What to Know About Radiation Therapy for Prostate Cancer

Clinical Contributors to this story:

As treatment options for prostate cancer get better, it can be tough for men to understand what to expect, especially when it comes to radiation therapy.

“It’s critical that men find a care location that not only offers the latest clinical advancements, but has an experienced and diverse team that treats all aspects of cancer, including the physical, functional and emotional aspects of the disease,” shares Glen Gejerman, M.D., co-director of urologic oncology at Hackensack Meridian Health’s John Theurer Cancer Center.

Dr. Gejerman, as well as radiation oncologists Prashant Desai, M.D., medical director of radiation oncology at Ocean Medical Center and Priti Patel, M.D., medical director of radiation oncology at Riverview Medical Center, helped answer some of the most commonly asked questions about radiation therapy for prostate cancer below.

Q: What are the different types of radiation therapy for prostate cancer?

There are several forms of radiation therapy, but they can be broken down into two main categories:

External Beam Radiation (EBRT) - This form of therapy is more common, and delivers radiation from outside your body to treat cancer. This type of therapy can be used on its own or in combination with brachytherapy, depending on how aggressive your cancer is. There are three main techniques of delivering EBRT for prostate cancer:

Intensity-modulated radiation therapy (IMRT) - IMRT uses computer programs to treat a tumor from multiple angles while optimizing this approach to minimize risk of high doses to critical healthy tissues nearby.

Stereotactic body radiation therapy (SBRT) - SBRT is an advanced treatment option that provides high doses per treatment that are precisely targeted. Treatment can be delivered in as little as five sessions.

Proton therapy - Unlike the EBRT techniques described above, which use x-rays, protons therapy uses protons. Because of their different physical properties, protons can deposit most of their energy over a shorter distance than x-rays. This further decreases radiation dose to nearby tissues while still enabling doctors to treat the tumor.

Brachytherapy - This type of therapy, also known as “internal radiation” involves placing radioactive seeds into the tumor. There are high-dose rate (HDR) and low-dose rate (LDR) brachytherapy options. This treatment is typically used when patients have advanced stage prostate cancer.

“In addition, image-guided radiation therapy (IGRT) is a tool that combines imaging technology (such as CT) with external beam radiation therapy,” says Dr. Gejerman. “It is used prior to treating a patient with EBRT to produce high-quality images so treatment can be aligned more precisely.”

Q: Is radiation therapy painful?

Radiation therapy itself is painless - you will not feel pain when you are on the treatment table. During treatment, side effects may lead to some mild discomfort throughout the course of your treatment. “Common side effects of radiation for prostate treatment include increased urinary frequency, nocturia (frequent urination at night) and urgency. Some men notice increased bowel movements. Most of these side effects can be managed with medication,” adds Dr. Patel.

Q: Is radiation therapy safe?

Radiation therapy is safe when you go to a center that has a lot of experience and a system for quality assurance. “Multiple members of our team look at a plan before it’s ever applied to a patient,” says Dr. Gejerman. “Our experienced team at John Theurer Cancer Center, who treats an extremely high volume of patients, has a robust review process to make sure everything is drawn properly before treatment is delivered.”

Q: When is radiation therapy the right choice?

Whether or not to pursue radiation therapy depends on a lot of factors unique to each person, and the decision should be made through a detailed discussion with your doctor.

“It’s often based on the stage of the cancer, age, risk factors and personal choice,” says Dr. Patel. “But it really is an individual choice made in collaboration with your doctor and what’s best for you.”

Q: How long does radiation therapy take?

The individual sessions are done in an outpatient setting, meaning you won’t have to stay in the hospital. Usually, sessions only take about 10 to 15 minutes each. The entire course of treatment can usually be completed in 1-8 weeks, depending on the type of radiation therapy you’re receiving.

Q: What are the latest advancements in radiation therapy for prostate cancer?

According to Dr. Gejerman, image guidance through IGRT is making a big difference in patient care. “With IMRT alone, there was still a requirement to put wide margins around the treatment area to make sure you captured it all, but with image guided radiation therapy, you can keep the margins much closer,” he says. This makes a huge difference in reducing damage to surrounding areas.

Hydrogel spacers are also advancing care, enabling doctors to separate the rectum from the prostate before radiation begins, therefore protecting the rectum from radiation during treatment.

Dr. Desai adds, “With emerging therapies, such as SBRT, treatment is also being completed in far less time. The shorter course of treatment is a huge draw for patients, allowing them to get back to quality of life, faster.”

Q: What is the success rate of radiation therapy for prostate cancer? 

Long-term studies show the success rate for patients who undergo radiation therapy is actually the same as those who get surgery. “If you catch it in its early stages, the 5-year survival rate is very high - in the high 90s, but early screening and early intervention is key and makes all the difference in the world,” says Dr. Gejerman.

Q: What should men with prostate cancer look for in a treatment center?

A: There are several things to look for in a cancer treatment center, but four critical components are:

Expertise: Research published in the New England Journal of Medicine shows that positive treatment outcomes are linked to the number of patients a center treats. “It is especially clear with prostate and pancreatic cancer that receiving treatment in a center with a high volume of patients and experienced staff makes a huge difference,” says Dr. Gejerman. “For example, at John Theurer Cancer Center we do more robotic surgeries than any other cancer center in the country - and the more you do, the better you get.”

Team Diversity: It’s important to find a cancer center that offers all the different types of treatment you might need under one roof. Having expertise at all levels (from biopsy to rehabilitation) ensures that the best course of treatment is defined and at your fingertips. “Hackensack Meridian Health’s cancer teams have tumor board discussions where everyone comes together to discuss a case and determine the best treatment plan,” says Dr. Patel. “Radiation Oncology requires teamwork among physicians, nurses, dosimetrists, physicists, navigators and therapists to deliver the best plan for that patient.”

Patient Experience: A cancer diagnosis is overwhelming and can be a huge burden on someone’s life. When looking for a cancer center, make sure to evaluate the atmosphere, compassion from the team and additional support that’s available to you. “Hackensack Meridian Health’s cancer centers have nurse navigators who help guide you both medically and logistically through your treatment,” says Dr. Desai. “They keep track of what you need to do, help set up appointments and try to make the experience as easy as possible for you, so you can focus on getting better.”

Clinical Research: Cancer centers that offer clinical research give patients, especially those with complex cases, the best shot at positive outcomes. “At John Theurer Cancer Center we are pioneering new cancer treatments every day while conducting some of the nation's top research, says Dr. Gejerman. “Continually advancing science enables us to offer the latest treatment and protocols, such as innovative immunotherapy options for prostate cancer that may be used in combination with radiation therapy,” says Dr. Gejerman.

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