External beam radiation therapy
External beam radiation therapy, EBRT or in its more precise form, intensity modulated radiation therapy, IMRT generally involves treatments 5 days a week for 6 or 7 weeks. The treatments cause no pain, and each session lasts just a few minutes. In many cases, if the tumor is large, hormonal therapy may be started at the time of radiation therapy and continued for several years. (More about hormonal therapy)
Depending on how extensive the cancer is or how big the prostate has grown, hormone therapy may be used before radiation therapy to help shrink the size of the tumor, thereby making it easier to treat. Hormone therapy decreases the amount of the male hormone testosterone in the body, which can promote the growth of cancer cells.
The primary target or External Beam Radiation is the prostate gland itself. In addition, the seminal vesicles may be irradiated (since they are a relatively common site of cancer spread). Radiating the lymph nodes in the pelvis, once common practice, has not proven to produce any long-term benefits for most patients, but it may be necessary in certain circumstances.
Possible problems
Because the radiation beam passes through normal tissues-the rectum, the bladder, the intestines-on its way to the prostate, it kills some healthy cells. Radiation to the rectum often causes diarrhea, but the diarrhea -as well as radiation-induced fatigue-usually clears up when treatment is over.
Radiation can also cause a variety of long-term problems. These include proctitis, inflammation of the rectum, with bleeding and bowel problems such as diarrhea, and cystitis, inflammation of the bladder, leading to problems with urination. In addition, some 40 to 50 percent of men treated with radiation therapy become impotent.
With newer techniques, available at state-of-the-art radiation therapy centers, side effects may be fewer. Higher-energy radiation beams can be more precisely focused, while computer technology allows a radiation oncologist to tailor treatment to the anatomy of the individual patient.
Internal radiation therapy
Radiation can also be delivered to the prostate from dozens of tiny radioactive seeds implanted directly into the prostate gland. This approach, known as interstitial implantation or brachytherapy, has the advantage of delivering a high dose of radiation to tissues in the immediate area, while minimizing damage to healthy tissues such as the rectum and bladder.
As practiced today, internal radiation therapy relies on ultrasound or CT to guide the placement of thin-walled needles through the skin of the perineum. Seeds made of radioactive palladium or iodine are delivered through the needles into the prostate, according to a customized pattern-using sophisticated computer programs- to conform to the shape and size of each man’s prostate.
The implantation procedure can be completed in an hour or two under local anesthesia; the patient typically goes home the same day. External beam radiation therapy
External beam radiation therapy, EBRT or in its more precise form, intensity modulated radiation therapy, IMRT generally involves treatments 5 days a week for 6 or 7 weeks. The treatments cause no pain, and each session lasts just a few minutes. In many cases, if the tumor is large, hormonal therapy may be started at the time of radiation therapy and continued for several years. (More about hormonal therapy)
Depending on how extensive the cancer is or how big the prostate has grown, hormone therapy may be used before radiation therapy to help shrink the size of the tumor, thereby making it easier to treat. Hormone therapy decreases the amount of the male hormone testosterone in the body, which can promote the growth of cancer cells.
The primary target or External Beam Radiation is the prostate gland itself. In addition, the seminal vesicles may be irradiated (since they are a relatively common site of cancer spread). Radiating the lymph nodes in the pelvis, once common practice, has not proven to produce any long-term benefits for most patients, but it may be necessary in certain circumstances.
Possible problems
Because the radiation beam passes through normal tissues-the rectum, the bladder, the intestines-on its way to the prostate, it kills some healthy cells. Radiation to the rectum often causes diarrhea, but the diarrhea -as well as radiation-induced fatigue-usually clears up when treatment is over.
Radiation can also cause a variety of long-term problems. These include proctitis, inflammation of the rectum, with bleeding and bowel problems such as diarrhea, and cystitis, inflammation of the bladder, leading to problems with urination. In addition, some 40 to 50 percent of men treated with radiation therapy become impotent.
With newer techniques, available at state-of-the-art radiation therapy centers, side effects may be fewer. Higher-energy radiation beams can be more precisely focused, while computer technology allows a radiation oncologist to tailor treatment to the anatomy of the individual patient.
Internal radiation therapy
Radiation can also be delivered to the prostate from dozens of tiny radioactive seeds implanted directly into the prostate gland. This approach, known as interstitial implantation or brachytherapy, has the advantage of delivering a high dose of radiation to tissues in the immediate area, while minimizing damage to healthy tissues such as the rectum and bladder.
As practiced today, internal radiation therapy relies on ultrasound or CT to guide the placement of thin-walled needles through the skin of the perineum. Seeds made of radioactive palladium or iodine are delivered through the needles into the prostate, according to a customized pattern-using sophisticated computer programs- to conform to the shape and size of each man’s prostate.
The implantation procedure can be completed in an hour or two under local anesthesia; the patient typically goes home the same day.
The seeds emit radiation for several weeks, then remain permanently and harmlessly in place. Alternatively, some doctors use much more powerful radioactive seeds over a period of several days. Such temporary implants, which require hospitalization, may be combined with low doses of external beam radiation.
Because the experience with modern internal radiation therapy techniques is relatively recent and limited to carefully selected patients, long-term results are not yet known. At 5 years, more than 90 percent of patients remain free of disease.
Internal radiation therapy is not well suited for large or advanced tumors, or for men previously treated with transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), who run an increased risk for urinary complications. For men with small, well-differentiated tumors, it may provide an option that is less invasive, has fewer side effects, takes less time to do, requires less time in the hospital, and is less costly than either external radiation or surgery.
Another form of brachytherapy, high-dose-rate (HDR) brachytherapy, may be used for patients who have somewhat more advanced or aggressive prostate cancer with an increased potential of microscopic extension beyond the prostate and the prostate capsule. In this procedure, the needles that guide the placement of the radioactive seeds are left in place for a day and a half. They are connected to a mobile radiation source that gives a brief, concentrated dosage of radiation at several intervals, allowing for a higher dosage in a brief period of time compared to permanent seeds. This form of treatment is also planned using the intraoperative computer program. It is sometimes combined with a five to six week course of 3-D conformal or IMRT radiation therapy.
Possible problems
Post-implant discomfort can usually be controlled by oral painkillers. The man can expect a few weeks of incontinence, but long-term complications such as prostatitis or urinary incontinence are uncommon and generally not severe. Sexual impotence occurs in about 15 percent of men under age 70 and 30 to 35 percent of men over age 70.
Treatment Options for Disease That Has Spread
If your cancer has grown beyond the prostate gland (Stage III), it cannot be stopped with local therapies -although radiation therapy can help to keep the tumor in check and hormonal therapy may slow its advance. If your prostate cancer is metastatic (Stage IV), it is usually treated with hormonal therapy, which can relieve painful or distressing symptoms and slow the progress of disease. Another option for metastatic disease is to enter clinical trials and accept new treatments that are being studied.
The seeds emit radiation for several weeks, then remain permanently and harmlessly in place. Alternatively, some doctors use much more powerful radioactive seeds over a period of several days. Such temporary implants, which require hospitalization, may be combined with low doses of external beam radiation.
Because the experience with modern internal radiation therapy techniques is relatively recent and limited to carefully selected patients, long-term results are not yet known. At 5 years, more than 90 percent of patients remain free of disease.
Internal radiation therapy is not well suited for large or advanced tumors, or for men previously treated with transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), who run an increased risk for urinary complications. For men with small, well-differentiated tumors, it may provide an option that is less invasive, has fewer side effects, takes less time to do, requires less time in the hospital, and is less costly than either external radiation or surgery.
Another form of brachytherapy, high-dose-rate (HDR) brachytherapy, may be used for patients who have somewhat more advanced or aggressive prostate cancer with an increased potential of microscopic extension beyond the prostate and the prostate capsule. In this procedure, the needles that guide the placement of the radioactive seeds are left in place for a day and a half. They are connected to a mobile radiation source that gives a brief, concentrated dosage of radiation at several intervals, allowing for a higher dosage in a brief period of time compared to permanent seeds. This form of treatment is also planned using the intraoperative computer program. It is sometimes combined with a five to six week course of 3-D conformal or IMRT radiation therapy.
Possible problems
Post-implant discomfort can usually be controlled by oral painkillers. The man can expect a few weeks of incontinence, but long-term complications such as prostatitis or urinary incontinence are uncommon and generally not severe. Sexual impotence occurs in about 15 percent of men under age 70 and 30 to 35 percent of men over age 70.
Treatment Options for Disease That Has Spread
If your cancer has grown beyond the prostate gland (Stage III), it cannot be stopped with local therapies -although radiation therapy can help to keep the tumor in check and hormonal therapy may slow its advance. If your prostate cancer is metastatic (Stage IV), it is usually treated with hormonal therapy, which can relieve painful or distressing symptoms and slow the progress of disease. Another option for metastatic disease is to enter clinical trials and accept new treatments that are being studied.