Prostate Cancer

Radiation therapy for prostate cancer

Radiation therapy for prostate cancer is a medical treatment that uses targeted doses of radiation to kill cancer cells or slow the growth of tumors in the prostate. This type of treatment is often used in conjunction with other kinds of prostate cancer treatments, like surgery or chemotherapy.

Radiation therapy is commonly used in advance of surgical treatment to shrink cancerous growths and make them easier to remove, or after surgery, to attack cancer cells that may remain. Depending on the type, radiation therapy is typically minimally invasive and can often be performed as an outpatient procedure.

Prostate cancer is a serious condition, but it is also one of the most survivable forms of cancer. Localized prostate cancer — meaning prostate cancer that has not spread to other parts of the body — has a 5-year survival rate of over 99%.

The prostate

The prostate is a part of the male reproductive system. About the size of a walnut, it is located deep inside the pelvis, between the base of the penis and the rectum. The prostate is responsible for producing the majority of seminal fluid and contains nerves that control some elements of sexual function. When cancer cells develop in the prostate, it is called prostate cancer.

Radiation therapy for prostate cancer is one of the most common therapies used to treat the disease, which is among the most common forms of cancer diagnosed in men. About 1 in 8 men will develop prostate cancer at some point in their lives, and around 1.2 million prostate cancer diagnoses occur each year. Prostate cancer is most common in older men, with about 60 percent of patients over 65 at time of diagnosis.

Types of radiation therapy for prostate cancer

There are two main types of radiation therapy for prostate cancer. The most common type, external beam radiation therapy, or external radiation therapy, uses a machine to direct radiation through the skin and into the prostate.

Brachytherapy, or internal radiation therapy, is a less common type of radiation therapy for prostate cancer which involves placing radioactive materials directly into the prostate, either temporarily or permanently.

External beam radiation therapy for prostate cancer

External beam radiation therapy (EBRT) uses a machine to generate focused beams of radiation which are directed at the prostate through the skin. The machine is carefully calibrated to deliver radiation only at cancerous cells, and not the healthy surrounding tissue.

The EBRT process is painless and is much like receiving an x-ray. You’ll lie on a table while technicians carefully monitor the radiation you receive.

Your doctor will likely perform EBRT as a series of outpatient visits over several weeks. The duration and frequency of treatments will depend on your individual medical needs.

There are several types of EBRT that may be available depending on the facility where treatment takes place. The goal of all of them is to accurately assess the shape of your individual prostate and the cancerous cells inside it, and to deliver radiation with as much precision as possible.

3D conformal radiation therapy

3D conformal radiation therapy (3DCRT) directs x-rays at cancerous tissue from several directions to match the unique shape of your anatomy, and minimize damage to healthy cells. The machine is guided by images created from positron emission tomography (PET) or magnetic resonance imaging (MRI) scans that give a precise picture of your body.

Image-guided 3D conformal radiation therapy

Image-guided 3D conformal radiation therapy (IGRT) is an advanced form of 3DCRT that uses repeated imaging to guide the delivery of radiation. While 3DCRT always involves taking images of the body, with IGRT, your doctor will take a new scan for each treatment. While it may be surprising, the prostate can move within the body between treatments; repeated scans ensure radiation is delivered with precision.

Intensity modulated radiation therapy

Intensity-modulated radiation therapy is a type of 3DCRT that can vary the power and intensity of the radiation beams it deploys. This variability allows the machine to target extremely small areas of tissue while leaving healthy tissues undamaged.

Side effects of EBRT

Treatment with EBRT can cause side effects. They include:

difficulty urinating
an urgent need to urinate
pain during urination
rectal bleeding
blood in the stool
urgent or more frequent bowel movements
erectile dysfunction

Brachytherapy

Brachytherapy involves the insertion of small amounts of radioactive material directly into the prostate. There are two primary types of brachytherapy.

Permanent brachytherapy

During permanent brachytherapy, also called low dose rate (LDR) brachytherapy, small pellets or “seeds” containing radioactive material are implanted into the prostate. These seeds are injected with a needle through the skin of the perineum, the area between the anus and genitals, as part of a brief outpatient procedure.

These implanted seeds release their radiation slowly over a period of weeks or months, damaging cancer cells and helping to slow or stop the disease progression. The implanted seeds (usually containing Iodine-125 or palladium-103) eventually release all of their radioactive energy and become inert. WIth this type of therapy, the seeds do not need to be removed and can simply remain in the prostate.

Temporary brachytherapy

Also known as high dose rate (HDR) brachytherapy, temporary brachytherapy also uses radioactive material implanted directly in the prostate. The materials used in this procedure emit larger doses of radiation for a comparatively shorter period of time, and are then removed at the end of an outpatient visit. This type of treatment is less common than permanent brachytherapy.

Side effects of brachytherapy

Brachytherapy can produce some side effects after treatment. These include:

difficulty urinating
an urgent need to urinate
pain during urination
rectal bleeding
blood in the stool
urgent or more frequent bowel movement
erectile dysfunction

Erectile dysfunction

The prostate and the area immediately surrounding it contains nerves that are important to achieving an erection, and which may be damaged by radiation therapy. Because of this, many patients undergoing radiation therapy for prostate cancer will experience erectile dysfunction after treatment.

Erectile dysfunction is the inability to achieve or maintain an erection, and it can be a particularly troubling side effect for patients who experience it.

In contrast to surgical treatment for prostate cancer, which can cause erectile dysfunction immediately after the procedure that then improves, erectile dysfunction is more likely to develop in the months and years after radiation therapy for prostate cancer, and to worsen over time.

Patients dealing with this difficult side effect have a number of treatment options. They include:

Oral medication: Well-known oral medications for erectile dysfunction can be effective in helping to treat erectile dysfunction caused by radiation therapy. These drugs work by increasing blood flow to the penis.
Penile implant: The most common penile implants involve surgically implanting a tube into the penis which is then inflated to create an erection.
Penile Injections: Administering medication via penile injections can be an effective treatment for erectile dysfunction following radiation therapy.

The Inspire Prostate Cancer Community can be a powerful resource for advice and support with difficult subjects, like the sexual side effects of radiation therapy for prostate cancer.

“I had 38 external radiation treatments in 2012 for prostate cancer. This was followed by 60 hyperbaric treatments for radiation burns (Penis and nerves.) and damage to my colon & rectum. I tried Cialis & Viagra as well a Stendra without a lot of success. I had some good results only to be hit with severe pain in my jaws, throat, and chest and this made my attempts seem useless. I even tried many herbs with limited success and the same pain. I was about to give up on “normal” sex.
Finally I told my doctor that I wanted to try “Trimix” injections.
It is taking a little time to learn best injection techniques but the sex is near normal if not exceeding normal for a man my age (64).”

Radiation therapy for prostate cancer can be an important part of a successful course of treatment. While this life saving procedure can have side effects that may be cause for concern, many patients find manageable ways to live fulfilling lives cancer-free.

Sources

Disclaimer

Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.

Written by: Jack Wesley

Published on 11/18/23

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