Prostate cancer is a disease in which malignant cells grow inside the prostate gland. The prostate lies just below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine and semen out of the body. Prostate cancer is the second leading cause of cancer in men, after skin cancer, and the second leading cause of cancer death in men. Prostate cancer is an adenocarcinoma, a type of cancer that originates in a gland or has glandular characteristics.
Your treatment at the Precision Radiotherapy Center is led by radiation oncologists who have specific expertise in treating patients with prostate cancer. Your multidisciplinary team also includes urologists, medical oncologists, diagnostic radiologists, and pathologists. This team meets on a regular basis to discuss cases of newly diagnosed patients and to recommend a treatment strategy.
As a patient at Precision Radiotherapy, you may qualify for participation in a clinical trial that explores promising new treatments.
Several treatment options are available to patients with prostate cancer.
- No treatment at the present time, also known as "watchful waiting", for slow-growing tumors that are unlikely to affect the patient's lifespan.
- Hormonal therapy, which involves slowing cancer growth by reducing the amount of testosterone in the body; it is most often used in patients with advanced or metastatic disease.
- Prostatectomy, the surgical removal of the prostate gland
- External radiation therapy, which involves targeting the tumor with radiation beams
- Brachytherapy, which involves the placement of radiation seeds inside the prostate
- A combination of external and brachytherapy
Radiotherapy is a treatment that uses targeted, high-energy x-rays from a machine to kill cancer cells. Radiation works by damaging the DNA inside cells, making them unable to divide and grow. Treatment sessions are done on an outpatient basis. Radiotherapy treatments are given 5 days a week over a period of 7 to 8 weeks. The treatment takes approximately 20 minutes per day.
Patients typically do not experience side effects during the first 2 to 3 weeks of treatment. But during the last several weeks and for several weeks following treatment, patients may experience:
- Irritation of the bladder (burning or urgency)
- Irritation of the rectum (soreness when bowels move or diarrhea)
Bladder symptoms are generally well controlled with medication and wear off within several weeks after completion of radiation treatment. If a patient has good urinary function before radiation therapy, he is unlikely to have long-term urinary difficulties.
Irritation of the rectum also can generally be controlled with medication, and symptoms wear off within several weeks after treatment has been completed. Occasionally, patients experience long-term effects that include having to move the bowels more often than normal and occasional blood in the stool.
Of patients with normal sexual potency, approximately one-third to one-half are thought to lose potency because of the external radiation therapy. Overall, the course of external radiation therapy for cancer of the prostate is generally well tolerated, and working patients typically do not miss a day of work while going through treatment. Please see our Guide to Radiotherapy.
Brachytherapy involves the placement of radioactive seeds in the prostate gland. Radiation coming out of the seeds delivers a high dose to cancer cells and travels only a short distance. Because of technological advances, the placement of radiation seeds today does not require an open operation. Typically, the procedure is performed on an outpatient basis in a hospital setting, with the patient under general or spinal anesthesia. Image-guidance is provided by an ultrasound probe, which provides the surgeon with a clear image of the patient's prostate gland. The surgeon then deposits approximately 80 small radiation seeds into the prostate through approximately 12 needles. The needles are removed and the seeds are left in permanently. The procedure takes approximately 60 minutes.
Because the urethra travels through the middle of the prostate, it is often impacted by the radiation seeds. Irritation to the urethra (burning and/or frequent urination) typically begins 4 to 6 weeks after the placement of the seeds and lasts a number of months before resolving. Medications can help, and long-term urinary difficulties are uncommon. Bladder complications are uncommon. Rectal bleeding can occur but usually is minimal and usually resolves. Approximately 85 percent of patients with normal sexual potency prior to the procedure maintain that within 2 years of the procedure. Patients are advised not to hold babies or children in their laps for the first 4 months after the seeds have been placed.
Another treatment option involves the temporary placement of higher-strength radiation seeds, followed by removal after several days. A final option involves placing very high strength radiation seeds in the prostate for several minutes, removing them, and then repeating the procedure several times over several days. This treatment is called high-dose-rate (HDR) brachytherapy.
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