The prostate is a walnut-sized and shaped gland that is located below men’s bladder, near the rectum and surrounding the urethra. While healthy cells normally divide and die, prostate cells affected by cancer start to grow out of control. Due to the location of the prostate, the disease affects both the urinary and reproductive systems, causing symptoms like urinary problems including a slow or weak urinary stream or the need to urinate more often, especially at night; blood in the urine; erectile dysfunction; pain in the hips, back, chest, or other areas from cancer that has spread to bones; and weakness or numbness in the limbs.
Prostate cancer is the most common non-skin cancer among American men, but there are numerous treatment options, depending on the patient’s age and expected lifespan, any other severe health conditions, the stage and grade of the cancer, patient’s and physician’s feelings and opinions about the need to treat the cancer right away and potential side effects, as well as likelihood that each type of treatment will cure the cancer. Treatment options to address prostate cancer include watchful waiting, surgery, chemotherapy, cryotherapy, hormone therapy, vaccine treatment, bone-directed treatment, and radiation therapy.
Radiation Therapy for Patients with Prostate Cancer
“Radiation therapy uses high-energy rays or particles to kill cancer cells,” explain the American Cancer Society. It may be used “as the first treatment for low-grade cancer that is still just in the prostate gland,” which has similar cure rates to radical prostatectomy. But also “as part of the first treatment (along with hormone therapy) for cancers that have grown outside of the prostate gland and into nearby tissues; if the cancer is not removed completely or comes back (recurs) in the area of the prostate after surgery, or if the cancer is advanced, to reduce the size of the tumor and to provide relief from present and possible future symptoms.”
There are two main types of radiation therapy for patients with prostate cancer. External beam radiation therapy (EBRT) consists of placing beams of radiation on the prostate gland from a machine outside the body, and it is particularly indicated in early stages of the disease or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone. Treatment is usually performed five days a week in an outpatient center for about 7 to 9 weeks and it takes only a few minutes. Research enabled the development of new EBRT techniques to improve precision, including three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and proton beam radiation therapy.
The other type of radiation is called Brachytherapy, also known as internal radiation therapy or seed implantation or interstitial radiation therapy, and it consists of the use of small radioactive pellets, or “seeds,” each about the size of a grain of rice. The major difference in type type of radiation is that these pellets are placed directly into the prostate, and it is particularly indicated for patients with early stage prostate cancer that is relatively slow growing such as low-grade tumors. Brachytherapy is performed in an operating room, while the patient is under anesthesia, and it can be a permanent (low dose rate, or LDR) brachytherapy or a temporary (high dose rate, or HDR) brachytherapy.
Benefits and Risks of Prostate Cancer Radiation Therapy
While in earlier stages of prostate cancer, the most common course of treatment is watchful waiting, as the disease progresses, radiation therapy and surgery become more often. Both external beam radiation therapy and brachytherapy are known to be effective in destroying cancer cells, but there is more long-term data about the positive results with using external beam radiation. Despite the encouraging results, there are potential side effects associated with each type of radiation therapy.
In the case of external beam radiation therapy, the possible side effects include bowel problems, related to an irritation of the large intestine and rectum due to radiation (radiation proctitis), bladder problems due to irritation of the bladder related to radiation (radiation cystitis), urinary incontinence, erection problems including impotence more common years after the treatment than right after it, tiredness and fatigue that can last months, lymphedema due to damages caused by radiation to the lymph nodes around the prostate, and urethral stricture due to scarring and narrowing of urethra caused by radiation. In the case of brachytherapy, the possible risks and side effects are bowel problems as rectal pain, burning, and/or diarrhea, urinary problems, and erection problems.
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