FACTS ABOUT PROSTATE CANCER
Prostate cancer is the most common cancer in men. Prostate cancer is very manageable and often curable. More than 98 percent of men with prostate cancer will live more than five years after diagnosis.
TREATING PROSTATE CANCER
If you find out you have cancer, you should discuss your treatment options with a radiation oncologist, a cancer doctor who specializes in treating disease with radiation therapy, and a urologist, a surgeon who specializes in the genitourinary system. Prostate cancer treatment options include:
Surgery – An urologist surgically removes the entire prostate.
External beam radiation therapy – a radiation oncologist directs high energy radiation to noninvasively kill the cancer cells.
Brachytherapy – A radiation oncologist surgically implants high energy radiation seeds within the prostate.
Hormone therapy – a doctor prescribes medication to stop the production of hormones that help prostate cancer grow. The prescribing doctor may be an urologist, radiation oncologist or medical oncologist.
Chemotherapy – a medical oncologist prescribes medication to kill cancer cells.
Cryosurgery – doctor, usually an urologist or interventional radiologist, freezes the tumour within the prostate.
Sometimes a combination of treatments is best for your cancer, such as surgery followed by external beam radiation. Some men can safely postpone treatment and watch their cancer closely until treatment is needed. Often called active surveillance, this approach allows men with low-risk prostate cancer to avoid the potential side effects of treatment or to delay them if treatment becomes necessary. Ask your doctors about the risks and benefits of all treatment options compared to active surveillance.
EXTERNAL BEAM RADIATION THERAPY
External beam radiation therapy (also called
radiotherapy) involves a series of daily treatments
to accurately deliver radiation to the prostate.
Recently completed research trials have shown that
higher doses of radiation can improve cure rates.
With modern techniques, radiation therapy is as
effective as surgery to cure prostate cancer.
Before treatment begins, your treatment plan will be
designed. A CT scan is done in the position you will
be treated, often with a supportive device to keep
you comfortably in the same position for treatment.
Using information from your pathology, imaging and
exam, your doctor and planning radiation therapist
will design a treatment plan to treat the prostate
gland. Sometimes, this will also include treatment
of the seminal vesicles (glands on the back of the
prostate) and lymph nodes. Ask your doctor to
explain what treatment area is appropriate for you.
With CT scans, three dimensional plans (called
3D-CRT) can be created to fit the shape of the
treatment areas. These treatment plans focus
radiation beams on the prostate while limiting
radiation to healthy tissues around it. As higher
radiation doses have been used to improve cure
rates, more sophisticated forms of 3D-CRT, intensity
modulated radiation therapy (IMRT) and imaging
guided radiation therapy (IGRT), have been used.
These treatment approaches allow the radiation
beams to treat the cancer and lessen the risks of
External beam radiation therapy can be delivered
using a variety of conformal techniques such as
intensity modulated radiation therapy (IMRT).
With all external beam therapy, treatment is
delivered in a series of daily sessions, each about
15 minutes long, Monday through Friday, for several
weeks. Each treatment is painless, non-invasive, and
similar to a long X-ray: you hear noise but will feel
nothing. Each day, you will feel the same when you
leave as you did when you came.
The duration of your treatment will depend on your
health and the type of radiation plan used.
The use of even shorter schedules of external beam
radiation therapy is being studied for patients with
early stage prostate cancer. Hypofractionated
radiation is a form of daily treatment giving higher
doses over four to six weeks compared to more
standard seven to nine weeks of treatment.
Stereotactic body radiation therapy (SBRT)
is a technique for treating cancers in five or
fewer treatments at substantially higher doses
each treatment. Neither hypofractionated nor
stereotactic radiation is yet considered a standard
treatment option for prostate cancer. It is the subject
of ongoing investigations.
Brachytherapy (meaning “close treatment” in Greek)
involves treating the cancer by inserting radioactive
sources directly into the gland. Minimally invasive,
permanent brachytherapy requires anaesthesia
and is done as an outpatient surgical procedure.
(Outpatient surgery means you can go home the
same day as the implant.)
- Permanent seed brachytherapy consists of
inserting small metal seeds of radioactive
metal “seeds” directly into the prostate gland.
Sometimes, it is called a prostate seed implant or
low-dose-rate (LDR) brachytherapy. The seeds,
typically iodine or palladium, are temporarily
radioactive and deliver the radiation to the
prostate over several months. After losing their
radioactivity, the seeds remain in the prostate.
The seeds are then harmless and should not
bother you. For the short time that the seeds are
giving off radiation, men are asked not to be in
close proximity to children or pregnant women
because of the very small chance that the
radiation may harm the children or foetuses. Ask
your radiation oncologist for specific instructions
about radiation safety and exposure for pets or
- Temporary high-dose-rate (HDR) brachytherapy
delivers radiation to the prostate with a few
treatments using a single small radioactive source
given through narrow tubes called catheters
inserted into the prostate by your radiation
oncol-ogist. You will be under anaesthesia and
will not feel any pain. The tubes remain in place
for only one or two days. Once the treatment is
complete, the tubes and the radioactive source
are taken out. Because HDR brachytherapy
is temporary and there is no radioactivity in
your body, you will not need to take special
precautions around others after treatment.
Often multiple treatments are planned to give
an effective dose to treat prostate cancer.
Brachytherapy may treat prostate cancer alone or
may be combined with external beam radiation
therapy. Ask your doctor whether either approach
is a reasonable treatment option for you.
Depending on your cancer, you may benefit from
adding hormone therapy to radiation. HorPROSmone
therapy decreases testosterone production,
which plays an important role in prostate cancer
progression. It may be used together with radiation
therapy or before radiation to shrink the tumour.
Hormone therapy may be given by your radiation
oncologist, medical oncologist or urologist.
Side effects of hormone therapy may include hot
flashes, mild breast tenderness, diarrhoea, nausea
and tiredness. The length of time you will receive
hormone therapy depends on your cancer. Ask your
doctor for more information.
POSSIBLE SIDE EFFECTS OF RADIATION FOR PROSTATE CANCER
External beam radiation therapy is non-invasive, so it
is rare for side effects to show up immediately. With
brachytherapy, there may be some swelling, soreness
and frequent urination just after the procedure.
However, these side effects are from the
brachytherapy procedure rather than the radiation
Over a period of weeks, radiation therapy may have
other side effects develop:
Urinary frequency, urgency or a weaker stream
are reasonably common side effects, sometimes
with some mild discomfort. The symptoms tend
to be more noticeable with brachytherapy. You
doctor can prescribe medication to help relieve
Changes in bowel habits are also common,
usually some urgency or loose bowel movements.
In some cases, you may have some diarrhoea,
increased gas or some mucus. Less commonly,
some men have a flare of haemorrhoids. These
side effects are temporary, with long-term
symptoms less likely.
Mild fatigue may develop, starting in the middle
of treatment. However, tiredness from radiation
should improve within a few weeks after
radiation treatment ends.
Mild skin irritation can occur occasionally with
external beam radiation.
Impotence is a common side effect of any
treatment for prostate cancer. The risk depends
partly upon the ability to have an erection before
treatment. Many men treated with radiation
can maintain erectile function. Don’t be shy
about talking to your doctor about your sex life.
He or she may be able to suggest remedies or
Infertility can often occur after radiation. If you
wish to consider having children after radiation
treatment, ask your doctor about sperm banking
Very rare long-term potential side effects include hip
injury, oedema (swelling) or a second tumour from
the radiation treatment.
Some side effects can be controlled with medications
and changes to your diet. Ask your doctor or
radiation therapist whether you should make any
changes in your diet. Tell them if you experience any
discomfort so they can help you feel better.
CARING FOR YOURSELF
Get plenty of rest during treatment, and don’t
be afraid to ask for help.
Follow your doctor’s orders. Ask if you are unsure
about anything. There are no stupid questions.
Tell your doctor about any medications or
vitamins you are taking to make sure they are
safe to use during radiation therapy.
- Eat a balanced diet.
Treat the skin exposed to radiation with special
care. Avoid hot or cold packs, only use lotions
and ointments after checking with your doctor
or radiation therapist
Clean the area with warm water and mild soap
(Dove) or Aqueous cream.
Cancer treatment can be difficult. You have many
issues to cope with. Your oncology team along with
family and friends are available to help.