ALL ABOUT RADIOTHERAPY FOR PROSTATE CANCER
Radiotherapy for prostate cancer have become one of the best treatment options available today. Excellent results have been seen in over 95% of patients selected at an early stage of the disease.
Indeed, when prostate cancer is diagnosed early—before spreading outside the gland—it may be cured through radiation or surgery. However, prostate radiotherapy does not present the risks of traditional surgery and has the advantage of short protocols.
Choosing which treatment to have is difficult, though. There are pros and cons to them all. Also, you must consider side effects. So, we are here to tell you about all the treatment options available and help you decide if radiotherapy is right for you.
How Does Radiotherapy for Prostate Cancer Works?
Radiotherapy works by using powerful X-rays to cause permanent damage to the cancer cell’s DNA. Since tumor cells can’t repair themselves, they die and stop spreading to nearby tissues and organs. Conversely, healthy cells can repair themselves more easily.
External beam radiotherapy uses X-rays directed to the prostate from outside the body. It treats the whole prostate. However, if cancer has spread, you may receive radiation to a wider area, including the surrounding pelvic lymph nodes.
External beam radiotherapy is the best-known type of radiation therapy for prostate cancer. But, there are newer options, including brachytherapy or internal radiation, that can offer great results.
Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on February 7, 2022
Who Can Have Radiotherapy for Prostate Cancer?
Your doctor will use the results of the prostate exam, biopsy, and scans to determine the stage of your prostate cancer (how far cancer has advanced or spread). Together, the staging and your general health will determine the course of treatment.
Radiotherapy is used as the first line of treatment to cure:
- Localized prostate cancer that hasn’t spread outside the prostate.
- Locally advanced prostate cancer that has spread to the area just outside the prostate.
- Recurrent prostate cancer, aka cancer that has come back after treatment.
Clinical trials have shown that radiotherapy can be adjuvant therapy and work alongside prostate removal surgery to increase the chances of a cure. However, research is still pending into when exactly it should be initiated after surgery.
This therapy can also be given to some patients with advanced or metastatic prostate cancer (cancer that has spread to other parts of the body.) It can help ease bone pain and relieve other symptoms, not cure cancer, though. This is called palliative radiotherapy.
Finally, you can have salvage or second-line radiotherapy if your cancer has come back after surgery. It could also be an option after high-intensity focused ultrasound (HIFU) or cryotherapy (freezing the tumor cells.)
Radiotherapy for Prostate Cancer Plus Hormone Therapy
If you’re having radical radiotherapy for localized prostate cancer, you will likely be on hormone therapy six months before, during, and after external beam radiotherapy. The main goal of hormone therapy is to block the effects of testosterone.
Since prostate cancer needs testosterone to grow, hormone therapy is a powerful treatment ally. It can effectively shrink the prostate and cancer inside it. Hence, the tumor will be easier to treat.
Suppose there is a risk of cancer spreading outside your prostate (locally advanced prostate cancer). In that case, you may be on hormone therapy for a longer period, up to three years after you finish your radiation.
In Which Cases Is Prostate Radiotherapy Not Recommended?
Radiotherapy might not be the best option for you if you have Crohn’s disease or ulcerative colitis. In this case, it could worsen your bowel disorders.
Also, radiation therapy isn’t recommended if you have had previous radiation therapy on your pelvic area.
What are the Benefits of Radiotherapy for Prostate Cancer?
Radiotherapy has many advantages.
- It can cure localized or locally advanced prostate cancer, especially if you refuse surgery or prostatectomy is too risky for you.
- After the radiotherapy sessions, you can carry on with your normal activities, including work and driving.
- Radiation is painless, although you might find the treatment position a bit uncomfortable.
- It is a quick procedure. The treatment only lasts around 10 minutes. However, you’ll need to be at the hospital for nearly an hour each day to prepare for your session.
- There are no overnight hospital stays.
Despite the many advantages, there are a few special considerations. For example, radiation therapy is given on daily sessions, five days a week for a few weeks. So, you must make transport arrangements and make time every day for your therapy.
Also, your bowel may need to be empty before each treatment session. So, you will be prescribed an enema or laxative to help empty your bowel each day.
What are the Side Effects of Radiotherapy for Prostate Cancer?
Radiotherapy may make you feel extremely tired. Also, it can cause side effects such as bowel, urinary, and erection problems.
Side effects happen because radiotherapy kills cancer cells but also damages the healthy tissue near the prostate.
Possible urinary problems are known as radiation cystitis. So, you may feel the urge to urinate often, experience difficulty urinating, or feel a burning sensation. Also, you may find blood in your urine or, in rare cases, end up with leakage or incontinence.
Urinary problems usually start midway through your treatment and improve a few weeks after treatment is over. Rarely, some patients may have side effects for longer.
Radiotherapy can irritate the rectum and cause radiation proctitis. So, you may experience diarrhea, the need to empty your bowel more often, feeling that your bowels haven’t emptied properly, abdominal pain, or in your back passage.
Additionally, you may present erection or ejaculation problems: impotence, discomfort when you ejaculate, or a reduced amount of semen or no semen at all (don’t ejaculate) when you have an orgasm.
Other disadvantages or side effects include:
- Lymphoedema or a build-up of fluid in your legs. This happens to some men after radiotherapy to the lymph nodes.
- An increase for having bladder or rectal cancer later in life.
If you have radiotherapy as your first line of treatment and your cancer comes back or spreads, you won’t be eligible for surgery afterward. Radiotherapy may damage pelvic tissues, making it difficult to remove your prostate and increasing the risk of side effects.
Which One Is Better: Surgery or Radiotherapy for Prostate Cancer?
Both options may be used to treat localized prostate cancer. They work well in this scenario and the risk of your cancer spreading is low.
Both treatments have side effects, though. Prostate radiotherapy is more likely to cause bowel problems, while surgery could cause leaking urine or erection disorders.
In your particular case, one treatment may be better than the other considering your life expectancy, other health conditions, your feelings about each treatment, or if surgery is too risky for you. In the end, you and your doctor must thoroughly discuss your situation.
Also, remember that treatment choices are different for advanced prostate cancer that has spread outside of the prostate or throughout the body.
How Are the Radiotherapy Sessions?
A week or two before your therapy begins, you’ll have a planning session. This is to ensure the radiographers know the size, exact position, and shape of your prostate.
The planning session will help better target the radiation at your prostate so that the surrounding tissues receive the less radiation possible. You’ll have a series of tests, including a CT (computerized tomography) scan and maybe an MRI (magnetic resonance imaging) scan.
Then, your radiographer will make three tiny permanent marks (ink tattoos) on your skin. This will help you get into the right treatment position during every session. You will be given an enema or a suppository before each treatment session to ensure your bowel is completely empty.
Also, your radiographer may use a rectal spacer to protect the inside of your back passage (rectum) from radiation. This may help to lower the risk of bowel side effects. The spacer goes between your prostate and your back passage.
Then your radiographer will put you into the same position you were during your planning session. They’ll use the ink marks made on your body as a guide. This will ensure that the radiation targets the same area each time.
When the treatment starts, the machine will move around your body. It won’t touch you, and it is completely painless. But, you must keep very still.
After the session is over, it’s safe for you to be around children and pregnant women. You won’t be radioactive.
How Many Radiotherapy Sessions Will I Need?
If you have localized prostate cancer, you will have treatment five times a week between 4 to 9 weeks.
Also, higher doses of radiation can be given using an intensive protocol (hypofractionated radiation therapy). In this case, you will have 20 treatment sessions over four weeks.
New Advances in Radiotherapy for Prostate Cancer
Newer techniques focus the radiation more precisely on the prostate tumor. Hence, protocols can give higher doses of radiation while reducing side effects and damage to nearby healthy tissues.
With three-dimensional conformal radiation therapy (3D-CRT), special computers precisely map the location of your prostate. So, radiation beams are shaped and directed to the prostate from several angles.
Intensity-modulated radiation therapy (IMRT), an advanced kind of 3D-CRT therapy, uses a computer-driven machine that moves around you as it delivers radiation. In this case, the strength of the radiation can be controlled so that different areas get a different dose.
Can I Have Both External Radiotherapy and Brachytherapy for Prostate Cancer?
Brachytherapy alone is generally used only in low-grade, early-stage prostate cancer patients.
But, suppose there’s a risk that your cancer could spread outside the prostate. In that case, your doctor will prescribe you high dose-rate brachytherapy alongside a short course of external radiotherapy, plus hormone therapy. This is called brachytherapy boost.
Of course, having both types of radiotherapy can help make treatment more effective. However, it might also increase side effects.
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A center specialized exclusively in the care of oncology patients.
A center area of 700 m2 distributed over four floors.
Latest technologies in radiation oncology, including brachytherapy equipment.
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Doctor Benjamín Guix Melcior
Specialist in Radiotherapy for Prostate Cancer
More than 35 years of experience in prostate cancer treatment.
Director of the IMOR Institute (Barcelona, Spain).
American Brachytherapy Society (ABS) Award 2009
Languages: Spanish, English, French
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Bibliography – More recent publications:
Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis. Wallis CJD, Saskin R, Choo R, Herschorn S, Kodama RT, Satkunasivam R, Shah PS, Danjoux C, Nam RK.Eur Urol. 2016
Advances in Radiotherapy for Prostate Cancer Treatment. Podder TK, Fredman ET, Ellis RJ.Adv Exp Med Biol. 2018
Radiation Therapy for Prostate Cancer. Kamran SC, D’Amico AV.Hematol Oncol Clin North Am. 2020
Information in radiotherapy for men with localised prostate cancer: An integrative review. Gordon L, Dickinson A, Offredy M.Eur J Cancer Care (Engl). 2019
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