External Beam Radiotherapy
Radiotherapy involves the use of various types of X-rays (radiation) to treat cancer.
External beam radiotherapy (EBRT) has been the traditional method of delivering the radiation. Short pulses of tightly focused beams of X-rays are delivered from outside the body into the prostate for a few minutes each day. Treatment continues five days a week for seven weeks. Conformal radiotherapy, allows the X-rays to be directed very accurately to the prostate in three dimensions. EBRT has a track-record of success in "curing" cancers confined to the prostate that is very close to that of surgery or brachytherapy. The long term overall quality of life after EBRT has also been shown to be the same as for patients undergoing surgery or brachytherapy. It is quite common for doctors to recommend hormone therapy immediately before or after radiation as part of the total treatment. This is particularly true for patients who have Gleason 7-10 or a PSA over 10. In these situations, hormone therapy has been shown to improve cure rates.
From a patient’s perspective, the advantages of EBRT are that it is less intrusive and stressful than surgery, with no risk of infection. It is suitable for patients of any age, and is of particular advantage for older men or those with fitness or other health problems that make the risk of surgery greater. The disadvantages are that time for treatment is much longer and may involve travel and accommodation problems, particularly for country patients. Like surgery and brachytherapy, EBRT can damage other organs, particularly the bowel and bladder. Irritation of the bowel is a common side effect that can trouble patients for six months or longer after treatment. Rates of occurrence of incontinence and impotence are similar to surgery, but tend to occur later. With radiotherapy up to 50% of men develop erection problems and many develop mild to moderate inflammation of the bowel, although only approximately 3% of men develop severe, ongoing bowel problems. It is also important to mention that it is not uncommon after radiotherapy to develop a change in bowel habit, with looser and more frequent bowel movements, increased flatus and possible bleeding.. Once again, the skill, experience and result record of the Radiation Oncologist and standard of the treating equipment are paramount to the outcome. Intending patients should enquire carefully into these matters before making a selection.
After treatment you will have further PSA tests to monitor developments. Your PSA should gradually reduce over about 12 months to between 0 and 2. If the PSA rises again, it is often 10 years or longer before problems arise. There are several treatment options available if the PSA rises (“salvage treatments”). Salvage treatments after EBRT include radical prostatectomy, cryotherapy, high-frequency ultrasound (HI-FU), hormone therapy and chemotherapy.