External Beam Radiation Therapy
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.
Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.
How Does External Beam Radiation Therapy Work
External beam radiation therapy, or EBRT, uses a machine to direct high-energy X-rays at the cancer in daily doses. The radiation beam is generated by a machine called a linear accelerator or LINAC. Using treatment planning computers and software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.
To minimize side effects, the treatments are typically given five days a week over a six-to-nine week period. The break in days allows the doctors to get enough radiation into the body to kill the cancer while giving healthy cells time to recover.
Watch our expert medical oncologist, Dr. Alicia Morgans from Vanderbilt-Ingram Cancer Center, discuss external beam radiation therapy:
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Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy causes similar side effects to external beam radiotherapy. If you have brachytherapy on its own, some side effects may be less severe. If you have it with external beam radiotherapy, they may be more severe.
Brachytherapy causes similar side effects to external beam radiotherapy. Having brachytherapy with external beam radiotherapy may make some side effects more severe. Some side effects may take several weeks to develop and may last for longer.
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Low Dose Rate Or Seed Brachytherapy
How it works
In this type of brachytherapy, small seeds of radioactive Iodine are placed into the prostate. Each seed is 5mm long and 1mm wide and 80 to 120 seeds would typically be used. These seeds deliver a high dose of radiation but do so over a long time . As they are placed within the prostate, this allows a high dose to be delivered directly to the tumour with minimal dose to the surrounding healthy organs, such as the rectum and bladder. Using this technique provides a very high chance of cure for suitable patients with reduced side effects.
Who is suitable?
This treatment is suitable for lower risk, localised prostate cancers. There are some requirements that the radiation oncologist will discuss.
What are the benefits and side effects?
The main advantage of brachytherapy is the reduced long-term toxicities. However, there is still a small risk of urethral scarring and long-term change in bladder habit. Like all other prostate cancer treatments, there is a chance that men can develop erectile dysfunction. However, it seems that this risk is lowest with seed brachytherapy. Approximately 30-40% of men will have some erectile problems after LDR brachytherapy.
One of the other big advantages of this treatment is convenience. It typically requires 2 3 visits to the hospital with up to 1 night in hospital.
What is the procedure for treatment?
Results of LDR brachytherapy
For more information about this technique watch the video.
Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy
Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
Coping With The Side Effects
The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someones life.
The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:
- Urinating every few hours
- Limiting caffeine intake
- Talking to your healthcare team about any medications or other interventions that may be helpful
Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:
- Having open communication with your partner
- Prioritizing activities for the day and taking breaks as needed
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Success Rates And Side Effects
Treatment success rates for prostate cancer brachytherapy have been excellent, especially for men diagnosed with an early stage of the disease, for which survival rates are generally comparable to those produced by prostate surgery. In addition, the new intraoperative computer-based conformal optimization approach, and the enhanced precision it allows, reduces the likelihood of both urinary and rectal side effects when compared to external beam radiation. Another benefit of treating prostate cancer with brachytherapy is that the time commitment required to perform it is dramatically less than that required for external beam radiation, which is usually delivered in about 50 sessions over the course of ten weeks.
We are one of a few institutions in the world using this particular intraoperative CT scanning device on a regular basis to help us to optimize the quality and accuracy of the seed implant procedure, Dr. Zelefsky notes. We think it may be appropriate for many forms of brachytherapy, and we are exploring the use of these procedures to treat a variety of other cancers.
Surgery Vs Radiation For Prostate Cancer: Uses Benefits Side Effects
Prostate cancer is the most common form of cancer other than skin cancer in people who have a prostate . Depending upon the stage of the cancer, different treatment options are available. These treatment options include:
This article will review how surgery and radiation are used to treat prostate cancer. Both can be very effective forms of treatment in men with the disease. Although they may have the same goals of therapy, there are differences between these treatments.
Be sure to see your healthcare provider for the diagnosis, so you can receive the best treatment for you.
The Good Brigade / Getty Images
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Radiation Therapy Has Most Side Effects
Prostate cancer is expected to be diagnosed in more than 240,000 men in the United States in 2012, according to the American Cancer Society.
Ciezki and colleagues analyzed data on 137,427 men from National Cancer Institute Medicare data collected between 1991 and 2007.
Of the total, 43% of men were treated with surgery , 44% with external beam radiation therapy, and about 13% with brachytherapy. Researchers looked only at side effects that required a procedure to correct them.
Over a six-year period, on average, 8.8% who had external beam radiation therapy, 6.9% of patients who underwent surgery, and 3.7% who had brachytherapy needed a procedure to fix a therapy-related effect.
A total of 7.1% of patients who received external beam radiation therapy experienced problems such as incontinence or bladder bleeding, compared with 6.7% of those treated with prostatectomy and 3.4% of those treated with brachytherapy.
And 1.7% of EBRT patients had gastrointestinal side effects such as rectal bleeding, compared with 0.1% of prostatectomy patients and 0.3% of brachytherapy patients.
Brachytherapy was the cheapest treatment: $2,557.36 per year. Prostatectomy was slightly more expensive, at $3,205.71, followed by EBRT at $6,412.29.
Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
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What Happens During The Procedure
The entire procedure takes approximately 90 minutes. Most patients go home the same day.
A radiation oncologist and urologist perform the procedure. Both physicians are actively involved in all aspects of the implantation, from the planning to the post-operative care. During the procedure, the urologist provides ultrasound guidance and the radiation oncologist places the radioactive seeds.
The procedure is performed as follows:
Diarrhea Flatulence Or Painful Defecation
These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.
Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.
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A Brief History Of Prostate Treatment From Surgery To Radiation
Surgery has been the standard of care for prostate cancer for the past 150 years. Although effective, radical prostatectomies are invasive and not without complications. But then, shortly after the discovery of X-rays and radium at the turn of the last century, physicians began to explore how these modalities might improve survival and decrease potential side effects from the radical surgery. In 1917, Dr. Benjamin Barringer, chief of urology at what is now known as Memorial Sloan Kettering Hospital, espoused the use of radium needles for prostate cancer.
Initially, radioactive seed implantation was performed via free-hand technique, using direct visualization of the prostate to guide the radiation oncologist with seed placement. However, the results of this preliminary approach were hampered by suspect dose distribution in the prostate.
In 1987, Dr. John Blasko from Seattle described a reproducible system to implant radioactive iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patients perineum . The template guides the placement of the needles that are loaded with radioactive seeds. This technique allows a reproducible, uniform dose distribution to the prostate.
At Princeton Radiation Oncology, our radiation oncologists have been performing the prostate seed procedure since 1997. We use the Seattle groups criteria for implant selection.
After The Implant Surgery
Most patients are discharged three to four hours after the implant procedure. Occasionally, a patient may need to be observed in the hospital until the next day. Your urologist will determine when you will be discharged from the hospital.
You will be given specific instructions about your implant. Keep these instructions so you can share them with your family members or with any doctors you see after your implant. The instructions will answer any questions you may have about radiation exposure to your family and friends after the implant. They are the same precautions that the radiation oncologist discussed with you.
There is little discomfort after the implant. Some patients do experience mild soreness when they sit. This soreness may last for one or two days after the implant. Sometimes, a patient will notice small spots of blood on his underwear after the procedure. This comes from the spot where the needles were inserted and should stop within 24 hours. Applying mild pressure with a clean cloth will stop the spotting. You may notice a small amount of blood in your urine. This is normal and should stop within one to two days after the implant. If the blood in your urine lasts more then two days, or if you see clots, call your urologist.
You should avoid heavy lifting or hard, physical activity for the first two days that you are home. After that time, you may return to your normal activity level.
Common side effects of prostate brachytherapy include:
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What Other Details About The Radioactive Seed Implant Procedure Are Important
Close, prolonged contact with young children should be limited to 20 minutes per hour for the first two months after the procedure. Its safe to sleep in the same bed if your partner/spouse is NOT pregnant. If your partner/spouse is pregnant, separate sleeping arrangements will be necessary for two months. If you have other questions, please call your radiation oncologist or urologist.
Last reviewed by a Cleveland Clinic medical professional on 11/30/2020.
References
Who Is A Candidate For Prostate Seed Implantation At Princeton Radiation Oncology
Prostate seed implantation is not for everyone. Treatment decisions are based on important prognostic factors:
An ideal candidate should have a PSA level less than 10 and a Gleason grade 6 or less, with non-palpable disease. The size of the prostate is also an important factor. As a general rule, patients with prostate glands greater than 60cc are at increased risk for pelvic arch obstruction and poor dose distribution. Several months of androgen deprivation can be used to shrink large prostates to allow an optimal seed implant.
Patients whove previously had a vigorous transrectal resection of the prostate for benign prostatic hypertrophy may not be ideal candidates for this implant procedure. Higher rates of urinary complications have been reported for this subset of patients.
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Online Support Groups For Prostate Cancer
- Us TOO. This organization has more than 200 support groups in the United States and abroad.
- Prostate Cancer Research Institute. This website allows you to search for support groups by state.
- Cancer Care. This site offers 15-week online support groups for people diagnosed with prostate cancer. Co-sponsored by the National Alliance of State Prostate Cancer Coalitions.
- Male Care. This organization offers online support groups for people with prostate cancer and their partners or caregivers.
- Imerman Angels. This support community offers one-on-one support with a mentor.
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, its no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Preparing For The Implant
Two or three weeks before your implant surgery, your urologists staff will call you to schedule you for routine blood work and a chest x-ray. It is important to have these done promptly, since your seeds have been ordered.
Be sure to tell your doctor if you take aspirin, aspirin products, or blood thinners, such as coumadin®. Your doctor will instruct you on when to stop taking these medications before your surgery.
Your urologists staff will give you instructions regarding what you may eat and/or drink the day before your implant surgery. You will also be given instructions on the use of a laxative and/or enema. A nurse from the Same Day Surgery Department will call you the afternoon before the day of your surgery. The nurse will go over your instructions and will tell you where to park and when and where to report. Please plan to have a friend or family member come to the hospital with you on the day of your surgery, because you will not be able to drive home.