Radiation Therapy for Prostate Cancer: Which Type Is Best?
If you’ve been diagnosed with prostate cancer, you can expect to live a long and full life. Treatment for prostate cancer has improved dramatically in recent years, and radiation therapy is one of the most important advances.
There’s no single “best” radiation treatment for prostate cancer. The treatment that’s right for you will depend on the stage and size of your tumor, your Gleason score, your general health, and your personal preferences.
This article will discuss the types of radiation therapy available for prostate cancer, along with their pros and cons. This information should help you have a productive conversation with your healthcare team about the best path forward.
Types of Radiation Therapy for Prostate Cancer
When it comes to prostate cancer, radiation therapy isn’t a one-size-fits-all deal. There are several different types, each with its own way of attacking those cancer cells. Let’s break down some of the most common approaches:
External Beam Radiation Therapy (EBRT)
EBRT is probably what most people think of when they hear “radiation.” It’s where the radiation comes from a machine outside your body. Traditional EBRT usually means going in for treatments multiple times a week for a few weeks – we’re talking maybe 45 to 48 sessions. They use machines called linear accelerators (LINACS) to zap the prostate with high-energy X-rays.
But things have gotten more sophisticated. Now, there are fancier EBRT techniques like Intensity-Modulated Radiation Therapy (IMRT) and proton beam therapy. IMRT is cool because it tweaks the intensity of the radiation to really target the prostate while trying to avoid hitting healthy tissue around it. Proton beam therapy uses protons instead of X-rays. The cool thing about protons is that they dump most of their energy at a specific depth, which might mean fewer side effects.
Stereotactic Body Radiation Therapy (SBRT)
SBRT is like EBRT’s souped-up cousin. It delivers really high doses of radiation, but in fewer sessions. You might also hear it called Stereotactic Ablative Radiotherapy (SABR). Instead of weeks of treatment, SBRT might only take about 5 sessions. And some studies are showing it’s safe and effective for certain guys.
For example, MSK Precise™ is a type of SBRT that spreads out the radiation over slightly longer times, and the early results have been really promising. The aim is to be super precise and cut down on side effects.
Brachytherapy
Brachytherapy is different because instead of shooting radiation from outside, they put radioactive “seeds” right inside your prostate gland. These seeds are tiny – less than half a centimeter thick and about 4.5 millimeters long.
There are two main types of brachytherapy: low-dose rate (LDR) and high-dose rate (HDR). LDR means they permanently implant the seeds and let them slowly release radiation over time. HDR involves temporary implants where they stick the seeds in, give a higher dose of radiation, and then take them out.
Image-Guided Radiation Therapy (IGRT)
IGRT isn’t really a type of radiation therapy, but more of an add-on. It uses imaging like CT scans, MRI scans, or even ultrasound to make sure they’re hitting the right spot every time. Your prostate can shift around a bit from day to day, so IGRT helps them adjust the radiation plan based on where your prostate is that day.
Factors Influencing Treatment Choice: Personalizing the Approach
Choosing the “best” radiation treatment for prostate cancer isn’t a one-size-fits-all decision. Several factors come into play, and the ideal approach is highly personalized.
Disease Stage and Risk Stratification
The stage of your prostate cancer significantly impacts treatment options. Early-stage prostate cancer might be effectively managed with various radiation techniques. In some very low-risk cases, active surveillance (closely monitoring the cancer without immediate treatment) may even be considered.
For intermediate- or high-risk prostate cancer, doctors may recommend a combination of therapies. For example, brachytherapy (internal radiation) might be combined with external beam radiation to achieve the best possible outcome.
Patient Characteristics and Preferences
Your age, overall health, and lifestyle are all important considerations. A younger, healthier patient may be able to tolerate more aggressive treatment, while an older patient with other health conditions might benefit from a less intensive approach.
It’s essential to openly discuss any quality-of-life concerns with your doctor. Consider the potential side effects of each treatment option and how they might impact your daily life, including sexual function, urinary control, and bowel habits.
The Importance of a Multidisciplinary Team
Seeking input from a multidisciplinary team of specialists is crucial for making informed decisions. This team should include a urologist (a doctor specializing in the urinary tract and male reproductive system), a radiation oncologist (a doctor specializing in radiation therapy), and potentially a medical oncologist (a doctor specializing in cancer treatment with medication).
These specialists can conduct a comprehensive evaluation of your case and develop a personalized treatment plan that addresses your specific needs and goals. High-volume cancer centers, where doctors treat a large number of prostate cancer cases, often have more experience and resources, which can lead to better outcomes. Experienced radiation oncologists, in particular, can optimize treatment plans to maximize effectiveness and minimize side effects.
Managing and Mitigating Side Effects of Radiation Therapy
Modern radiation techniques, like IMRT, IGRT, and proton therapy, are designed to minimize side effects by carefully targeting the prostate while reducing exposure to surrounding tissues. Still, some side effects are possible.
Common side effects often involve urinary and bowel issues, but these are frequently temporary and manageable with medication and lifestyle adjustments. Conditions such as Ulcerative Colitis can also impact male fertility. Erectile dysfunction is a potential long-term side effect that can also be addressed with medication or other treatments, though other surgeries such as knee surgery can also increase the risk of ED.
Here are some things your doctor might do to minimize side effects:
- Using a rectal spacer gel to reduce radiation exposure to the rectum.
- Careful treatment planning and monitoring throughout your treatment.
Emerging Therapies and Advanced Approaches
Newer therapies offer additional options for treating prostate cancer with radiation.
- Radium-223 therapy is a targeted treatment specifically for prostate cancer that has metastasized to the bones. It can improve survival rates and delay bone-related complications.
- Researchers are investigating combining radiation with hormonal therapies to see if this approach can improve outcomes for some patients.
- Active research in oligometastatic prostate cancer (cancer that has spread in a limited way) is exploring aggressive local treatments to slow the cancer’s progression.
- The approach used at Memorial Sloan Kettering (MSK) emphasizes individualized treatment plans that incorporate advanced imaging techniques and genomic testing to tailor the treatment to the specific patient and their cancer.
Frequently Asked Questions
What is an alarming PSA level?
Generally, a PSA level above 4 ng/mL is considered potentially alarming and warrants further investigation. However, it’s important to remember that PSA levels can be affected by factors other than cancer, like age, prostate size, and certain medications. Your doctor will interpret your PSA level in conjunction with other factors.
What is the downside of prostate radiation?
Potential downsides of prostate radiation include side effects like urinary problems (frequency, urgency, burning), bowel issues (diarrhea, rectal discomfort), erectile dysfunction, and fatigue. While often temporary, some side effects can be long-lasting. Newer techniques, like SBRT, aim to minimize these side effects.
How many rounds of radiation is normal?
The number of radiation treatments varies depending on the type of radiation used. Traditional external beam radiation therapy (EBRT) typically involves daily treatments five days a week for several weeks (e.g., 7-9 weeks). Stereotactic body radiation therapy (SBRT) uses higher doses per treatment and can be completed in as few as five treatments.
Does radiation stop stage 4 prostate cancer?
Radiation can be used in stage 4 prostate cancer to manage symptoms, such as pain caused by bone metastases, and potentially slow the cancer’s growth. However, it’s unlikely to completely stop or cure stage 4 prostate cancer. Treatment at this stage often involves a combination of therapies, including hormone therapy and chemotherapy.
What is the new breakthrough for prostate cancer?
There isn’t one single “new breakthrough,” but several promising areas of research are advancing prostate cancer treatment. These include more precise radiation techniques (like SBRT and proton therapy), targeted therapies based on genetic mutations, immunotherapies that harness the body’s immune system, and advanced imaging techniques to better detect and monitor the disease.
Wrapping Up
There’s no one “best” radiation treatment for prostate cancer that works for every person and every situation. The treatment that will work best for you will depend on your particular health profile and the specific characteristics of your cancer.
What’s most important is that you develop a personalized treatment plan in consultation with a team of healthcare professionals who can look at the whole picture.
Be sure to discuss the benefits and risks of each treatment option, as well as any side effects you might experience. Radiation therapy is constantly evolving, so new options are always becoming available to improve your outcome and minimize potential side effects.
Stay informed, ask questions, and be an active participant in your treatment decisions. The more you know, the better prepared you’ll be to make the right choices for yourself.