Common Prostate Cancer Treatments

The Options

When a patient is first diagnosed with prostate cancer and has had all the relevant tests to check the extent of the disease he will normally have an appointment with his doctor to discuss what is best for his individual circumstances. The prescribed prostate cancer treatment will depend on the extent of the cancer and on the intent of the treatment. For example early prostate cancers will be treated with surgery, radiotherapy or watchful waiting.

Prostate cancer surgery is a definite possibility for many men in the early stages of the disease and so the subject should be discussed with the doctor. Late prostate cancers will be treated with hormone therapy, radiotherapy, chemotherapy or a mixture of all 3. Often patients will be given a choice of treatments by the doctor and the pros and cons of each option explained. There is no best cancer of prostate treatment because the treatment you receive will depend on the extent of your cancer.

Prostate Cancer Radiotherapy (commonly called prostate cancer radiation treatment)

Many men undergo radiotherapy as it is often regarded asthe best prostate cancer treatment. This may be with the aim to cure the cancer or to shrink and control it depending on the stage. Often hormone treatment is given prior to radiation treatment to help reduce the size of the cancer and improve the rate of cure. Most small cancers do not normally need this hormone pre-treatment.

Types of Prostate Cancer Radiotherapy

Radiotherapy is the treatment for cancer of the prostate with radiation. This is most often as X-rays which pass through the body and kill the cancer cells in its path known as “external beam radiotherapy”. The alternative way to treat the prostate is from within the body using small radioactive sources known as “brachytherapy”. Brachytherapy is only suitable for a small proportion of men with early prostate cancer and with a suitable sized prostate gland. It has the advantage of slightly fewer side effects during the treatment but would not be so effective at curing more bulky prostate cancers.

External Beam Radiotherapy for Prostate Cancer

The majority of men with cancer of the prostate will have this type of radiation treatment. It is given by a machine called a Linear Accelerator. This makes high energy X-rays which are good at killing cancer cells. Linear accelerators are worked by radiographers who will also help you get into the right position for your treatment and give you advice during your treatment.

For the treatment the patient has to lie on a thin couch, rather like those used in the CT or MRI scanners. The machine then moves around the patient to deliver X-rays from several different angles, all pointing towards the prostate gland. Each treatment takes approximately 10 minutes to give, and the full dose of treatment is spread out to be given every day over a few weeks. This helps to give a big enough dose to the prostate to kill the cancer whilst reducing the side effects of treatment.

To make sure you are in the correct position and the prostate is being treated properly either an X-ray picture or more usually an extra CT scan will be taken before treatment starts to locate the prostate gland accurately. At this time you will also be given several tattoos (tiny dots on the skin) so that when you lie on the couch for each treatment the radiographers can make sure you are lined up properly. This helps to make sure the prostate gland is treated fully and to reduce side effects.

Patients are not able to feel X-rays or even be aware that the treatment machine is on. However as patients go through the weeks of treatment there are a number of common side effects that can be expected. Most of these are short term side effects which slowly build up through the treatment, are worst at or just after the end of treatment and then improve quite quickly (within a few weeks). There are also some long-term or late side effects which can occur.

What are the Side Effects of Radiation Treatment for Prostate Cancer?

Despite the precautions taken to give the radiotherapy as accurately as possible there will always be some side effects associated with radiotherapy to the prostate gland even with “best treatment”. This is partly because to reach the prostate gland from the outside the X-rays have to pass through normal tissues (bladder, bowel, skin) and partly because an area around the prostate gland needs to be treated in case the prostate is in a slightly different position each day (e.g. because the bladder if filled to a different extent) and because it can treat any cancer cells which are trying to invade out of the prostate gland itself.

Early Side Effects

a. Tiredness and Fatigue – most patients receiving radiotherapy will feel tired especially towards the end of treatment.
b. Skin reaction – this is usually very mild with prostate cancer treatment and may be a slight pinking of the skin or sometimes a sore back passage
c. Diarrhoea – the x-rays will have to pass through some of your bowel to reach the prostate gland and this can irritate the bowel and cause diarrhoea, it can usually be well controlled by medication
d. Cystitis – a burning feeling when you pass water is due to irritation of the bladder by the X-rays on their way to the prostate gland
e. Piles – these can often flare up during treatment
f. Loss of Hair – you may lose some of your pubic hair where the x-rays pass through the skin but this normally grows back after treatment finishes, the hair on you head will not be affected
g. Impotence – radiotherapy may make it difficult for you to have or maintain an erection

Late Side Effects

In a small number of patients permanent damage to bowel or bladder may occur and can sometimes require treatment. In some men the impotence fails to recover.

While there are forms of alternative prostate cancer treatment, the above are considered to be the proven techniques and procedures.