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External beam radiation therapy (also called radiotherapy) involves a series of treatments to accurately deliver radiation to the prostate.
Before treatment begins, optional procedures may be done to minimize side effects, such as placing a spacer between the prostate and rectum, and to improve treatment accuracy, such as placing marker seeds (not radioactive) in the prostate. Your radiation oncologist will then develop a treatment plan using information from your biopsy, imaging and physical exam. A CT scan, also known as a planning 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. This is often called a pre-treatment mapping or simulation. Sometimes you will be asked to have a comfortably full bladder and empty rectum to minimize side effects. Your treatment plan will include the prostate, but may also include 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 the planning scan, the prostate and normal tissues are identified to help create a treatment plan. These treatment plans focus radiation beams on the prostate while limiting radiation to healthy tissues around it, such as the bladder and rectum. Intensity modulated radiation therapy (IMRT) and imaging guided radiation therapy (IGRT) are treatment approaches that allow the radiation beams to treat the cancer and lessen the risks of side effects.
External beam radiation therapy can be delivered using a variety of techniques. With all external beam therapy, treatment is delivered in a series of daily sessions, Monday through Friday, for several weeks. Each treatment is non-invasive, painless and similar to a long X-ray; you hear noise but will feel nothing at the time of treatment.
Hypofractionated radiation is a form of external beam treatment giving slightly higher doses over four to six weeks compared to a more standard treatment time of seven to nine weeks. Studies have shown similar results compared to standard treatment times. Stereotactic body radiation therapy (SBRT, also known as stereotactic ablative radiotherapy (SABR)) is a technique using high-dose and high-precision treatment setup and imaging for the treatment of cancer. This is typically done in five or fewer treatments.
SBRT is currently being evaluated for long-term side effects and may be considered for certain patients.
In most cases, external radiation is in the form of high-energy photons, or X-rays. In a few clinics around the country, proton beam therapy is used to treat prostate cancer. Proton therapy is a form of external beam radiation therapy that uses protons rather than photons to treat cancer cells. Protons may be considered for certain patients. Protons compared to photons in treating prostate cancer patients continues to be studied.
The length of your treatment will depend on your health and the type of radiation used.
Brachytherapy involves treating the cancer by inserting radioactive sources directly into the prostate. Brachytherapy may be used to treat prostate cancer alone or may be combined with external beam radiation therapy and hormonal therapy.
For the short time that the seeds are giving off larger amounts of radiation, men should avoid being in close proximity to children or pregnant women. Ask your radiation oncologist or oncology nurse for instructions about radiation safety and exposure for family members and pets.
Ask your doctor if brachytherapy is a treatment option for you.
Depending on your cancer, you may benefit from adding hormone therapy to your radiation treatment. Hormone therapy lowers testosterone production. Testosterone is a hormone that plays an important role in prostate cancer growth. Hormone therapy scheduling may vary. It can be used together with radiation therapy and/or after radiation therapy has been completed. Hormone therapy may be given by your radiation oncologist, medical oncologist or urologist.
The length of time you will receive hormone therapy can be months to years depending on your overall health, quality of life goals, cancer stage and the type of radiation used. Ask your doctor for more information.
If you are diagnosed with prostate cancer, you should discuss treatments and quality-of-life issues with your cancer care team.
Your team should include a urologist and a radiation oncologist. You can also get helpful advice from a medical oncologist.
Common treatments are surgery and radiation. However, there is another approach to learn about. It’s called “active surveillance” or “watchful waiting.” It’s for men with low-risk prostate cancer.
In active surveillance, your team watches your condition closely. If tests show that it’s getting worse, you will get treatment. Discuss active surveillance with your team.
Radiopharmaceutical therapy – a radiation oncologist or nuclear medicine physician prescribes a radioactive drug delivered into the veins to help kill prostate cancer cells.
Surgery - a urologist surgically removes the entire prostate.
Chemotherapy - a medical oncologist prescribes medication as a pill or medicine delivered through the veins to kill cancer cells.
Sometimes a combination of treatments is best to treat your cancer, such as hormonal therapy along with external beam radiation therapy or brachytherapy combined with external beam radiation therapy.
Ask your doctor about the risks and benefits of all treatment options including active surveillance.
