As early as 1909, radium bromide was shown to relieve obstructive urinary symptoms, hematuria, urgency, and pain from advanced sarcoma.
Today, prostate cancer is the most commonly diagnosed noncutaneous malignancy in men.
Palliation may be necessary for symptomatic metastatic disease to the lymph nodes or bone or, less commonly, for local symptoms such as mechanical obstruction of the bladder or rectum, hematuria, and pain.
Radiation continues to be a mainstay in alleviating these symptoms, given its effectiveness, non-invasive nature, and relative ease of administration.
Radiation therapy is a form of treatment used to treat prostate cancer. It can be used alone or in conjunction with surgery.
Radiation therapy involves the use of radiation directed at the cancer site to kill cancer cells. Treatment is meticulously planned to minimize damage to normal cells.
Treatment is generally carried out as an outpatient procedure and lasts for several weeks (depending on the nature of the tumor). There are different forms of radiation therapy to the prostate available.
Radiation therapy fights cancer by using high-energy radiation to kill rapidly multiplying cancer cells. It stops cancer cells from multiplying and stops cancer growth.
It is a commonly recommended form of treatment, as it is less invasive and does not carry as many risks as surgery.
Types of radiation therapy
There is a wide range of forms of radiation therapy in the treatment of prostate cancer.
External beam radiation therapy
As the name implies, a beam of radiation generated by an external source is aimed at the lower abdomen.
Typically, this is an outpatient procedure, and the most common pattern is 20 to 30 minutes of treatment, 5 days a week for 6 to 7 weeks.
External Beam Therapy is divided into Standard External Beam Therapy and 3D Conformal Therapy.
The latter uses rays that adapt to the contour of the prostate. And computer images are used to focus the rays precisely.
This newer form of radiation therapy allows more precise targeting of the cancer and therefore carries a lower risk of side effects.
Image guidance from the body and computer-controlled robotics are used to apply about 1,200 high-energy radiation beams to the tumor with great precision.
The goal is to attack the tumor with radiation strong enough to kill cancer cells and leave surrounding healthy tissue intact.
About 3 months before radiation therapy, hormone therapy will usually be given.
This shrinks the prostate tumor, making the radiation more likely to kill cancer cells, which are now concentrated in a smaller area.
It should be taken into account that these hormones can affect the sexual life of the patient.
Possible side effects and risks
The main side effects of radiation therapy are bladder irritation and the need to urinate more often. These effects are usually mild, although a very small proportion of patients will be severely affected.
You may also feel irritation or discomfort in and around the rectum, and notice some diarrhea and bleeding, these effects are usually temporary, last only a few weeks, but can persist for longer in some men.
Recently, it was reported that men who underwent pelvic irradiation for prostate cancer have a slightly increased risk of developing rectal cancer , so you should see your doctor if you have posterior duct bleeding for some time after treatment.
A proportion of patients who have had radiation therapy to the prostate will develop problems with erections.
This problem tends to develop gradually over 6 to 12 months, but can usually be overcome with the use of treatments such as Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) or prostaglandin injections .
In this type of therapy, radioactive granules are implanted into the prostate, so the radiation is emitted from the inside rather than from an external source (as is the case with external beam radiation therapy).
The pellets are left inside the patient where they gradually lose their radioactivity over the next 12 months.
Brachytherapy is a form of radiation therapy used in more localized prostate cancer, that is, cancer that is more confined to the prostate itself.
This procedure allows radiation to be delivered at a higher dose in a more concentrated way.
Brachytherapy is a fairly short procedure. Typically, patients are required to stay in the hospital for only one night.
In this type of brachytherapy, thin, rigid plastic tubes are inserted through the perineum (the area of skin behind the scrotum) and into the prostate.
This is done under anesthesia. A radiation therapy machine inserts a radioactive wire through each plastic tube and into the prostate.
These cables are left in place for a few minutes and then removed. Patients stay in the hospital overnight.
The next day, the procedure for inserting and removing the radioactive cables is repeated. The procedure takes about half an hour. Before implanting the granules, the radiation therapist will need to evaluate the prostate.
To do this, an ultrasound probe will be inserted into the rectum so that an ultrasound can be viewed on a computer screen.
The granules that are placed in the prostate, are generally between 60 and 100, radioactive seeds.
In this procedure of seeding the radioactive seeds that are implanted in the prostate, they destroy the cancer cells and the levels of the prostate specific antigen gradually diminish, but generally they are not as low a value as after the surgery.
Brachytherapy is best suited for patients with smaller, lower-risk cancers and for men who have small or medium-sized prostates.
If a transurethral resection of the prostate has previously been performed, to treat benign prostatic hyperplasia, the radioactive seeds may not be properly located in the gland.
Pretreatment with drugs that shrink the prostate, such as luteinizing hormone-releasing hormone analogs, can sometimes make brachytherapy suitable for men with especially large glands.
Brachytherapy is not appropriate for men whose cancer has spread beyond the prostate.
Possible side effects and risks
Up to 10 years after treatment, the results appear to be good in terms of maintaining low prostate-specific antigen and local control of the cancer.
Because radiation targets the prostate so precisely, urinary problems and rectal damage are probably less common after brachytherapy than after external beam radiation therapy.
One problem with brachytherapy is that it is difficult to treat recurrent cancer after this treatment, as surgery in this situation is risky.
Advantages of prostate radiation therapy
The option of radiation therapy as a treatment for prostate cancer has the following advantages:
- It does not carry the risks of surgery, therefore it is useful in patients who cannot undergo surgery.
- It does not require a long hospital stay. Patients receiving external beam radiation do not even have to stay in the hospital, it is done as an outpatient procedure.
- Patients can return to normal life fairly soon, usually within a few days.
Disadvantages of prostate radiation therapy
- Tiredness, diarrhea, and cystitis (inflammation of the bladder that causes a burning sensation when urinating) are common short-term side effects.
- Damage to surrounding structures, such as the bladder or large intestine, sometimes occurs, but this is rare as precautions are taken to minimize damage to structures other than cancer cells.
- A small proportion of men, less than 5%, will have long-term bowel problems, bowel movements may become looser and more frequent. However, in most men these symptoms set in gradually.
- Patients receiving external beam therapy require frequent visits to the hospital radiotherapy unit as an outpatient for up to 6 weeks.
- There is a risk of impotence (inability to achieve and maintain an erection) and urinary incontinence (leakage of urine).
- The skin in the area where the treatment is directed may hurt.