Radiation Treatment for Prostate Cancer: Pros and Cons to Be Aware Of

The Pros and Cons for Radiation Treatment for Prostate Cancer

With a 94% cure rate, radiation therapy for prostate cancer is the best treatment when the cancer has begun to move beyond the prostate, or into the lymph nodes.  Your doctor may have recommended radiation because surgery is too risky or because you already have physical issues that preclude you from surgery.

After surgery, radiation is the most common treatment for prostate cancer.  If the disease is advanced, radiation treatment for prostate cancer can reduce the tumor’s size and provide relief from the cancer’s symptoms, as well as prevent symptoms in the future.

Radiation is also the treatment of choice for early-stage prostate cancer.  It is highly effective when the cancer is still contained inside the prostate gland or has only metastasized to nearby tissue.

Brief History of Radiation Treatment for Prostate Cancer

Radiation therapy for prostate cancer has been around since the turn of the 20th century.  Alexander Graham Bell, one of the first to propose radiation as a treatment for cancer, had said, “There is no reason why a tiny fragment of radium sealed in a fine glass tube should not be inserted into the very heart of the cancer, thus acting directly upon the diseased material.”   While the use of external radiation to treat for prostate cancer has been around for almost a hundred years, it did not become a widespread therapy until the 1960’s.  Earlier attempts were successful in killing prostate cancer, but they tended to kill the patient as well.  By the 1980’s, advancements in technology had made the delivery of radiation not only easier and quicker but more focused and more efficient.

The Objective of Radiation Therapy for Prostate Cancer

Radiation treatment for prostate cancer is often preferred, because it does minimal harm to normal tissue.  With recent advances in the planning and delivery of radiation, the effects are even fewer.  Radiation therapy uses high-energy rays or particles to kill the malignant cells, which are not as efficient at repairing radiation injury as normal cells.  It disrupts the deoxyribonucleic acid (DNA) of cancer cells, which grow more rapidly than do normal cells.  While both normal and cancer cells are damaged, the malignant cells are damaged more severely.  Unlike with cancer cells, your body can replenish your normal cells through its usual process of cell growth and replacement.

With recent advances in the planning and delivery of radiation treatment for prostate cancer, the effects of radiation on normal cells are even fewer. With the information from your CT scans, your individual anatomy, and understanding of the particular kind of prostate, physicians can now custom-design a very precise radiation treatment so there is minimal damage to normal tissues.

What are the Pros and Cons to Radiation Treatment for Prostate Cancer?

Advantages

Disadvantages

  • Radiation therapy for prostate cancer is a suitable treatment for most men and the outcomes are relatively predictable.
  • Radiation therapy requires no surgery, meaning no risk for anesthesia and no recovery time from a major operation.
  • The treatment can be performed on an outpatient basis.
  • Most men who receive external beam radiation are able to continue working during the course of their treatment.
  • Men who undergo brachytherapy for prostate cancer (implantation of radioactive seeds) can often go back to work after a few days of recovery and return to most of their normal, daily activities in a week.
  • Treatment program can be prolonged; external beam radiation requires daily treatments for 6-8 weeks.
  • Some men feel fatigue when treatment ends.
  • Men often experience erectile dysfunction.
  • Other prostate cancer radiation side effects include urinary frequency & urgency and rectal bleeding.
  • There is a possibility of tumor regrowth.
  • Failures cannot be treated with surgery.

Candidates for Radiation Therapy for Prostate Cancer

While it is true that candidates for radiation therapy are often men who cannot have surgery for medical reasons, some men opt for radiation therapy simply because they do not wish to subject their bodies to major surgery with its own set of risks and extended recovery. Radiation treatment for prostate cancer is also the wiser choice for older men whose life expectancy is less than 15 years, and is increasingly being used after the prostate has been removed.  Following surgery, if discovered that not all the disease was removed, radiation therapy for prostate cancer has been found to be an effective treatment

Are You a Good Candidate for Radiation Therapy?

Likely Candidate

Unlikely Candidate

  • Men with less severe forms of prostate cancer.
  • Men whose tumor is not palpable (stageT1c), or palpable but occupying less than half of one lobe (stage T2a), and PSA that is less than 10, and Gleason score is 6 or less.
  • For Gleason scores of 7 or more, seed therapy used together with beam therapy is recommended.
  • For beam therapy, men with the lowest percentages of cancer-positive cores (1/3 or less) on biopsy.
  • Men who are in fairly good health and who expect to live at least 10-15 years.
  • Men whose prostate is bigger than 20cc’s and smaller than 60 cc’s.
  • Those with large prostrates (over 50-60 grams,) because large prostate require more seeds and increase the treatment’s side effects. In some cases, large prostates can be reduced first with hormone treatments.
  • Men with diseases of the urinary tract or disease of the colon, like ulcerative colitis, because radiation can exacerbate such diseases.

The Types of Radiation Treatment for Prostate Cancer

The two major approaches to radiation therapy for prostate cancer.   They are brachytherapy for prostate cancer, also known as interstitial radiotherapy, which involves implanting radioactive seeds directly into the tumor, and external beam radiation for prostate cancer (EBRT), also known as teleradiotherapy, which sends radiation into the tumor from the outside.

Brachytherapy for Prostate Cancer External Beam Radiation for Prostate Cancer
Treatment Time 1-2 days 7 weeks
Anesthesia Yes No
Pain No Not Usually
Fatigue Yes No
Incontinence Infrequent Infrequent
Bleeding Infrequent Possible, Delayed
Impotence 25% 25%-50%
Bladder/Rectal Irritation 10%-15%
Severe Reaction (Bleeding, Fistula, Pain) 1% 1%

External beam radiation for prostate cancer is as effective as radical prostatectomy for the first 7 to 10 years after treatment, while brachytherapy for prostate cancer has proven effective the first 5 to 10 years after treatment.  Their effectiveness in the long term is still being determined.   Many doctors now combine the two methods for maximum benefits.

Major surgery and its complications can be avoided by using radiation therapy for prostate cancer. Radiation treatment when your prostate cancer is still in its early stages may help extend your life.  And with continuing technological advances, such as the development of proton beam therapy for prostate cancer, radiation treatment for prostate cancer now reduces the chance of you having adverse effects and increases your chances of success.

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2 Responses to Radiation Treatment for Prostate Cancer: Pros and Cons to Be Aware Of

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