both for bowel movements and for urination. Somewhere around the fourth or fifth week, some people may experience referred pain. It can be pain at the tip of the penis, or even hemorrhoidal itching. Patients are not receiving radiation to those areas, but it is often referred from the radiation on the inside.
During and after radiation
As you go through the process, we evaluate your side effects on a weekly basis to see if your side effects are appropriate for the amount of radiation you’ve received. At the completion of therapy, we’re going to set up some appointments for you including a return visit to see Dr. Garza, and an appointment with your Urologist. We’ll also set a schedule to monitor your response to therapy by checking your PSA. Over a period of time, we expect your PSA to have difference types of responses depending on where you are on the spectrum.
Patients are always curious as to what else they can do to enhance their response and to lower side effects. During the course of treatment, we’re going to talk to you about diet. In reality, there is no special diet for prostate cancer, it’s the same heart healthy diet you should be on already. However, there are certain foods that can aggravate your symptoms. If appropriate, we’ll give you a list of foods that will help reduce those side effects in the long run. If you have too much gas production, we have a list of foods that can actually help reduce the amount of gas that you have.
One of the biggest mistakes that people make while they’re on radiation therapy is that they take it too easy and they don’t exercise. Exercise is definitely important. We recommend a combination of cardiovascular exercises as well as weight resistance.
One of the ways to maximize your response to radiation therapy is to bring a list of your prescription medications and over-the-counter supplements to your consultation. Radiation therapy works through an oxidative process. It’s important to review your medications to make sure you’re not taking any extra antioxidants. Antioxidants are great for the prevention of prostate cancer, but during treatment, they can really deter the benefits that radiation provides.
In general, radiation is very well tolerated, but you can have radiation or cancer therapy induced fatigue. Typically the fatigue will get better as you go through the course of radiation therapy and as your body adjusts. Fatigue can also be caused by emotional issues including anxiety during treatment.
For certain types of prostate cancer, generally in the middle or more aggressive groups, we use hormonal therapy as an adjunct to the radiation therapy. Hormonal therapy comes in different forms; a common form is Lupron therapy. The main goal of hormonal therapy is to take away the food that feeds prostate cancer – typically testosterone. Lupron is designed to reduce testosterone to very low levels so that it starves the prostate cancer. Hormonal therapy helps radiation therapy work better, shrinks your prostate so that you’re able to urinate better, and it kills more cancer cells in places that the radiation is unable to reach. However, it causes menopause for men (andropause). Patients experience bothersome symptoms like hot flashes and they lose their sex drive. Without exercise, their muscles will get smaller and it’s very easy to gain weight.
If you choose to get treated with radiation therapy, rested assured that the Austin Center for Radiation Oncology has the expertise available, and we have a passion for delivering state-of-the-art care. Please take some time to review the rest of our website which is full of information and resources. We look forward to visiting with you. Contact our office to schedule an appointment with Dr. Richard Garza.