Prostate Cancer

You can receive radiation therapy via external beams or using radioactive implants

External-Beam Radiation Therapy (EBRT)

External beam radiation treatment makes use of high-powered X-rays to kill cancer cells, using a machine to deliver the radiation beam.

This type of radiation is effective at destroying cancerous cells, but it can also scar adjacent healthy tissue. The first step in radiation therapy is to map the precise area of your body that needs to receive radiation. Doctors often use three-dimensional scans to determine the exact location of your prostate and surrounding structures. Computer-imaging software gives the radiation oncologist the ability to find the best angles to aim the beams of radiation. By using new techniques which allow for more precise focusing of the radiation beams with a concentration of the radiation dose to the targeted area greater doses of radiation can be administered to your prostate without harming surrounding tissue.

How Does EBRT Work?

A body supporter holds you in the same position for each treatment. You’ll also be asked to arrive with a full bladder for therapy. This will push most of your bladder out of the path of the radiation beam. Ink marks on your skin help to guide the radiation beam, and small gold markers may be placed in your prostate to ensure the radiation hits the same targets each time. Custom-designed shields help protect nearby normal tissue, such as your bladder, erectile tissues, anus, and rectal wall.

EBRT Treatments

Are generally given five days a week for about eight weeks. Each treatment appointment takes about 10 minutes. However, much of this preparation time radiation is received for only about 1 minute. You don’t need anesthesia with external-beam radiation because the treatment isn’t painful. Most men have mild side effects from this type of treatment, but most of the side effects disappear shortly after treatment is completed. Most men don’t have problems with erections or intercourse immediately after radiation therapy.

Side Effects of EBRT

Frequent Urination

However, radiation can cause sexual side effects in some men later in life. Most of these men respond to medications used for ED. The younger you are, the better your chance of retaining normal sexual function. During treatment, some men experience urinary problems. The most common signs and symptoms are urgency to urinate and frequent urination. These problems usually are temporary and gradually diminish in a few weeks after completing treatment. Long-term problems are uncommon.

Bowel Movements

Rectal problems including loose bowel movements, scant rectal bleeding, discomfort during bowel movements, and a sense that you have to have a bowel movement (rectal urgency) may arise during treatment. Once the treatment course is complete, these symptoms generally subside. However, a few men may continue to experience rectal problems months after treatment, but these improvements are on their own in most men. Most long-term rectal symptoms are controlled with medications. Rarely, do people develop persistent bleeding or a rectal ulcer after radiation. Surgery may be necessary to alleviate these problems.

Brachytherapy

Radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than external beams, but over a substantially greater period.

Ultrasound-Guided Needles

During the implant procedure which typically lasts about one to two hours, done under general anesthesia on an outpatient basis between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles. The exact number of seeds inserted depends on the size of your prostate. The therapy is generally used in men with smaller or moderate-sized prostates with small and lower-grade cancers.

Sometimes, hormone therapy

Is used for a few months to shrink the size of the prostate before seeds are implanted. The seeds may contain one of several radioactive isotopes including iodine and palladium. These seeds don’t have to be removed after they stop emitting radiation. Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn’t likely to escape your body in significant doses. However, doctors recommend that for the first few months you stay at least six feet away from children and pregnant women, who are especially sensitive to radiation. In most cases, the radiation inside the pellets runs out after a year.

Side effects of seed implants

Side effects of seed implants are somewhat different from that of external-beam radiation. Seed implants deliver a higher dose of radiation to your urethra, causing urinary signs and symptoms, such as frequent, slower, and painful urination, to occur in nearly all men. You may require medication to treat these signs and symptoms, and some men require medications or the use of intermittent self-catheterization to help them urinate. Urinary symptoms tend to be more severe and longer lasting with seed implants than with external-beam radiation. Rectal symptoms, however, may be less frequent and less severe. Some men experience impotence due to radioactive seed implants.

When you have prostate cancer, male sex hormones (androgens) can stimulate the growth of cancer cells. The main type of androgen is testosterone. Hormone therapy either uses drugs to try to stop your body from producing male sex hormones or involves surgery to remove your testicles, which produce testosterone. Hormone therapy can also block hormones from getting into cancer cells. Sometimes doctors use a combination of drugs to achieve both.

In most men with advanced prostate cancer, this form of treatment is effective in helping to slow the growth of tumors. Because it’s effective at shrinking tumors, doctors use hormone therapy in some early-stage cancers often in combination with radiation and sometimes with surgery. Hormones shrink large tumors so that surgery or radiation can remove or destroy them more easily. After these treatments, the drugs can inhibit the growth of stray cells left behind.

Side Effects of Hormone Therapy

Side effects of hormone therapy may include breast enlargement, reduced sex drive, impotence, hot flashes, weight gain, and reduction in muscle and bone mass. Some of these drugs can also cause nausea, diarrhea, fatigue, and liver damage.

Because most testosterone is produced in your testicles, surgical removal of your testicles (castration) also can be an effective form of therapy, especially for advanced prostate cancer. The procedure can be performed on an outpatient basis using a local anesthetic.

Luteinizing hormone-releasing hormone (LH-RH) agonists

Some drugs used in hormone therapy decrease your body’s production of testosterone. The hormones known as luteinizing hormone-releasing hormone (LH-RH) agonists can set up a chemical blockade. This blockade prevents the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Viadur) and goserelin (Zoladex). They’re injected into a muscle or under your skin once every three or four months. You can receive them for a few months, a few years, or the rest of your life, depending on your situation.

Anti-androgens

Other drugs used in hormone therapy block your body’s ability to use testosterone. A small amount of testosterone comes from the adrenal glands, and won’t be suppressed by leuprolide or goserelin. Certain medications known as anti-androgens can prevent testosterone from reaching your cancer cells. Drugs typically used for this type of therapy include flutamide (Eulexin), bicalutamide (Casodex), and nilutamide (Nilandron). They come in tablet form and, depending on the particular brand name of the drug, are taken orally one to three times a day. These drugs typically are given with an LH-RH agonist.

Simply depriving prostate cancer of testosterone usually doesn’t kill all of the cancer cells. Within a few years, cancer often learns to thrive without testosterone. Once this happens, hormone therapy is less likely to be effective. However, several treatment options still exist.

To avoid such resistance, intermittent hormone therapy programs have been developed. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. You resume taking the drugs if your PSA level rises again.

Surgical removal of your prostate gland, called radical prostatectomy, is another option to treat cancer that’s confined to your prostate gland. During this procedure, your surgeon uses special techniques to completely remove your prostate and local lymph nodes, while trying to spare muscles and nerves that control urination and sexual function.

Two surgical approaches are available for a prostatectomy, retropubic and perineal:

Retropubic Surgery

In this approach, the gland is taken out through an incision in your lower abdomen that typically runs from just below your navel to an inch above the base of your penis. It’s the most commonly used form of prostate removal for two reasons. First, your surgeon can use the same incision to remove pelvic lymph nodes, which are tested to determine if the cancer has spread. Secondly, the procedure gives your surgeon good access to your prostate, making it easy to save the nerves that help control bladder function and erections.

Perineal Surgery

It involves making an incision between your scrotum and anus. There’s generally less bleeding with perineal surgery, and recovery time may be shorter, especially if you’re overweight. With this procedure, your surgeon isn’t able to remove nearby lymph nodes.

When you recover from your operation, a catheter is inserted through your penis into your bladder to drain urine. The catheter will likely remain in place for one to two weeks after the operation while the urinary tract heals.

After the catheter is removed, you’ll likely experience some bladder control problems (urinary incontinence) that may last for weeks or even months. Most men eventually regain complete control. Others may experience stress incontinence, meaning they’re unable to hold urine flow when their bladders are under increased pressure, as happens when they sneeze, cough, laugh, or lift. In some men, major urinary leakage persists, and secondary surgical procedures may be needed in an attempt to correct the problem.

Impotence

Impotence is another common side effect of radical prostatectomy because nerves on both sides of your prostate that control erections may be damaged or removed during surgery. Most men younger than age 50 who have nerve-sparing surgery can achieve normal erections afterward, and some men in their 70s can maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery.

Brachytherapy

Radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than external beams, but over a substantially greater period.

Ultrasound-Guided Needles

During the implant procedure which typically lasts about one to two hours, done under general anesthesia on an outpatient basis between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles. The exact number of seeds inserted depends on the size of your prostate. The therapy is generally used in men with smaller or moderate-sized prostates with small and lower-grade cancers.

Sometimes, hormone therapy

Is used for a few months to shrink the size of the prostate before seeds are implanted. The seeds may contain one of several radioactive isotopes including iodine and palladium. These seeds don’t have to be removed after they stop emitting radiation. Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn’t likely to escape your body in significant doses. However, doctors recommend that for the first few months you stay at least six feet away from children and pregnant women, who are especially sensitive to radiation. In most cases, the radiation inside the pellets runs out after a year.

Side effects of seed implants

Side effects of seed implants are somewhat different from that of external-beam radiation. Seed implants deliver a higher dose of radiation to your urethra, causing urinary signs and symptoms, such as frequent, slower, and painful urination, to occur in nearly all men. You may require medication to treat these signs and symptoms, and some men require medications or the use of intermittent self-catheterization to help them urinate. Urinary symptoms tend to be more severe and longer lasting with seed implants than with external-beam radiation. Rectal symptoms, however, may be less frequent and less severe. Some men experience impotence due to radioactive seed implants.

This type of treatment uses chemicals that destroy rapidly growing cells. Chemotherapy can be quite effective in treating prostate cancer, but it can’t cure it. Because it has more side effects than hormone therapy does, chemotherapy often is reserved for men who have hormone-resistant prostate cancer, especially if their cancer is causing symptoms.

As new chemotherapy drugs are developed, trials continue using single-drug chemotherapy, multiple combinations of chemotherapy, and combinations of chemotherapy and hormone therapy. Early results are positive, but extensive experience with newer drug agents is still unavailable. In the future, gene therapy or immune therapy may be more successful in treating metastasized tumors of the prostate.

Current technology limits the use of these experimental treatments to a small number of centers due to patient safety.

The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose watchful waiting as a treatment option. In watchful waiting (also known as observation, expectant therapy, or deferred therapy), regular follow-up blood tests, rectal exams, and possibly biopsies may be performed to monitor for evidence of the progression of your cancer.

During watchful waiting, no medical treatment is provided. There is no usage of drugs, radiation, or surgery. Watchful waiting may be an option if your cancer isn’t causing symptoms, is expected to grow very slowly, and is small and confined to one area of your prostate.

Watchful waiting may be particularly appropriate if you’re elderly, in poor health, or both. Many such men will live out their normal life spans without treatment and without cancer spreading or causing other problems. But watchful waiting can also be a rational option for a younger man as long as you know the facts, are willing to be vigilant, and accept the risk of a tumor spreading during the observation period, rendering his cancer incurable.

Regular exercise can help prevent heart attacks and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren’t as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including prostate cancer.

Exercise strengthens your immune system, improves circulation, and speeds digestion all of which may prevent cancer. Exercise also helps to prevent obesity, another potential risk factor for some cancers.

Regular exercise may also minimize your symptoms and reduce your risk of prostate gland enlargement, or benign prostatic hyperplasia (BPH). Physically active men usually have less severe symptoms than men who get a little exercise.

A Mayo Clinic study released in March 2002 suggests that regular use of Aspirin, ibuprofen (Advil, Motrin, others) and other nonsteroidal anti-inflammatory drugs (NSAIDs) may help protect against prostate cancer.

There is a link between prostate cancer and high-fat diets. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables, and whole fibers may help you reduce your risk. Foods rich in lycopene, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit, and watermelon. Garlic and cruciferous vegetables such as arugula, bok choy, broccoli, brussels sprouts, cabbage, and cauliflower also may help fight cancer.

Soy products contain isoflavones that seem to keep testosterone in check. Because prostate cancer feeds off testosterone, isoflavones may reduce the risk and progression of the disease.

Vitamin E has shown promise in reducing the risk of prostate cancer among smokers. It will take more research, however, to fully determine the extent of Vitamin E’s benefits.