Treatment Overview

Radiation therapy uses high doses of radiation, such as X-rays, to destroy cancer cells. The radiation damages the genetic material of the cells so that they can't grow. Although radiation damages normal cells as well as cancer cells, the normal cells can repair themselves and function, while the cancer cells cannot.

Radiation therapy may be used alone or combined with hormonal treatment to treat prostate cancer. It is most effective in treating cancers that have not spread outside the prostate. But it also may be used if the cancer has spread to nearby tissue. Radiation is sometimes used after surgery to destroy any remaining cancer cells and to relieve pain from metastatic cancer.

Radiation is delivered in one of two ways.

• External-beam radiation therapy uses a large machine to aim a beam of radiation at your tumor. After the area of cancer is identified, an ink tattoo no bigger than a pencil tip is placed on your skin so that the radiation beam can be aimed at the same spot for each treatment. This helps focus the beam on your cancer to protect nearby healthy tissue from the radiation. External radiation treatments usually are done 5 days a week for 4 to 8 weeks. If cancer has spread to your bones, shorter periods of treatment may be given to specific areas to relieve pain.
  • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
  • Intensity-modulated radiation therapy (IMRT) uses a carefully adjusted amount of radiation. This protects healthy tissues more than conformal radiotherapy does.
• Brachytherapy, or internal radiation therapy, uses dozens of tiny seeds that contain radioactive material. It may be used to treat early-stage prostate cancer. Needles are used to insert the seeds through your skin into your prostate. The surgeon uses ultrasound to locate your prostate and guide the needles. As the needles are pulled out, the seeds are left in place. The seeds release radiation for weeks or months, after which they are no longer radioactive. The radiation in the seeds can't be aimed as accurately as external beams, but they are less likely to damage normal tissue. After the seeds have lost their radioactivity, they become harmless and can stay in place.

Sometimes treatment combines brachytherapy with low-dose external radiation. In other cases, treatment combines surgery with external radiation.

Another kind of radiation therapy used mostly in clinical trials is proton therapy. Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton therapy is combined with X-ray therapy.

Before radiation therapy is scheduled, your doctor probably will order a bone scan and CT scan to find out whether the cancer has spread to other parts of your body. If it has, your doctor may offer you the option of a clinical trial for treatment.

What To Expect After Treatment

Side effects may last only as long as the treatment, or they may continue and become chronic. Some side effects develop after treatment, such as erection problems. For some men, this problem gets gradually worse over the course of several years after treatment. The long-term effects of radiation therapy on the main body systems are not yet known. Side effects include:²

• An irritated rectum that can cause an urgent need to pass stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.
• Bleeding from the rectum or blood in the urine.

Why It Is Done

Radiation therapy is used for:

• Cancer that has not spread in generally healthy men who are younger than 70.
• Cancer that has spread to the bones, is not getting better with hormonal treatment, and is causing pain.
• Cancer that has come back in the prostate after surgery.
• Cancer cells that may remain after surgery, especially if all the cancer cannot be removed. This is done very rarely.

How Well It Works

For early-stage prostate cancer, prostatectomy and radiation appear to work equally well. Radiation appears to work as well as prostatectomy and active surveillance for most men over 65 who have early stage prostate cancer (stages I and II, also called localized prostate cancer). For men younger than 65, treatment with surgery may help them live longer.¹

For treating advanced prostate cancer that has grown beyond the prostate but not into lymph nodes or bones, external-beam radiation combined with hormone drugs can work better than surgery. This treatment often results in controlling cancer growth and in many years of disease-free survival.²

For stage III prostate cancer, there is evidence that combining radiation with hormone drugs improves survival rates.² One study that followed men with stage III prostate cancer for 20 years after radiation therapy showed that:²

• 44% had no problems with prostate cancer for the rest of their lives.
• 47% eventually died of prostate cancer.

Risks

Side effects are common. Some men develop long-term problems that may have a significant impact on their quality of life. Long-term problems that can be caused by radiation treatment include:

• An irritated rectum and an urgent need to pass a stool. This is called proctitis.
• An inflamed bladder and urination problems. This is called cystitis.
• An inflamed intestine and diarrhea. This is called enteritis.
• Being unable to have an erection. This is called impotence.
• Being unable to control urination. This is called incontinence.
• Painful urination. This is called dysuria.

What To Think About

A newer form of brachytherapy involves placing radioactive material into the prostate and then removing the material.

This technique—also called high-dose rate, or HDR, brachytherapy—uses tiny tubes that are placed through your skin into your prostate. Radioactive material is injected into the tubes, which are left in place for 5 to 15 minutes. The tubes are removed at the end of each treatment. About three brief treatments are given over 1 or 2 days.

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