Radiotherapy for Prostate Cancer: Types, Success Rate, Side Effects And More

What is Radiotherapy for Prostate Cancer?

Radiotherapy, also known as radiation therapy, is a cancer treatment that uses high-energy rays to kill cancer cells or stop them from growing. In the case of prostate cancer, radiation therapy, specifically radiation treatment for prostate cancer, targets the prostate gland with high-energy rays to kill cancer cells and shrink tumors. This form of radiotherapy prostate treatment is a common and effective way to treat prostate cancer, often used alone or in combination with other treatments like surgery or hormone therapy.

External Beam Radiation Therapy (EBRT)

External Beam Radiation Therapy (EBRT) uses a machine to direct high-energy beams of radiation at the prostate gland. These beams damage the DNA of cancer cells, preventing them from growing and dividing. EBRT is a highly effective treatment for localized prostate cancer, meaning cancer that has not spread beyond the prostate gland. One advanced form of EBRT is Intensity-Modulated Radiation Therapy (IMRT). IMRT uses computer-controlled machines to deliver precise radiation doses to the tumor while minimizing exposure to healthy tissues. This helps to reduce side effects and improve treatment outcomes.

Brachytherapy

Brachytherapy for prostate cancer involves placing radioactive seeds directly into the prostate gland. Low-Dose-Rate (LDR) brachytherapy involves the permanent implantation of radioactive seeds into the prostate, which release radiation over several weeks. High-Dose-Rate (HDR) brachytherapy uses a temporary applicator placed in the prostate to deliver high doses of radiation over a short period, after which the applicator is removed.

Both LDR and HDR brachytherapy are effective treatments for prostate cancer, and the best choice for a patient depends on various factors, including the stage of the cancer and the patient’s overall health.

What are the Side Effects of Radiotherapy for Prostate Cancer?

Radiotherapy for prostate cancer can have side effects, which vary from person to person. Common side effects include urinary problems, such as frequent urination, urgency, difficulty starting or stopping urination, and urinary incontinence; bowel problems, such as diarrhea, constipation, and rectal bleeding; and sexual dysfunction, which may include erectile dysfunction and decreased libido.

While most side effects are temporary, some, such as sexual dysfunction, may be long-lasting. However, there are treatments and strategies to manage these side effects. It’s essential to talk to your doctor about any concerns you have and to seek support from patient organizations or support groups.

Short-Term Side Effects

The skin in the treated area may become red, swollen, warm, and sensitive, as if it has a sunburn. It may also peel or become moist and tender. Many people feel tired after several weeks of treatment. For most, this fatigue is mild. But some people lose a lot of energy and need to change their daily routine. Radiation can irritate the bladder, leading to a condition called radiation cystitis. Symptoms include frequent urination, burning during urination, and blood in the urine.

Long-Term Side Effects

Long-term side effects of radiation therapy for prostate cancer include urinary incontinence, which is the inability to control urine flow and can range from slight leakage to complete loss of bladder control, and erectile dysfunction, which is the inability to achieve or maintain an erection.

While these side effects can be distressing, there are treatments and lifestyle changes that can help manage them. These include medications, pelvic floor exercises, and medical devices. It’s essential to talk to your doctor about any concerns you have and to seek support from patient organizations or support groups.

How is Radiotherapy for Prostate Cancer Administered?

A planning CT scan is used to determine the exact location and size of the tumor. Patients may need to empty their bowels and fill their bladder to a comfortable level to reduce prostate movement and minimize radiation exposure to healthy tissues.

Treatment Planning

Contouring is a critical step in radiation therapy planning for prostate cancer, involving the outlining of the target volume (the prostate gland) and organs at risk (OARs) on CT images. Accurate contouring is essential for delivering precise radiation doses to the tumor while minimizing damage to healthy tissues. Dose calculation follows, where radiotherapists determine the optimal radiation dose to target the tumor while protecting surrounding healthy tissues. Finally, a personalized treatment plan is created based on the patient’s scan.

Treatment Sessions

Positioning involves placing patients on a treatment table using marks or tattoos to ensure consistent alignment during each session. Radiation delivery is carried out using a machine that rotates around the patient, delivering precise doses to the tumor from multiple angles. Treatment sessions typically last a few minutes and are administered daily, Monday through Friday, over the course of several weeks.

Tips for Preparing for Radiotherapy

Bladder and bowel preparation involves following your doctor’s instructions before scans and treatments, which may include drinking fluids or using enemas to ensure optimal positioning of the prostate. Skin care is essential, requiring the treatment area to be kept clean and dry while avoiding harsh soaps, lotions, or powders. For comfort, it is recommended to wear loose-fitting clothing and comfortable footwear. Emotional preparation includes discussing any concerns or anxieties with your doctor or a counselor.

What Should Patients Expect During Radiation Treatment?

Before the Treatment – Upon arrival at the radiation therapy center, you will check in with the staff. During positioning, you will be placed on a treatment table, and the radiation therapist will use lasers and marks on your skin to ensure accurate alignment. Immobilization devices such as bolsters or straps may be used to help you remain still during treatment.

During the Treatment – Radiation delivery involves the radiation therapy machine targeting the specific area of your body to administer radiation. Although the actual radiation treatment time is usually short, often just a few minutes, the entire process, including positioning and setup, may take longer.

After the treatment, the radiation therapist may monitor you briefly to ensure there are no immediate side effects. Once this is complete, you can leave the center and resume your normal activities.

Learn More About Radiotherapy Side Effects by Special Article on OncoDaily

How Long Does It Take to See Results?

It’s important to understand that the effects of radiation therapy aren’t immediate. It takes time for the radiation to work and for your body to respond. While you may not notice immediate changes, over time, radiation therapy can shrink the tumor, leading to improvements in symptoms like difficulty urinating or pain, and slow or stop the growth of cancer cells, helping to prevent the cancer from spreading.

Measuring Outcomes

Your doctor will monitor your progress through regular check-ups and tests, including physical exams to assess your overall health and any side effects, blood tests to check for changes in your blood count or other markers, PSA tests to measure levels of prostate-specific antigen (a protein produced by the prostate gland, with lower PSA levels indicating successful treatment), and imaging tests such as CT scans, MRI scans, or bone scans to evaluate the size and spread of the tumor.

Follow-up Imaging Scans

 You’ll likely have follow-up imaging scans, such as CT scans or MRI scans, at regular intervals after treatment to monitor for any changes in the prostate gland or the surrounding tissues. These scans can help detect any recurrence of cancer or any side effects that may develop over time.

What Are the Costs of Radiotherapy for Prostate Cancer?

The cost of radiation therapy for prostate cancer can vary significantly depending on several factors, including the type of radiation therapy (such as external beam radiation therapy or brachytherapy), the duration of treatment (as the number of sessions required can impact the total cost), the technology used (with advanced technologies like intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) potentially increasing costs), the healthcare provider and facility where the treatment is administered, and your insurance coverage, as health insurance may cover a portion of the cost, but out-of-pocket expenses can still be substantial.

Navigating Insurance Coverage and Financial Aid Options

Review your health insurance policy to understand what is covered and what your out-of-pocket costs may be. Contact your insurance provider to clarify any questions about coverage and billing. Many organizations offer financial assistance programs for cancer patients. Research patient advocacy groups and foundations that specialize in prostate cancer. Consider government programs like Medicaid or Medicare, if eligible.  Discuss your financial concerns with your doctor or a healthcare financial counselor. They may be able to provide information about payment plans, discounts, or other financial assistance options.

How Does Radiotherapy Compare to Other Treatments for Prostate Cancer?

Radiotherapy is a standard treatment for prostate cancer, offering effective tumor control and the potential for cure in localized disease. It is often compared to surgery (radical prostatectomy) and systemic therapies like androgen deprivation therapy (ADT) or chemotherapy. Radiotherapy is non-invasive, preserves the prostate, and can be combined with ADT for advanced cases, improving survival outcomes. Surgery may be preferred for younger patients or those with localized disease Systemic therapies are used for metastatic or recurrent disease. Each treatment is selected based on disease stage, patient health, and individual preferences.

Radiotherapy

Less invasive than surgery, often suitable for older patients or those with underlying health conditions. Can be effective for localized prostate cancer. Potential long-term side effects like urinary and bowel problems, and sexual dysfunction.

Surgery (Prostatectomy)

Can potentially cure localized prostate cancer by removing the entire prostate gland. More invasive than radiotherapy, with risks of complications like incontinence and erectile dysfunction.

Chen et al. (2017) published a study in Oncotarget on localized prostate cancer, comparing RP and EBRT. RP was associated with lower overall and cancer-specific mortality, but no significant CSS differences were found for low- to intermediate-risk patients. The study suggested EBRT as a potential alternative with better quality of life. Larger prospective studies were recommended for a comprehensive comparison.

Chemotherapy

Can be effective for advanced prostate cancer that has spread to other parts of the body. More severe side effects than radiation therapy, including hair loss, nausea, and fatigue. Docetaxel was the first chemotherapy to improve overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC), as shown in two phase III trials (Tannock et al. 2004; Berthold et al. 2008). It improves OS, symptoms, PSA, and quality of life but causes side effects like neutropenia, neuropathy, and sepsis. Retreatment after remission (>6 months) remains under evaluation. Cabazitaxel, approved in 2010 as second-line therapy, overcomes docetaxel resistance by disrupting microtubule function. Phase III trials (TROPIC, FIRSTANA, PROSELICA) showed it prolongs OS with manageable toxicity. Common side effects like neutropenia, diarrhea, and fatigue. Neuropathy is less frequent than with docetaxel. Mitoxantrone, a topoisomerase II inhibitor, was approved in 1996 for symptom control in mCRPC but lacks significant survival benefit. It provides palliative relief but carries notable toxicity. Further research is needed to explore its efficacy in prostate cancers with DNA repair defects. This review was published in Cold Spring Harbor Perspectives in Medicine (Sumanasuriya & De Bono, 2018).

Hormone Therapy

 Can slow the growth of prostate cancer cells by reducing testosterone levels.  Can cause side effects like hot flashes, weight gain, and decreased libido.

Hekman et al. (2024) published a systematic review in Clinical Genitourinary Cancer comparing radical prostatectomy (RP) and radiation therapy (RT) for localized and regional prostate cancer. The study found similar cause-specific survival (CSS), overall survival (OS), and disease-free survival (DFS) between RP and RT in patients with low to intermediate-risk prostate cancer. Both treatments resulted in similar long-term cancer outcomes, with RP leading to more urinary symptoms and sexual dysfunction, while RT caused more bowel issues like blood in stools and fecal incontinence. The study concludes that both treatment options offer comparable survival rates, with side effects differing by type of therapy. Multidisciplinary approaches and considering patient preferences are key to selecting the ideal treatment.

How Does Radiotherapy Affect Sexual Health and Fertility?

Radiation therapy can damage the nerves and blood vessels responsible for erections, leading to erectile dysfunction. This can be a significant concern for many men. However, the severity of erectile dysfunction can vary, and it’s important to remember that it’s not always permanent. Radiation therapy can also affect libido, or sex drive. This is often related to hormonal changes and psychological factors associated with cancer treatment.

A systematic review by Ballal et al., published in the 2024 Journal of Psychosexual Health (Sage Journals), highlights significant negative trends post-radiotherapy in prostate cancer (PC) patients. Five out of twelve studies reviewed showed a marked decline in sexual health, including erectile dysfunction, reduced ability to ejaculate, diminished sexual function, lymphedema, diarrhea, and urinary incontinence. Despite improvements in morbidity and quality of life, these issues present considerable challenges for patients following treatment.

A study by Hoffman et al., published in the American Journal of Clinical Oncology in 2018, found no significant difference in sexual health outcomes between dose-escalated hypofractionated intensity-modulated radiation therapy (HIMRT) and conventional fractionated radiation therapy (CIMRT) for prostate cancer patients. Both treatment arms reported similar rates of erectile dysfunction, with no increase in the burden of sexual symptoms at 2, 3, 4, and 5 years after treatment. This suggests that moderate hypofractionation (72 Gy in 2.4 Gy fractions) does not exacerbate sexual health issues compared to conventional treatment.

Infertility

Radiation therapy can affect fertility, especially in younger men. If you’re considering having children in the future, it’s crucial to talk to your doctor about sperm banking before starting treatment. Sperm banking allows you to preserve your fertility for future use.

Coping with Sexual Side Effects

Medications like phosphodiesterase-5 inhibitors (e.g., Viagra, Cialis, Levitra) can help improve erectile function.  Talking to a therapist can help you cope with the emotional impact of sexual side effects and explore strategies for maintaining intimacy with your partner. These exercises can help strengthen the pelvic floor muscles, which may improve urinary control and erectile function.

Can All Prostate Cancer Patients Receive Radiotherapy?

Not all prostate cancer patients are eligible for radiotherapy. Radiotherapy is often a suitable option for localized prostate cancer, meaning the cancer is confined to the prostate gland. However, advanced-stage cancer that has spread to other parts of the body may require different treatments.  Patients with significant underlying health conditions that could compromise their ability to tolerate radiation therapy may not be ideal candidates.  Ultimately, the decision to undergo radiation therapy is a personal one. Patients should discuss their options with their doctor and make an informed choice.

How Can Patients Support Their Health During Radiotherapy?

Nutrition is key during treatment, with a balanced diet rich in fruits, vegetables, lean proteins, and whole grains providing essential nutrients, and staying hydrated by drinking plenty of water. A registered dietitian can offer personalized advice. Gentle exercises like walking, yoga, or swimming, as approved by your doctor, along with balancing rest, help prevent fatigue. For stress management, relaxation techniques such as deep breathing, meditation, or mindfulness reduce anxiety. Connecting with loved ones or support groups and considering professional counseling can help manage emotional challenges.

Additional Tips

Skin care involves following your doctor’s advice on caring for the treatment area, while maintaining good hygiene to prevent infection. Regular check-ups with your healthcare team are essential to monitor your progress and address any side effects.

What Support is Available for Patients Undergoing Radiotherapy for Prostate Cancer?

Facing a prostate cancer diagnosis and undergoing radiation therapy can be emotionally challenging, but it’s important to know you’re not alone. Many resources and support services are available to help you through this journey. Psychological and emotional support, such as counseling, can help you cope with the emotional impact of cancer, including anxiety, depression, and fear. Joining a support group allows you to connect with others who are going through similar experiences, providing comfort and understanding. Additionally, online forums and communities offer a platform to connect with people from around the world who have undergone prostate cancer treatment, where you can ask questions, share experiences, and receive support and encouragement.