Radiotherapy for Prostate Cancer


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Radiotherapy can be given three ways.

It can be given by external beam radiation, high dose rate bracchytherapy or low dose rate bracchytherapy.1

The external beam radiation involves a patient lying down on a machine, getting external radio waves given Monday to Friday for a total of 20 minutes each for about seven weeks.

It’s aimed at treating the cancer and patients usually have this as an outpatient and can often work during the treatment.

They do have some side effects such as lethargy and some nausea on occasions.

The other side effects of radiotherapy relate to the effect of radiotherapy to adjacent organs such as the back passage and the bladder. 2

So a small percentage of patients can have quite serious long term side effects such as bleeding, urgency and frequency of both the bladder and the back passage.2

Usually if patients have an active or aggressive cancer we would combine hormone therapy with radiotherapy so that they have about 12 months of hormone therapy with the radiotherapy.3

So one needs to take into consideration that they might have this treatment and this hormone therapy also has some side effects.

One of the important things is that you have radiotherapy in general you can’t have surgery afterwards because the radiotherapy leads to significant scarring and makes a subsequent operation more difficult.4

Most studies show that radiotherapy and surgery offer equivalent results of 10 years but there is some contention about the results beyond 10 years.5, 6

So in general if we have a young patient or a patient with a very long life span we would generally favour surgery to external beam radiation.

There are also some issues regarding secondary cancers with perhaps a slightly increased incidence of bladder cancer and also some other cancers through the body but this is somewhat contentious.7

So external beam radiation is an accepted treatment. 8

It’s also very important to ensure what sort of dosage is given.

So there’s a standard way of giving external beam radiation and also a conformal way where we can increase the dose of radiotherapy that’s given.

So it’s important that when you’re having radiotherapy that you check with the institution as to what dosage they are delivering.

References

1. Radiation Therapy for Prostate Cancer - Hiram A. Gay and Jeff M. Michalski - Mo Med. 2018 Mar-Apr; 115(2): 146–150 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139853/
2. Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study - E. Sutton, J. A. Lane, M. Davis - Cancer Causes Control. 2021; 32(3): 261–269 - doi: 10.1007/s10552-020-01380-3
3. Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art - Piotr Milecki, Piotr Martenka, Andrzej Antczak, et al. (2010) - Cancer Management and Research, 2, 243–253. https://doi.org/10.2147/CMR.S8912
4. Adverse Effects of Radiation Therapy - Hafsa Majeed and Vikas Gupta - NLM - https://www.ncbi.nlm.nih.gov/books/NBK563259/
5. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer - Freddie C. Hamdy, Jenny L. Donovan, J. Athene Lane - N Engl J Med 2023;388:1547-1558 DOI: 10.1056/NEJMoa2214122
6. Radiotherapy or surgery for prostate cancer? Ten and fifteen-year results of external beam therapy - G E Hanks - Acta Oncol 1991;30(2):231-7. doi: 10.3109/02841869109092359
7. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis - Christopher J D Wallis, Alyson L Mahar, Richard Choo - BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i851
8. Localized prostate cancer treated with external beam radiation therapy: Long-term outcomes at a European comprehensive cancer centre - Anna Boladeras, Evelyn Martinez, Ferran Ferrer, et al - Rep Pract Oncol Radiother. 2016 May-Jun; 21(3): 181–187 - doi: 10.1016/j.rpor.2015.12.002