The radiation oncologist recommends his patients meet with the staff dietitian for a nutritional evaluation during treatment. The Dietitian reviews medical history, eating habits, and questions from patients and their families. Nutrition therapy needs are assessed and individualized nutrition counseling is provided. Many health issues can be improved with good nutrition through balance, moderation and variety in your diet. During your treatment, it will be important to maintain current weight and fluid intake.
The usual first step is to make an appointment for a consultation with your physician to be sure that you are a good candidate for radiation treatment. This visit is similar to those in other doctor’s offices with a review of your history and a physical examination. We then review with you the procedure as well as its risks. You receive no radiation exposure at this time.
The treatment is a Medicare reimbursed therapy and is approved by most private insurance carriers. Coverage is generally good, although your individual plan may be subject to co-pay and/or deductible amounts. Feel free to contact our staff if you have any questions, and we will do our best to help you.
We acquire images on a daily basis which helps us target the treatment delivery. Staff uses the image by superimposing it over the image acquired from the CT scan. The treatment position can be adjusted to accommodate organ movement by shifting the table to the exact location of the volume to be treated. As a result, we increase the accuracy of the treatment delivery over the course of therapy. This increases the potential for cure while decreasing the risk of side effects.
While Intensity Modulated Radiation Therapy (IMRT) is very accurate, it does have a shortcoming. The entire plan is based upon your initial CT-Scan image which fixes the position of the internal organs. However, the prostate, bladder, rectum and other organs display some movement, and there can be a variation in position of several millimeter to as much as a centimeter or two (1 cm= 4/10 inch) of the organs relative to the initial CT-Scan.
Image guided therapy requires your radiation oncologist to place several inert marker seeds in the prostatic area. These marker seeds are then visualized just prior to therapy in the treatment room and compared to the initial seed position. Adjustments can then be made.
Your radiation treatments are administered by a trained radiation therapist in a dedicated room. The treatment is given by a linear accelerator (pictured below) while you lie on a couch. The arrangement is quite “roomy” unlike that of a CT-scan or MRI. The actual treatment is painless. When receiving the treatment, you are monitored by a closed circuit TV and you may converse with the staff by intercom.
When your IMRT is complete, the staff will arrange for a verification simulation appointment. You will be brought to the actual treatment room for a final run through to double check your position, measurements, and the feasibility of the computer derived plan. An x-ray taken at this time. Generally, everything checks out and your treatment begins.
Several steps are required to set up your therapy. Prior to beginning your treatment, you will come to our office for imaging. Generally speaking, a CT scan of the pelvis is performed, although occasionally additional scans including an MRI are obtained. At the time of the CT-Scan, the staff will place you in treatment position. A small amount of dye may be introduced into the urethra at this time. The whole process generally takes about 40 minutes to an hour. During the next few days, the planning process takes place using the images from the CT-Scan. You do not need to be present at this time. Your IMRT treatment plan is prepared by your physician in conjunction with the medical physics staff.
Intensity modulated radiation therapy (IMRT) is a relatively new technique to improve external delivery of radiation therapy by linear accelerator. Instead of maintaining a uniform radiation beam as used in conventional or 3-dimensional radiation, IMRT uses devices within the machine to divide the radiation beam into multiple smaller beams called beamlets that can have different intensities (modulated) within the area being treated. This allows more precise delivery of radiation doses to the tissues within the target area, allowing increased doses to the prostate while relatively sparing the surrounding bladder and rectum. This is important as several recent medical studies have suggested that higher prostate doses are associated with increases curability.
Image guided radiotherapy represents one of the most significant technical advances in radiotherapy. Image guided radiotherapy shows significant promise in improving our ability to give sufficient radiation doses to sterilize tumors while protecting normal structures; thus, potentially decreasing the risk of complications. This is an available treatment in AUS’ Center for Prostate Cancer
Radiation Therapy is a time proven treatment for cancer. Most tumors are more sensitive to radiation than the surrounding normal structures (your bladder and rectum); thus, can be effectively treated. Radiation can take several forms including radioactive seeds (gamma rays), proton beam, and man-made x-ray treatment.
Remain Calm. A wide range of good treatment options exist for prostate cancer. AUS’ Team of Board Certified Urologists are here to provide you the best treatment options available for you.
Learn about the AUS Physicians and the best personal care they provide every day
RD, LD Dietitian
Chief Radiation Therapist
"Dr. Herzog is an outstanding and highly-skilled doctor. I have been a patient of Dr. Herzog's since 2008 and I feel that he goes above and beyond for his patients.His excellent bedside manner and incredible medical knowledge truly make me feel that he is the best. He patiently answers all my questions and I feel confident knowing that I am in his care." -EK
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