Frequently Asked Questions
To better assist our current and future patients, we have compiled a comprehensive list of frequently asked questions that Dr. Garza hears on a routine basis. We always encourage patients to bring questions to their initial consultation. And of course, we welcome questions throughout the treatment process.
Frequently Asked Questions about radiation therapy
Q. I feel fine. How do you know I have cancer?
A. Prostate cancer is often diagnosed before any symptoms develop. Most patients present with either an elevated screening PSA or urinary symptoms that prompt a visit to a urologist. Ninety percent of men do not have symptoms of prostate cancer at diagnosis. Prostate cancer usually does not present with symptoms until it progresses to an advanced stage. In order to diagnose prostate cancer, patients have a prostate biopsy during which samples of prostate cells are taken. The samples are then analyzed under a microscope by a pathologist. Dr. Garza will review your pathology report with you.
Q. What kind of cancer do I have?
Cell Type: Prostatic Adenocarcinoma
Gleason Score Grade:
Dr. Garza will review and discuss this with you at your visit.
Group Stage: I, II, III, or IV
Dr. Garza will review and discuss this with you at your initial visit.
- Very Low
- Favorable Intermediate
- Unfavorable Intermediate
- Very High Risk
Dr. Garza will review and discuss what risk group you fall in during your initial visit.
Q. How can I learn more about different risk groups?
A. We recommend going to the National Comprehensive Cancer Network website. The NCCN is a not-for-profit alliance of 27 leading cancer centers in United States that develop national guidelines and recommendations. Access to the guidelines is free but you need to register an account.
Q. What makes the Austin Center for Radiation Oncology special?
A. The Austin Center for Radiation Oncology is a center designed to exclusively treat patients with genitourinary cancers such as prostate cancer, bladder cancer, and testicular cancer. Since 2009, we have treated over 1,000 men with prostate cancer, and that number continues to grow. Concentrating on a particular type of cancer allows us to focus our expertise for the best outcomes.
Q. What will we talk about during the consultation?
A. Dr. Garza’s presentation will cover the following topics:
- Your type of cancer.
- Do we even have to treat your cancer? Is Active Surveillance an option?
- What it is like to get radiation therapy.
- The short-term side effects of radiation.
- The long-term side effects of radiation.
- The logistics of radiation therapy treatment.
- How we determine the response to radiation.
- The financial cost of radiation therapy.
- How quality of life after radiation compares to other types of treatment for prostate cancer.
- Review consent forms.
- Dr. Garza will perform a physical exam on you.
- Final summary of the discussion.
Q. What is it like to get radiation treatment on the machine?
A. The actual treatment is very quick and painless. It takes about 10-15 minutes and it involves lying flat on your back. The biggest challenge for most patients is keeping their bladder full for the duration of the treatment.
Q. What is involved in radiation planning?
A. Radiation planning involves creating a 3D image of your body using a sophisticated computer-based radiation planning system. You will be scheduled for a scan called CT simulation. If you still have a prostate, we may be placing fiducial markers in your prostate that allow us to quickly and reliably identify your prostate.
Q. What are the logistics of daily radiation therapy?
A. Effective radiation therapy requires delivery of treatments, called fractions, five days a week for a number of weeks. Each fraction delivers an amount of radiation that allows the normal tissue to repair between treatments and on weekends. Each treatment takes less than 15 minutes. You should plan to arrive at the center 10 minutes prior to your appointment time, spend 15 minutes on the treatment table and allow 10 minutes to change clothes. In general, most patients are in and out of the clinic in 45 minutes.
Q. Do I need a driver?
A. If you drive yourself to the clinic, you should be able to drive yourself home. You are not sedated at any point.
Q. What if I choose not to proceed with treatment?
A. Active surveillance is an option for some patients, especially those with Low Risk or Favorable Intermediate Risk cancer. Active surveillance involves regular monitoring of PSA levels and repeated prostate biopsies. It is not recommended for patients with Unfavorable Intermediate Risk, High or Very High Risk prostate cancer.
Q. Do you recommend adding hormonal therapy, also known as Androgen Deprivation Therapy (ADT) to the radiation treatments?
A. The decision to add Androgen Deprivation Therapy depends on your risk group and your medical history. Typically, patients that have low risk cancer do not require hormonal therapy. Patients that have intermediate, high or very high risk prostate cancer require 6 months, 18 months or 24 months of hormonal therapy, respectively. Patients receive a Lupron (leuprolide) shot every six months. Patients who cannot tolerate the side effects have an option of receiving a lower dose Lupron injection every three or four months. The most common side effects of hormonal therapy are hot flashes, fatigue, weight gain, muscle loss, decreased libido, osteoporosis, and irritability.
Q. If you can’t see the tumor, how do you know where to aim the radiation?
A. We follow very strict standards of practice when designing a radiation plan for patients that still have a prostate (Intact) and those that have had their prostate removed (PostOp).
- For “Intact Prostate” patients, we use a planning CT scan to identify the prostate and the area around the prostate where the cancer can extend. Based on your individual risk, we may also include seminal vesicles and pelvic lymph nodes in the radiation field.
- For “Post Operative” patients, we use the planning CT scan to identify the prostate fossa, which is where the prostate and seminal vesicles used to be. Based on your individual risk, we may also include pelvic lymph nodes in the radiation field.
Q. Where are the radiation treatments given?
A. Everything except hormonal therapy is performed at the Austin Center for Radiation Oncology..
Q. How do the long-term side effects of radiation compare to other types of treatment?
A. We will thoroughly discuss the sexual, urinary and rectal side effects of radiation, surgery, and hormonal therapy.
Q. Can I be around babies, children, and pregnant women while I undergoing treatment?
A. Yes. With Intensity-Modulated Radiation Therapy (IMRT), you are not radioactive when the machine is turned off. You will not spread radiation, contaminate your clothes, or expose people you interact with once you leave the treatment room.
Q. What is the most common complaint and what should I expect each week?
A. The most common complaint we hear is “I am going to the bathroom more often for bowel movements and urination.” This is due to the fact that you drink more water to keep your bladder full before treatment and from the inflammation caused by radiation.
You can expect the following symptoms each week:
- Week 1 – No symptoms, maybe more frequent urination from drinking more water.
- Week 2 – Fatigue as your body releases chemicals from the repair process. Cardiovascular exercise helps.
- Week 3 – More frequent urination and bowel movements from inflammation as the radiation does its job.
- Week 4 – Burning at the tip or base of the penis caused by referred pain from the prostate area.
- Week 5 – Hemorrhoid itching.
- Week 6 – Hemorrhoid irritation requiring a hydrocortisone cream or suppository.
- Week 7 – 9 – Most side effects remain stable or get better.
Your symptoms will start to get better two weeks after radiation and will continue to improve over next 2 months.
Q. Is the Austin Center for Radiation Oncology part of Urology Austin?
A. Yes. The Austin Center for Radiation Oncology is part of Urology Austin. Being part of a large urology practice allows us to have immediate access to your medical records at your urologist’s office. Most importantly, it allows us to focus on genitourinary cancers such as prostate, bladder and testicular cancers. The Austin Center for Radiation Oncology is considered a high-volume prostate cancer radiation center.
Q. What if I miss a day?
A. Radiation works best when given on a continuous basis. Your radiation dose is based on the total number of treatments, not number of weeks. If you absolutely need to miss a treatment, we will add the missed treatment to the end of your original finish date.
Q. Can I be sexually active during radiation?
A. Yes. You may be sexually active during radiation. Sexual activity will not cause your cancer to spread or affect the treatment. You will not transmit cancer to your partner. There is a high likelihood that you will have more difficulty getting and sustaining an erection. On occasion, you may notice that climax is not pleasurable or stings due to inflammation from the radiation. If you still have a prostate, the semen that is being released may also diminish with time and may have blood in it. You may use Cialis, Viagra, Stendra, or Levitra as needed during radiation. These medications do not interfere with radiation therapy.
Q. How is the number of treatments determined?
A. The number of treatments is based on the results of clinical trials performed over the past 35 years. We follow the model of Memorial Sloan Kettering Cancer Center in New York City (Dr. Zelefsky). It is based on delivering a high total dose with small dose per day to protect healthy tissue. In general, if you have a prostate, the treatments last nine weeks and if your prostate has been removed, the treatments last about eight weeks.
Q. Does everybody get the same dose of radiation?
A. If you have a prostate, you will receive approximately 45 treatments and if you don’t have a prostate, you will receive approximately 39 treatments. Most patients will get the same dose per day. It has been found that low through high risk patients benefit from a dose escalated therapy (81 Gy). The size of the radiation field, organs included in the radiation field, the beam angles, and time for each angle vary from patient to patient.
Q. Do I have to change my diet?
A. No. You do not have to adjust your diet specifically for radiation therapy but benefits of making healthier food choices extend beyond loosing weight. While no single food can prevent cancer, the American Institute for Cancer Research strongly recommends a diet filled with fresh fruits, vegetables, lean protein, whole grains and legumes. There are certain foods that may irritate your bladder such as cranberry juice, alcohol, coffee or foods high in vitamin C. Let us know if you would like a complete list of bladder friendly foods.
Q. Can I exercise during a radiation therapy?
A. Yes, in fact it is strongly encouraged. You should develop an exercise plan that includes cardiovascular workout and weight resistance. There are no specific restrictions for patients on radiation therapy. I highly recommend you work with a personal trainer or physical therapist to develop a customized program. Gyms like the YMCA offer free programs for cancer survivors. Keep in mind that being active around the house is not a substitute for a structured exercise regimen. It is even more important to have a formal program if you are on hormonal therapy. If you need an exercise prescription, please ask Dr. Garza.
Q. Should I continue taking my current medications?
A. Yes, do not stop taking any prescribed medications without consulting with your doctor first. You should, however stop all mega-doses of antioxidants, including general multivitamin, while on radiation therapy. Radiation therapy is based on an oxidative process and thus antioxidants could theoretically work against the therapy. You may resume them after completion of radiation. Dietary antioxidants from whole fruits and vegetables are permissible.
Q. What are common mistakes that patients make?
- Overeating. Prostate cancer and radiation therapy for prostate cancer do not make you lose weight. Your recommended daily caloric intake should be the same as before you started radiation.
- Not exercising. Many patients take it too easy during their radiation therapy. Lack of regular physical activity causes patients to become deconditioned, which in turn leads to fatigue and weight gain.
Q. How does radiation kill cancer?
A. Radiation therapy fights cancer in a number of ways. Radiation not only kills cancer cells, several studies have shown that radiation can also activate the immune system to attack tumor cells. The main way radiation kills cancer is by causing DNA damage to both normal cells and cancer cells. Normal cells can repair the damage. Cancer cells cannot repair their DNA and die off as they try to divide. Prostate cancer divides very slowly and you will see a change in your PSA over 18-22 months.
Q. Can I travel after the radiation therapy?
A. You may travel at anytime during a course of radiation as long as you return before your next treatment. You may also travel as soon as your entire course is completed. Before you make travel plans, you should be aware that you will need to make frequent bathroom breaks. Most patients will wait at least 1 month after radiation before making extensive travel plans.
Q. Follow up after the radiation therapy?
A. Your follow up after radiation therapy will be a combination of visits with your urologist and radiation oncologist. Your first appointment after radiation therapy will be with the urologist one month after your last treatment. You will have an appointment with the radiation oncologist four months after your last treatment. We will check your PSA level before each appointment. We will then arrange for alternating appointments every 3 months for the first year. As time goes by, we will increase the intervals between your appointments depending on your progress.
Q. How much of the radiation therapy will I be financially responsible for?
A. It takes a team of experts, from radiation oncologist to medical physicist, and many hours of meticulous planning and calculations to design a treatment plan that is as safe and effective as possible. Most of that work takes place before your first radiation treatment when you are not at the clinic. Some of the charges you may see on your bill have procedure codes like 77300, 77301, and 77338. Let us know if you have any questions about your bill.
Q. Can I see my dentist, get my teeth cleaned, and get dental x-rays?
A. Yes. Your radiation treatment does not require you to take antibiotics before dental cleaning or dental procedures. The radiation treatments to your pelvis also do not prevent you from getting dental x-rays.
Q. Why is it important to keep my bladder full before treatment?
A. The radiation treatment plan is designed to minimize the amount of radiation to your bladder. The bladder sits on top of the prostate and it is easier to limit the dose to the bladder if it is filled like a balloon. If your bladder is empty and flat like a pancake, it will get more radiation than needed and increase the risk of long-term urinary side effects.
Q. How can I keep my bladder full prior to treatment?
A. Everybody is different and you will learn what works for you. We suggest that you start by going to the restroom for a bowel movement and urination one hour before your appointment time. Start drinking water right after and allow your bladder to fill. You have two factors, time and water volume, under your control to get your bladder full before your treatment. If your bladder is not sufficiently full, you can increase the amount of water you are drinking or you can start drinking earlier. The amount of time it takes for your bladder to fill depends on your hydration status, which can be affected by the time you spend outdoors, your activity level, salt in your food, and any diuretic medications. If you mow the lawn or spend a considerable time outdoors you will be in a negative hydration status. When you drink water after being in the negative status, the water you drink goes to your body and not your bladder. If you have a large salt load with a meal such as most restaurant foods, the water you drink will stay in your soft tissue and not flow to your bladder. If you take diuretics (water pills), you can alter the time you take the
pill to facilitate your bladder filling.
Q. What happens if I cannot hold my urine for treatment?
A. Keeping a full bladder is challenging for a lot of patients. If you absolutely cannot hold your urine, you may relieve the pressure by going to the bathroom and partially eliminating urine and restarting your water intake. If you cannot partially urinate without completely emptying your bladder, it is something you should practice. When you urinate, try stopping the urine flow by performing Kegel maneuvers twice during the flow. This will help strengthen your pelvic muscles and help increase your bladder capacity.
Q. How can I keep my rectum empty prior to treatment?
A. If you are told that your rectum was too distended/full, you should attempt to empty it more effectively just prior to your next treatment. Fiber supplements or prunes may make it easier for you to have a bowel movement 1 hour before your treatment. If you are distended due to gas, you can take Gas- X (Simethicone) or Beano (Alpha Galactosidase). Simethicone breaks the excess gas bubbles in your
digestive tract. Beano contains a natural digestive enzyme that can help prevent gas from beans from forming.
Q. What should I expect my PSA blood level to be after treatment?
A. After treatment we are no longer using PSA as a screening tool. We are using the PSA blood test as a marker for response to therapy. That means that the reference range of 0-4 as “normal” no longer applies. If you still have a prostate, we want the value to be as low as possible within 18-22 months. It may even be undetectable if we used hormonal therapy. After it reaches its lowest value, called “Nadir PSA,” it will start to bounce. PSA bounce is normal. We are not concerned unless the PSA rises to “Nadir PSA +2.” If your prostate was removed before radiation, we expect your PSA to be < 0.2 or undetectable.
Q. When will my testosterone level return to normal?
A. Radiation therapy does not lower testosterone levels significantly. Androgen deprivation therapy, referred to as ADT, hormonal therapy, or Lupron does lower your testosterone significantly. If you are on hormonal therapy, your testosterone should rebound to its baseline about 10 months after the hormonal therapy has left your body. The older you are, the longer it takes for testosterone to rebound to baseline. If your testosterone was low at the time of prostate cancer diagnosis if may never return to normal range regardless of the type of treatment you received.
Q. Is it safe to get the flu shot during radiation therapy?
A. Yes. Receiving the flu shot is recommended and does not interfere with radiation therapy.
Q. Does PSA tell you if you have other cancers?
A. No. PSA stands for Prostate Specific Antigen and is specific to prostate cancer. A PSA can give you a hint that prostate cancer has spread to other parts of your body.
Q. I heard PSA is not very accurate.
A. PSA as a screening tool for prostate cancer is controversial however, now that you have been diagnosed with prostate cancer, we are using your PSA as a prognostic tool and to assess response to therapy.
Q. Before biopsy my PSA was bouncing around, is that important?
A. PSA is an indirect measurement of activity in the prostate. Benign tissues and cancer can cause PSA to rise. Now that you have been diagnosed with prostate cancer, the fluctuations you had in the past are less important. We are more concerned when the PSA goes from below ten to above ten or when the PSA goes from below twenty to above twenty.
Q. I already have a vacation planned. Should I keep the reservation I made?
A. Yes. Prostate cancer is typically a slow growing cancer and it is acceptable to postpone your radiation treatments for a few weeks. However, once you start your treatments, it is best to follow the radiation schedule and minimize the number of treatments missed.
Q. What resources are available to patients undergoing radiation therapy?
A. There are a lot of local resources available to patients. Let us know if you need assistance with transportation or if you have any other needs. You can also check the Helpful Links page on our website.
Q. What internet sources do you recommend to patients to help make a treatment decision?
A. The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. They help create the most respected guidelines for the treatment of prostate cancer. The have both a patient set and physician set of guidelines for many types of cancers.
You can also check the Helpful Links page on our website.
This list of frequently asked questions is meant to help patients considering radiation therapy at the Austin Center for Radiation Oncology. We encourage you to bring your own questions when consulting with Dr. Richard Garza. Contact us to schedule a consultation about radiation therapy.