If you have localized prostate cancer, your doctor will probably give you a choice of treating your disease with either surgery or radiation. At this point, no studies have definitively established that one treatment is better than the other.
Radiation therapy has some advantages over surgery: You can continue to work during treatment, and you won't have as long a recovery period as you would after surgery. In addition, radiation therapy can cure localized prostate cancer, as can surgery. You may want to read about the side effects of radiation therapy before making a decision about treatment.
If you have advanced prostate cancer, your doctor will probably recommend managing the disease with radiation therapy, hormone therapy or chemotherapy. In this case, radiation may be used to shrink the tumor and provide pain relief.
Prostate cancer is treated with both external and internal radiation therapy. Some men will be treated with both types.
External Radiation Therapy
External radiation therapy typically is given five days a week for a period of six to eight weeks, using a machine that looks much like a regular X-ray machine. The procedure is not painful, and each treatment lasts only a few minutes.
You may have your radiation therapy on an outpatient basis at the Seattle Cancer Care Alliance (SCCA) clinic on Lake Union under the supervision of a UW Medicine radiation oncologist who specializes in treating men with prostate cancer.
During the treatment, your radiation oncologist will be using state-of-the art technology to ensure you are receiving radiation just to the prostate and not to surrounding tissues. Using a tracking system called GPS for the Body, your internal-organ movement will be tracked and monitored so radiation is delivered right on target.
Internal Radiation Therapy
Internal radiation therapy, also known as brachytherapy, is a procedure in which radioactive seeds are implanted directly into the prostate to kill the cancer.
Brachytherapy is more convenient than external radiation therapy because it requires only one procedure that takes about an hour, rather than daily visits to the medical center for six to eight weeks. However, it is not appropriate for some men, especially men whose cancer is more advanced.
You will receive either a general anesthetic or a spinal anesthetic before this procedure. The seeds will be left in place in the prostate after their radioactive material is used up.
Internal radiation therapy is done as a day surgery at the SCCA Prostate Center, located at University of Washington Medical Center, by a radiation oncologist and a urologist who specialize in treating men with prostate cancer.
With the opening of SCCA Proton Therapy, A ProCure Center at Northwest Hospital, SCCA can now offer proton therapy as a treatment option. The clinical benefits proton therapy offers over standard X-ray treatment for certain types of cancer are becoming increasingly well known. The accuracy of the delivery of proton radiation, for example, reduces damage to the healthy tissues and organs surrounding tumors. Other benefits include fewer side effects, including a decreased risk of developing secondary tumors (cancers that result from radiation treatment). Learn more about proton therapy for prostate cancer.
Side Effects of Radiation Therapy
Any man considering radiation therapy will want to weigh the risks and benefits of the procedure. For both types of radiation—external and internal (the radioactive seeds)—possible side effects include incontinence, the loss of control over the release of urine, and impotence, the inability to get or sustain an erection.
Other risks include significant change in urinary habits (occurs in 12 to 20 percent of men), which is higher if there are preexisting problems.
If you have the seed implants, you can expect to feel some pain in the area for about a week after the seeds are put in place, and you may notice blood in your urine.
Radiation therapy can cause incontinence if the urinary sphincter is damaged by the radiation. Some leakage, with an urge to urinate, occurs in eight to 10 percent of men after radiation treatment, with only about half of them permanently needing to wear a pad for leakage. Severe incontinence can sometimes be corrected with surgery. You may also want to ask your doctor about medication that may help with this problem.
Impotence is the inability to have or maintain an erection. The majority of men with good pre-radiation function notice some decrease in their sexual health, with more than 50 percent having a permanent change. Some men are helped by medication, for which you may consult your doctor.
If you have radiation therapy, you probably will be infertile. If fertility is a concern for you, talk to your doctor about options such as freezing your sperm before your treatment so that it will be available if you want to father a child later on.
Radiation therapy may cause problems such as diarrhea, bowel urgency, burning with bowel movements and a flare-up of hemorrhoids, particularly if you had bowel problems before your radiation treatments. In most cases, the symptoms are temporary and can be controlled with medication, although up to 20 percent of men note some long-term, significant change in their bowel habits.
External radiation therapy can cause fatigue that may not go away until a month or two after treatment ends. Expect to take naps if you are experiencing fatigue. You may want to talk with a nutritionist about dietary changes that may help.
Severe tissue damage is very rare, occurring in less than 1 percent of all men with prostate cancer who are treated with external radiation therapy. Radiation therapy can damage the bladder, rectum and other surrounding tissues, causing problems that may need surgery to correct.
We use the latest technology to provide the most precise treatment possible, including special equipment to detect motion and position of the prostate during radiation treatment.