Radiation for prostate cancer is a complex treatment option, however, and has risks and side effects as well as benefits.
Understanding what radiation for prostate cancer involves is essential for anyone wanting to make an informed decision about their treatment.
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How does radiation therapy work?
Using radiation for prostate cancer treatment involves exposing cancer cells to high doses of radiation.
Radiation works by disrupting the DNA in cancer cells so that they are unable to continue multiplying.
Cancer cells develop and divide much faster than healthy cells. Radiation treatment can disrupt the DNA in cancer cells, preventing them from multiplying. As well as stopping their spread, it can kill them completely.
Radiation can be used to "cure" the body of cancer, and this is known as a curative treatment. It may be used on its own or alongside other treatments.
If prostate cancer is too advanced to be removed completely, radiation therapy can be used to help control it.
It may also relieve some of the symptoms. This is known as palliative treatment.
Starting radiation for prostate cancer
As with most cancers, a team of experts will be assigned to a person with prostate cancer to help determine the best treatment.
With radiation for prostate cancer, this team may include a radiation oncologist and a radiation oncology nurse. Oncologists are cancer specialists.
Other medical professionals may include a dosimetrist, who will calculate the dose of radiation used, and a radiation therapist, who operates the radiation equipment.
All of these professionals will work together to recommend and plan radiation treatment for someone with prostate cancer.
Types of radiation therapy for prostate cancer
There are several types of radiation treatment available for prostate cancer. These are external beam radiation, internal radiation, and systematic radiation.
External beam radiation
In external beam radiation therapy, or EBRT, a large machine is used to direct X-ray beams onto the prostate gland from outside the body.
The radiation team will prepare for the radiation therapy by taking measurements and calculating the correct dosage of radiation to use. This may involve CT and MRI scans as part of imaging tests.
EBRT can last for several weeks. This is because the amount of radiation required to kill the cancer cells is usually too high to be given in one go. Instead, it is spread out over several sessions to avoid damaging healthy cells or increasing the risk of side effects.
To ensure that healthy cells are not subjected to lasting damage, a 2-day pause between each treatment is standard practice.
Internal radiation therapy is sometimes known as brachytherapy or IRT. This type of radiation for prostate cancer involves placing seed-sized radioactive pellets internally on the prostate. In some cases, a pellet may be larger because it contains a higher dose of radiation.
There are temporary and permanent variations of IRT. The temporary version of the radioactive pellets may only be inserted for a short time, varying from a few of minutes to a couple of days. The permanent pellets will need to be removed when they are no longer radioactive.
Before insertion of the radioactive pellet, an individual will be given either a general or local anesthetic.
As with EBRT, X-rays or MRI scans may be done as well. The medical team will use these to ensure accurate insertion of the radiation pellet.
Systematic radiation is administered orally or through a vein.
A third type of radiation used for prostate cancer is systematic radiation.
A liquid composed of radioactive substances is taken orally or given through a vein. The liquid will move around the body, through the blood, to the site of the cancer.
In some cases, it is possible that more than one type of radiation therapy will be recommended for different times during a person's treatment. If one type is unsuccessful, another may be tried.
Radiation therapy may sometimes be used alongside chemotherapy to tackle the cancer more effectively. The chemotherapy can make cancer cells more receptive to radiation, so achieving better results.
Radiation therapy vs. surgery
Surgery is also a treatment option for prostate cancer alongside radiation. Known as radical prostatectomy surgery, this treatment involves entirely removing the prostate itself, and in some cases the seminal vesicles. These are the tubes that secrete fluid that is part of the semen.
There are three distinct types of radical prostatectomy surgery:
- robotic assisted prostatectomy
- retropubic prostatectomy
- perineal prostatectomy
Whether or not surgery is recommended depends on different factors. A medical team will base their recommendation on the individual and the progress of their cancer.
If the cancer is only found in the prostate, surgery may be the best option. If it has spread beyond the prostate, surgery may not be effective enough to warrant the risk.
In some situations, both radiation therapy and surgery will be recommended. This is uncommon and is only chosen when combining treatments gives the most benefit.
There are other treatment options available besides surgery and radiation for prostate cancer. These include high-intensity focus ultrasound, or HIFU treatment, as well as hormone treatment, which may be recommended in cases of advanced prostate cancer.
Damage to healthy cells
One of the problems that radiation therapy poses is damage to normal, healthy cells.
The radiation cannot tell cancerous and healthy cells apart. This means that normal skin cells can be damaged during radiation for prostate cancer. However, cancer cells cannot repair themselves after exposure to radiation, but healthy cells can often repair themselves.
Radiation can be physically and mentally exhausting, so people having treatment are encouraged to join therapy groups.
Skin sensitivity at the site of the radiation is a frequent side effect. Lotions may be given by a doctor to treat this. Avoiding extreme temperature changes is usually advised, as well.
Radiation therapy for prostate cancer can be a physically draining process, as well as emotionally draining. People with cancer undergoing radiation treatment are often encouraged to seek counseling or join therapy groups.
Resting is also essential, to ensure that the body and mind can continue with treatment.
There is a limit to how much radiation the body can withstand without suffering long-term irreversible side effects.
In some cases when radiation therapy for prostate cancer has been tried before, it will not be recommended again to avoid exceeding this radiation limit.
With each type of radiation treatment for prostate cancer, a person is radioactive for a while afterward. Because of this, they may have to stay at the treatment center for a couple of days until the radiation wears off.
Different types of radiotherapy pose varying radiation risks. With EBRT, a person receiving it does not pose a risk to others. With IRT, however, there is a radiation risk to consider.
It is always suggested that a person speaks to their medical team about any side effects or risks before undergoing radiation therapy. The medical team can help to manage and reduce potential side effects, as well as explain risks clearly.
Radiation treatment for prostate cancer will only be recommended if doctors believe the benefits outweigh any risks and side effects.
Anyone with prostate cancer should speak to their doctor about the available treatment options, before deciding which to have.