Patient FAQs

Your physician may at some point recommend a yearly digital rectal exam (DRE) which can help discover any unusual changes in prostate size, shape or firmness. Discussions about this screening usually start around the age of 50 if there are no particular risk factors.

Another routine test that your PCP may mention is the PSA. The general guidelines recommend that men between the ages of 55 and 69 benefit most from receiving a PSA test (prostate specific antigen blood test). However, you should consult with your physician who can help you with this decision based on many individual factors such as race and family history.

A physician may also suggest a random biopsy of the prostate which removes tissue samples (cores) from the prostate. However, with modern imaging technologies such as multi-parametric MRI, random prostate biopsies are no longer recommended as an initial screening test. Any biopsy carries risk (e.g., infections) and the specificity of random biopsies – the ability to confirm the absence of clinically significant cancer – is relatively low.

An MRI (Magnetic Resonance Imaging) machine generates various magnetic fields that cause molecules in your body to emit signals that are captured and translated into detailed images of the region of interest. In contrast to X-Ray imaging, MRI does not deposit radiation that is harmful to the body.

Multi-parametric MRI refers to the fact that the MRI scanner takes different types of scans during one setting. The clinician will compare the results of these different types of scans to ensure an accurate diagnosis.

MRI is an imaging modality that helps your physician determine with more certainty than DRE or PSA alone if there is clinically significant disease. MRI imaging can also increase the confidence in a diagnosis of benign or dormant disease.

With suspicious MRI findings you may be referred to receive a targeted (non-random) biopsy which is the current gold standard to determine if any lesion (suspicious tissue development) is cancerous, what type and stage of cancer it may be, and how aggressive it is.

Before the MRI, you will be asked to remove all metal from your body such as jewelry, watches, keys and wear a medical gown. For people with certain medical implants like metal joint replacements or pacemakers or those who may have fragments of metal embedded in their body or eyes (shrapnel in soldiers or metal shavings in welders) there are additional guidelines.

You will be put on a patient table which the nurse or technologist roles into the donut shaped MRI machine. Some people may feel uncomfortable in small spaces which you should mention to your care provider. For the imaging sequence you will be asked to lie very still for several minutes. Because the MRI machine generates loud noises (humming, clacking, thumping) you will be provided with ear plugs or other hearing protection.

Sometimes the radiologist may inject intravenous contrast during the diagnostic procedure to further enhance the images of the prostate.

You may spend up to two hours at the hospital including the time when the staff prepares you for the exam. The actual imaging procedure can take about 45 minutes.

For an MRI exam you are usually awake. You may receive a mild sedative or medication to calm you down if you are afraid of small spaces.

An endorectal coil functions like an antenna encased in a soft, flexible balloon that is inserted into the rectum. The coil does not send any radiation or signal into your body but rather receives a signal that your body emits when the scanner generates and switches various magnetic fields.

The prostate sits in the middle of your body in the pelvic region. That can make it harder for the MRI machine to produce high quality images without the eCoil.

The eCoil is inserted into your rectum and placed right next to the prostate. This closeness to the prostate allows the coil to generate high quality images with high spatial resolution and high signal to noise ratio (SNR – a measure to compare the level of desired signal to the level of undesired background noise). With better images your physician is able to render a diagnosis with more confidence.

A number of small clinical studies have confirmed that experienced clinicians can significantly increase the sensitivity – the ability to correctly identify and localize clinically significant cancer. At the same time, the use of an endorectal coil helps maintain or improve the specificity – the ability to correctly determine when a result is negative – as compared to imaging without an endorectal coil. Importantly, these studies have also shown that using an endorectal coil reduces the risk of missing clinically significant cancer lesions especially when they extend beyond the prostate capsule.

Globally recognized guidance (PI-RADS 2.1 – Prostate Imaging- Reporting and Data System) confirms that eCoils can enhance image quality at any field strength and suggests that “with some 1.5T MRI systems, especially older ones, use of an [eCoil] is considered indispensable for achieving the type of high-resolution diagnostic quality imaging needed for staging prostate cancer.” Field strength is a measure of the strength of the MRI machine expressed in units of “Tesla” (e.g., 1.5T or 3.0T). In general terms, the higher the field strength the better the image quality.

With a history of close to 30 years of use, endorectal coils have helped enhance MR imaging procedures in hundreds of thousands of patients.  During this time, patients and their physicians have confirmed that it is a well tolerated medical device and procedure.  For some patients, there may be more of a feeling of embarrassment during insertion rather than actual physical discomfort or pain.

In order to ease the insertion, the health care provider will lubricate the flexible balloon with gel.  You will likely still feel some pressure as the coil is inserted and especially as it is positioned.  This may feel like the urge of having to go to the bathroom.  In some cases, the clinician may opt to use topical analgesic gel to reduce any sensitivity.

There are multiple potential options for patients with suspected or confirmed prostate cancer.  These paths can range from “Watchful Waiting” and “Active Surveillance” to chemo or hormone therapy, to radiation treatment either through external beam radiation therapy (EBRT) or brachytherapy (implanted radiation), to surgery.  You need to discuss with your treating physician(s) which path may be most suitable depending on your personal situation.

EBRT involves high energy X-Rays or proton beams that are concentrated on the prostate to destroy cancer cells. Modern RT systems are highly conformal, meaning the radiation beams are very focused to target the cancerous tissue as much as possible and avoid surrounding healthy tissue as much as possible.

An individual radiation therapy session typically takes 15 to 20 minutes even though the actual time when the radiation happens, i.e., beam on time, only lasts a couple of minutes.

Based on the individual diagnosis and the availability of different technologies, the entire radiation treatment may last as long as eight to nine weeks with up to 45 individual daily sessions during the week and may be as short as one week with three to five individual sessions.

The side effects of prostate radiation therapy are caused when healthy tissue around the cancer lesion is exposed to radiation. They are usually categorized into acute effects, those occurring within 90 days of treatment, and late effects, i.e., those developing beyond 90 days after radiation treatment.

In general, radiation therapy can be accompanied by fatigue as an acute side effect. Beyond that, prostate radiation can impact urinary, bowel, and sexual health which as acute side effects typically resolve after about 3 months. In rare cases (1-3% of patients), long term urinary and bowl side effects can occur and can usually be managed with medication. Long term sexual side effects are more frequent and can impact close to 20% of patients by two years after radiation therapy. Sexual side effects can also be treated medically.

You should consult with your physician what specific side effects are possible and what strategies are available to avoid and treat them.

An Endorectal Balloon is a small, disposable medical device that is made of soft, pliable material with a small balloon sitting on the end of a thin tube. The balloon is inserted in the rectum and inflated to stabilize the prostate during verification imaging and radiation therapy treatments.

Because the prostate sits in the middle of the pelvis it can be subject to motion caused by breathing, movement in your bowel or your bladder. Even modern radiation systems cannot fully compensate for this likely motion in real time. Therefore, the radiation zone is expanded beyond the actual tumor to ensure it is fully covered by the radiation beams even when there is motion, thus increasing the risk that healthy tissue also gets irradiated. Due to their proximity to the prostate, the rectum and anus are two anatomical structures at increased risk of receiving high dose radiation when they should not.

An endorectal balloon, has been shown to effectively stabilize the prostate, meaning it reduces prostate motion in any direction. In addition, the balloon consistently pushes large parts of the rectum and anus away from the high dose radiation zone, therefore protecting healthy tissue and helping to avoid acute and long-term radiation toxicity.

Individual treatment sessions typically follow a consistent pattern throughout the entire course of radiation therapy but may differ based on the type of technology and techniques used at your treatment facility.

Usually, you will be asked to do bladder and bowl preparation before the session which may include drinking sufficient fluids to fill the bladder and getting a micro enema to empty the bowel.

When an endorectal balloon is used it will be inserted before a potential CT planning scan to confirm the position of the prostate and surrounding anatomy and to determine if any adaptations to the treatment protocol are necessary. The balloon is inserted with you either in the lateral position – lying on your side – or in the supine position – lying on your back. In both cases, usually your knees are bent. The balloon is lubricated to ease insertion while it is deflated. Once the balloon is inserted the clinician will inflate the balloon to a predetermined volume and position it to stabilize the prostate. A small disc called a migration stop is pushed on the balloon shaft towards the anus on the outside so that the balloon remains in position during treatment and to ensure consistent insertion depth.

With the balloon in place, the CT planning scan is performed. Typically, this will be done with you lying on your back since that is also the common position during radiation treatment.

You will be asked to lie very still during the radiation treatment which will only last a couple of minutes. The balloon is deflated and removed immediately after the radiation procedure is completed.

The radiation treatment is painless. You will feel some pressure when the endorectal balloon is inserted and positioned which may be a sensation similar to the urge of having to go to the bathroom. If there is more discomfort, the clinician may use topical analgesic gel to reduce any sensitivity. Studies have shown that patients tolerate the daily insertion of the endorectal balloon well throughout the entire course of treatment. Especially at the beginning of your course of treatment, you may experience a bit of embarrassment during insertion rather than actual physical pain or discomfort.

The purpose of the gel is to create distance between the prostate and the rectal wall and reduce the radiation dose delivered to the rectum during radiation treatment of the prostate. The two available gel spacers do a great job achieving this separation and studies have shown that they can help reduce toxicity effects on the rectum.

Similarly, the ultimate goals that endorectal balloons consistently achieve are to protect healthy tissue from undesired radiation exposure and to help avoid acute and late toxicity effects. In addition, endorectal balloons stabilize the prostate and significantly reduce motion which is something spacer gels cannot accomplish. Due to their shape and size, endorectal balloons have shown an equally protective effect on the anal area which gels do not have.

Lastly, spacer gels are not ideal for patients where the prostate cancer extends beyond the prostate capsule towards the rectum.  In these cases, the gel could be accidentally injected into and disrupt tumor cells or at a minimum displace them outside the planned treatment area.  This complication does not exist for endorectal balloons because they are isolated within the rectum.