Radiation therapy has been used to treat and cure prostate cancer for several decades. However, due to recent advances in technology, the cures have significantly improved while the side effects have fallen dramatically.
How does it work?
Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation works by disrupting the DNA in cancer cells so that they are unable to continue multiplying. Rapidly diving cells are the most susceptible to radiation damage…and since cancer cells divide at a very rapid rate compared to normal cells, they are very sensitive the radiation.
In most cases, radiation destroys the cancer cells’ ability to reproduce, rendering them unable to divide or spread.
Types of radiotherapy
Radiation therapy for prostate cancer is divided into two main categories: external beam radiation therapy (EBRT) and brachytherapy (prostate seeds and high dose rate radiotherapy).
External beam radiation
EBRT is performed as an outpatient on a machine called a linear accelerator. This machine generates radiation called photons which are aimed at the prostate. Each treatment is painless and takes about 10-15 minutes to complete. It is performed five days a week for about 7-8 weeks. New technology enables radiation to be extremely precise.
The other type of radiation is called brachytherapy. This form of radiotherapy is delivered through small radioactive pellets about the size of a grain of rice. These pellets are placed directly into the prostate through ultrasound guidance in the operating room under anesthesia. The entire procedure typically takes 30-40 minutes. It is most effective for men with early stage prostate cancer (PSA less than 10 and Gleason score of 6).
The seeds that are placed can be a permanent (low dose rate, or LDR) or temporary (high dose rate, or HDR).
What form of radiotherapy is best for me?
The best form of therapy for you is based on various factors, including your age, general health status, Gleason grade, PSA, and size of your prostate.
Your radiation oncology can you help you decide on the therapy which is best for you.
Prostate seed implants are best for patients with no significant heart or lung disease with low-risk prostate cancer (Gleason score of 6 and PSA less than 10). Other than receiving previous radiation to the pelvis, there are no contraindications for external beam radiotherapy to the prostate.
Radiation therapy versus surgery
Robotic prostatectomy is also a treatment option for prostate cancer. It has received a lot of attention for being an advanced type of therapy. However, recent data comparing surgery vs radiation for prostate cancer demonstrate that radiation results in equal and/or better cure rates with fewer side effects. Robotic prostatectomy may have some advantages over open prostatectomy, but there is no credible data to suggest it is better than radiotherapy.
Radiation therapy versus surgery
Many men learn about radiation for prostate cancer only after they have had surgery. Unfortunately, by then, many men have already experienced the permanent side effects of surgery such as impotence and incontinence. If you or loved one has been diagnosed with prostate cancer, make sure they see a radiation oncologist to learn about their treatment options before making any treatment decisions.
Lav Goyal MD MBA
Holy Cross Hospital
Fort Lauderdale, FL