Radiotherapy uses X-rays to destroy cancer cells. Radiotherapy may be used to treat different parts of the body that are affected by prostate cancer, and is used to treat both locally advanced and metastatic prostate cancer.
There are two main types of radiotherapy – external beam radiotherapy (EBRT) and brachytherapy. The difference is whether radiotherapy is applied from outside the body (EBRT) or inserted directly into the prostate (brachytherapy). Not all cancer treatment centres offer brachytherapy. Talk with your healthcare team about the availability of treatment options in your area.
Radiotherapy can be also given after surgery if:
- your cancer may have spread after initial treatment (e.g. surgery for locally advanced prostate cancer) – this is called ‘adjuvant’ radiotherapy
- your PSA level started to rise – this is called ‘salvage’ radiotherapy
For men with metastatic prostate cancer, a low dose of radiotherapy can be used to shrink the cancer and relieve some symptoms (such as swollen lymph nodes or bone pain). Radiotherapy can also slow down the cancer’s growth and size of the cancer in the treated areas and may reduce the amount of pain-relieving medications you may be required to take or are taking. It is relatively fast-acting and you should feel pain relief within 1-3 weeks. Such radiotherapy does have side effects, but these will depend upon the site treated and the dose prescribed, but the intent of such treatment is to keep these minimised. However if symptoms of pain return you may require further treatment (please see a later section for more information about treatments to relieve symptoms).
External beam radiotherapy (EBRT) uses high energy x-ray beams that are directed at the prostate from the outside. Generally people have this treatment in a hospital setting daily for 7-8 weeks. During your EBRT treatment, you can continue to do what you would normally do if you’re able but it can interfere with some day-to-day activities as you may need to schedule multiple hospital visits, and there are side effects.
External beam radiotherapy (EBRT) can cause side effects such as fatigue, skin discomfort around the area where the rays penetrated the skin, erectile problems, and urinary or bowel problems. Urinary problems can include burning or stinging during urination, or frequent urination or incontinence. Bowel problems can be mild but include looseness and frequency of bowel motions, or incontinence. Occasional bleeding from the back passage may occur, and should be reported to your healthcare team.
Brachytherapy is when radioactive material is inserted directly into the prostate. The procedure takes place at a hospital. It is sometimes given in combination with EBRT for locally advanced disease.
Brachytherapy can cause side effects such as soreness, frequent and difficult urination, and bowel discomfort. You can usually resume normal activities a couple of weeks after the procedure. You can start having sex straight after brachytherapy but you may not feel like it for the first few weeks. Initially you should wear a condom as the ejaculate may be bloodstained.
Use of hormone therapy before and after radiotherapy
Hormone therapy, also known as androgen deprivation therapy (ADT), is usually given before radiotherapy, called neo-adjuvant therapy, because this makes it a better treatment and improves treatment outcome. It’s been shown that using hormone therapy before and during radiotherapy can reduce the chance of the cancer spreading and improve survival. For men with higher risk cancer, hormone therapy is also given after radiotherapy (adjuvant therapy) to improve treatment outcome and overall survival.
There is more information about hormone therapy here.
Further questions to ask
As well as the questions in Section 3, the following could be useful for you to ask your healthcare team about the form of radiotherapy that is recommended to you:
- What are the advantages and disadvantages of EBRT and brachytherapy for my situation?
- Will hormone therapy be used before and/or after my radiotherapy?