Author: Dr. Mark Alden
Radiotherapy is an excellent option for the treatment of prostate cancer. But before this option is chosen, it’s important to take a look at the advantages and disadvantages.
Advantages of radiotherapy:
• No part of your anatomy is removed.
• It takes less than 15 minutes (daily).
• It’s easy to do and one of the best tolerated treatments.
• There is a significant body of literature documenting the 15-year-long term high success rate.
• It’s designed to kill every last cancer cell, not just shrink the prostate.
• It is exceedingly rare that radiation contributes to incontinence. (It is not on the list!)
• No one loses potency initially from radiotherapy, but this does occur in some men over time, reaching a similar average by 5 years, as those who underwent surgical prostate removal.
Disadvantages of radiotherapy:
• Visiting the radiation center 5 days a week for 8 to 9 weeks is inconvenient.
• There are some short-term side effects, such as urinary frequency, urgency, weak stream, burning, etc. and fatigue. (These go away when the treatment is done).
• There can be long-term side effects, such as smaller bladder capacity, loss of potency, occasional drop of blood in the stool. (Usually well tolerated, but may be permanent).
• There is a very small incidence of radiotherapy causing cancer about 20 years later.
Men with more advanced or “higher risk” prostate cancer (high PSA or high Gleason score) have a chance that their cancer has spread through the prostate capsule or into the lymph nodes near the prostate in the pelvis. For these patients, surgery or brachytherapy (“seed” implant) may not be sufficient. They may need a treatment that is able to be expanded to cover a wider area. In this case, radiotherapy is the best option. An Intensity Modulated Radiation plan can be generated to cover these at-risk sites in the pelvis, with relative sparing of the other organs. Radiation therapy is the most commonly recommended approach for men with high-risk disease.
Some men worry about backup. “What will I do if my first line of treatment fails?” This is a worth considering. What this question rests on, is “what is the chance that my treatment will fail?” This must be answered first. So, for low risk prostate cancer patients (whose PSA is under 10, whose Gleason score is 6 or less, and whose volume of disease is low) the cure rate is very high, better than 90%. The chance that they will need backup is small. So they should make their first choice of treatment the one that suits them the best. Backup is a secondary consideration.
Fortunately, there is backup for radiotherapy failures. Cryosurgery is the standard backup option. It is also fortunate that there is backup for surgical removal of the prostate. Radiation is the backup after surgery.
Radiotherapy is an excellent option for the treatment of prostate cancer. But before this option is chosen, it’s important to take a look at the advantages and disadvantages. Advantages of radiotherapy:
• No part of your anatomy is removed.
• It takes less than 15 minutes (daily).
• It’s easy to do and one of the best tolerated treatments.
• There is a significant body of literature documenting the 15-year-long term high success rate.
• It’s designed to kill every last cancer cell, not just shrink the prostate.
• It is exceedingly rare that radiation contributes to incontinence. (It is not on the list!)
• No one loses potency initially from radiotherapy, but this does occur in some men over time, reaching a similar average by 5 years, as those who underwent surgical prostate removal.
Disadvantages of radiotherapy:
• Visiting the radiation center 5 days a week for 8 to 9 weeks is inconvenient.
• There are some short-term side effects, such as urinary frequency, urgency, weak stream, burning, etc. and fatigue. (These go away when the treatment is done).
• There can be long-term side effects, such as smaller bladder capacity, loss of potency, occasional drop of blood in the stool. (Usually well tolerated, but may be permanent).
• There is a very small incidence of radiotherapy causing cancer about 20 years later.
Men with more advanced or “higher risk” prostate cancer (high PSA or high Gleason score) have a chance that their cancer has spread through the prostate capsule or into the lymph nodes near the prostate in the pelvis. For these patients, surgery or brachytherapy (“seed” implant) may not be sufficient. They may need a treatment that is able to be expanded to cover a wider area. In this case, radiotherapy is the best option. An Intensity Modulated Radiation plan can be generated to cover these at-risk sites in the pelvis, with relative sparing of the other organs. Radiation therapy is the most commonly recommended approach for men with high-risk disease.
Some men worry about backup. “What will I do if my first line of treatment fails?” This is a worth considering. What this question rests on, is “what is the chance that my treatment will fail?” This must be answered first. So, for low risk prostate cancer patients (whose PSA is under 10, whose Gleason score is 6 or less, and whose volume of disease is low) the cure rate is very high, better than 90%. The chance that they will need backup is small. So they should make their first choice of treatment the one that suits them the best. Backup is a secondary consideration.
Fortunately, there is backup for radiotherapy failures. Cryosurgery is the standard backup option. It is also fortunate that there is backup for surgical removal of the prostate. Radiation is the backup after surgery.
