Learn About Treatment Options for Prostate Cancer
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Prostate cancer is the most common malignancy in American men.
- Approximately 175,000 men will be diagnosed with prostate cancer this year.
- Nearly 31,000 men died from prostate cancer this year.
- More than 75 percent of prostate cancer is diagnosed in men over age 65.
After a diagnosis of prostate cancer has been established with a biopsy, the patient should be evaluated and discuss the different treatment options with a radiation oncologist and a urologist. Established treatment options to cure prostate cancer include:
- External beam radiotherapy
- Prostate brachytherapy (also sometimes called a seed implant)
- Radical prostatectomy (surgical removal of the prostate)
Whether one or all of these treatments are appropriate for you should be discussed with your doctors, as each approach has different advantages in terms of convenience, the need for a hospital stay, and the side effects that may come with each treatment.
Some men diagnosed with prostate cancer may also choose to pursue watchful waiting (close observation without any treatment), active surveillance or hormone therapy alone.
External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the prostate. There are two principal methods for delivering external beam radiation.
- 3-dimensional conformal radiotherapy (3D-CRT)combines multiple radiation treatment fields for precise delivery of radiation to the prostate. Each of the radiation beams is designed to accurately focus on the patient’s tumor while at the same time keeping radiation away from nearby organs such as the bladder, rectum or hips.
- Intensity modulated radiation therapy (IMRT)is an advanced version of 3D-CRT that modifies the intensity of the radiation within each beam. This technique allows more precise delivery of high doses of radiation to the tissues within the target area, potentially allowing an increased radiation dose to the prostate and reduced doses to nearby normal tissues.
Both types of external radiation treatments are acceptable approaches to treatment; IMRT offers advantages for some but not all prostate cancer patients. Radiation treatments usually last less than 5 minutes but your appointment time is 15-30 minutes each day, Monday through Friday, for four to nine weeks overall.
Higher doses to the prostate may translate into a greater chance for cure, while lower doses to surrounding organs may mean fewer side effects. However, each case is different and requires careful discussion about the pros and cons of higher doses of radiation therapy. Discuss with your doctor the correct length of external beam radiation therapy.
Potential side effects, including fatigue, increased frequency or discomfort of urination, and loose stools, typically resolve within a few weeks after completing treatments. Impotence is also a potential side effect of any treatment for prostate cancer. However, many patients who receive radiation therapy for prostate cancer are able to maintain sexual function. If you have any symptoms during treatment, talk to your doctor, as he or she may be able to provide medications or other treatments that may help.
Prostate brachytherapy, more commonly known as a seed implant, is usually done in the operating room. These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia.
Historically, prostate seed implants were planned before the procedure based on ultrasound or CT scans. At ROA, newer technologies allow more sophisticated real-time treatment planning of prostate seed implants, which are jointly performed by your radiation oncologist and urologist.
Radioactive iodine (I-125) seeds are most commonly used for permanent seed implants. The seeds are approximately four millimeters long and less than a millimeter in diameter. After the procedure is complete, the seeds remain in the prostate and release almost all of the radiation therapy over a period of several months. During that time, you may be advised to take certain simple precautions about radiation safety from a prostate seed implant.
In addition, newer techniques utilizing high-dose rate (HDR) brachytherapy are currently employed. Here, radioactive seeds are not placed permanently into the prostate. Rather, catheters are placed into the prostate and a radioactive seed is “loaded” into the catheters, delivering a localized radiation dose. When treatment is completed, the radioactive seed is removed as are the catheters and you go home without any radiation left within you.
The side effects from brachytherapy implants can be similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.
Certain patients may benefit from hormone therapy in addition to radiation. These medications interfere with prostate cancer cells’ ability to grow and divide by blocking testosterone production or action at their target prostate cells. In some patients, hormone therapy works with radiation therapy to improve cure rates. Because these medications can also have side effects, the decision to use them and the length of treatment are individualized to account for other important factors such as your medical history, quality of life and what other treatments are planned. When used with radiation treatment, this type of treatment usually lasts for at least a few months. Talk to you doctors to see if there is a role for using hormone therapy as part of your treatment.