Prostate cancer is the most common cancer in American men. The American Cancer Society estimates that one in every six men will develop prostate cancer in his lifetime. Prostate cancer is very manageable and often curable. More than 99 percent of men with prostate cancer will live more than five years after diagnosis.
Because surgery and radiation can both be equally effective curative treatments for prostate cancer, it is important to review all of your treatment options. Ask your urologist about surgery and your radiation oncologist about radiation therapy. Learn about the risks and benefits of both to see what best meets your goals balancing cure and quality of life.
If you find out you have cancer, you should discuss your treatment options with a radiation oncologist - a cancer doctor who specializes in treating disease with radiation therapy, a urologist - a surgeon who specializes in the genital and urinary systems, and a medical oncologist - a cancer doctor who specializes in treating cancer with chemotherapy.
Prostate cancer treatment options include:
External beam radiation therapy– a radiation oncologist directs high-energy radiation to kill the cancer cells.
Brachytherapy – a radiation oncologist surgically implants high-energy radiation seeds or delivers a high-energy radiation source through catheters within the prostate.
Surgery – a urologist surgically removes the entire prostate.
Active Surveillance – a physician monitors men with low-risk prostate cancer with repeat PSAs and biopsies
Hormone therapy – radiation oncologists, urologists or medical oncologists prescribe medicine to stop the production of hormones that help prostate cancer grow.
Chemotherapy – a medical oncologist prescribes medication orally (a pill) or medicine delivered intravenously (through the veins) to kill cancer cells.
Cryosurgery – a urologist or interventional radiologist freezes the tumor within the prostate.
High Frequency Ultrasound (HIFU) – a urologist or interventional radiologist uses high-intensity focused ultrasound beam energy to locally heat and destroy prostate tissue.
Sometimes a combination of treatments is best for your cancer, such as hormonal therapy along with external beam radiation therapy.
Ask your doctors about the risks and benefits of all treatment options including active surveillance.
External beam radiation therapy (also called radiotherapy) involves a series of daily treatments to accurately deliver radiation to the prostate. Research has shown that higher doses of radiation can improve cure rates. Modern radiation therapy is as effective as surgery to cure prostate cancer.
Before treatment begins your radiation oncologist will develop a treatment plan using information from your biopsy, imaging and physical exam. A CT 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 simulation. Sometimes your treatment plan will include not only the prostate, but 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 CT scans, 3-D targets of the prostate and normal tissues are created. 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 image 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. In most cases, external radiation is in the form of high-energy photons, or X-rays. In a few clinics in 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.
With all external beam therapy, treatment is delivered in a series of daily sessions, Monday through Friday, for several weeks. Each treatment is painless and similar to a long X-ray: you hear noise but will feel nothing.
The length of your treatment will depend on your health and the type of radiation used. The use of even shorter schedules of external beam radiation therapy is being studied for patients with early-stage prostate cancer.
Hypofractionated radiation is a form of daily treatment giving higher doses over four to six weeks compared to a more standard treatment time of seven to nine weeks. Stereotactic body radiation therapy (SBRT) is a technique for treating cancers in five or fewer treatments at substantially higher doses. Hypofractionated and stereotactic radiation are currently being evaluated for long-term data and may be considered for certain patients.
The CyberKnife System offers non-invasive radiation therapy treatments for prostate cancer. With the CyberKnife System, we can treat prostate tumors with pinpoint accuracy in just one treatment per day, for five days or less. Unlike conventional radiation therapy, the CyberKnife System leverages advanced robotics to precisely target tumors with high doses of radiation, minimizing damage to surrounding healthy tissue and minimizing side effects. The physicians of Peninsula Radiation Oncology Center have access to the Alaska CyberKnife Center at Providence Cancer Center in Anchorage. Ask your physician if the CyberKnife System is right for you.
Brachytherapy involves treating the cancer internally. Minimally invasive, permanent brachytherapy requires anesthesia and is done as an outpatient surgical procedure. (Outpatient surgery means you can go home the same day as the implant.)
- Permanent seed, or low-dose-rate (LDR) brachytherapy, consists of inserting small metal "seeds" directly into the prostate gland. This treatment is done as an outpatient surgical procedure and requires anesthesia. The seeds are temporarily radioactive and deliver the radiation to the prostate over several months. After losing their radioactivity, the seeds remain in the prostate. The seeds are then harmless and should not bother you.
For the short time that the seeds are giving off larger amounts of radiation, you 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 or pets.
- Temporary, or high-dose-rate (HDR) brachytherapy, delivers radiation to the prostate with a few treatments using a single small radioactive source travelling through each of the narrow tubes called catheters. These catheters are inserted into the prostate by your radiation oncologist. You will be under anesthesia and will not feel any pain. The tubes remain in place for only one or two days.
Once the treatment is complete, the tubes are taken out. HDR brachytherapy is temporary and there is no radioactivity left in your body. You will not need to take special precautions around others after treatment. Often multiple treatments are planned to give an effective dose to treat the cancer.
Brachytherapy may be used to treat prostate cancer alone or may be combined with external beam radiation therapy and hormonal therapy. Ask your doctor whether LDR or HDR brachytherapy is a reasonable treatment option for you.
Depending on your cancer, you may benefit from adding hormone therapy to radiation. Hormone therapy lowers testosterone production. Testosterone is a hormone that plays an important role in prostate cancer progression. It may be used together with radiation therapy, before radiation to shrink the tumor and also after radiation has been completed. Hormone therapy may be given by your radiation oncologist, medical oncologist or urologist. Side effects of hormone therapy may include hot flashes, mild breast tenderness, diarrhea, nausea and tiredness. The length of time you will receive hormone therapy depends on your cancer. Ask your doctor for more information.
External beam radiation therapy is noninvasive, so it is rare for side effects to show up immediately. With brachytherapy, there may be some swelling, soreness and frequent urination just after the procedure. However, these side effects are from the brachytherapy procedure rather than the radiation itself.
Some side effects can be controlled with medications and changes to your diet. Ask your doctor or nurse whether you should make any changes in your diet. Tell them if you experience any discomfort so they can help you feel better.
Cancer treatment can be difficult. You have many issues to cope with. Your oncology team, along with family and friends, are available to help.
- Get plenty of rest during treatment, and don’t be afraid to ask for help.
- Follow your doctor’s orders. Ask if you are unsure about anything. There are no stupid questions.
- Tell your doctor about any medications, vitamins or supplements you are taking to make sure they are safe to use during radiation therapy.
- Eat a balanced diet.