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cover of book Mayo Clinic on Prostate Health
A selection from:
Mayo Clinic on Prostate Health

Continuing from Chapter 7 (go to previous part)
What Are Your Options?

Destroying the cancer with radiation

Radiation treatment uses high-powered X-rays or other radiation to kill cancer cells. It's generally the preferred treatment if you're older or in poor health and might have a hard time withstanding surgery. For cancer confined to the prostate, radiation is often as effective as surgery for as much as 10 years.

Radiation also is used to treat cancer that has spread outside your prostate. It can destroy cancerous cells/ shrink tumors and relieve painful symptoms.

External beam

Radiation is most commonly delivered by a beam from a large machine placed over your body. Unfortunately, these "external beams" do more than destroy cancerous cells. They can damage healthy tissue in the same area.

That's why the first step in radiation therapy is to map out the areas in your body to receive radiation. Three-dimensional scans show the location of the prostate and surrounding organs. Computer imaging software allows a radiation therapist to rotate the picture in any direction to find the best angles to fire the beams.

Treatments are generally given 5 days a week for about 6 or 7 weeks. Each treatment takes about 15 minutes. However, much of this is preparation time. The actual length of time you receive radiation is only about 1 minute. To make sure the beams are always precisely on the mark, you'll have a body supporter that will hold you in the same position for each treatment. You'll also be asked to arrive with a full bladder, which will help hold your prostate in the same position during each treatment. Ink marks on your skin will help the radiation therapist hit the same targets each time. Custom-designed shields cover nearby areas such as your intestines, anus, rectal wall and urethra, protecting them from scattered rays.

During the procedure, you'll lie on a table while a machine known as a linear accelerator moves above you, targeting the cancer with radiation. The first phase of treatment usually involves blanketing the entire pelvic region with low doses of radiation to kill any microscopic cancer cells that have wandered away from detectable tumors. This continues for about 2 weeks.

During the second phase of treatment, the beams generally are narrowed and strengthened to target individual tumors. This gives your intestines and bladder a needed rest from the radiation. Higher doses of radiation are more effective in killing the cancer, but they're also more damaging to healthy tissue. After about 2 weeks of targeting the tumors, you may receive another 2 weeks or so of blanket radiation throughout your pelvis.

A new and promising external beam therapy known as three- dimensional conformal radiation therapy (3-D CRT) uses protons instead of X-rays to kill the cancer. Protons are parts of atoms that cause little damage to surrounding tissue but effectively destroy cells at the end of the beam. This allows your therapist to deliver stronger doses of beam radiation.

Seed implants

A second radiation method that's gaming popularity uses ultra- sound-guided needles to inject rice-size radioactive seeds into your prostate (see illustration). These seeds deliver double the dose of radiation of external beams, and the seeds cause less damage to healthy tissue.

line drawing showing the placement of seeds in a prostate
Several small radioactive seeds are inserted into the prostate gland. The seeds emit radiation designed to destroy the cancer.

The procedure takes about an hour and is done on an outpatient basis, with either general anesthesia or spinal (epidural) anesthesia that numbs the lower portion of your body.

Between 70 and 150 rice-size seeds are inserted throughout your prostate by way of a needle that passes through the skin of your perineum, the area between your scrotum and anus. The number of seeds inserted depends on the size of your prostate. The therapy generally works better on smaller or moderate-sized prostates.

Radioactive seeds may contain one of several radioactive substances, depending on the grade of the cancer. Typically, you'll be given iodine if your Gleason score is less than 6, or the more potent palladium (puh-LAY-de-um) if your score is higher. These seeds are left in even after they stop emitting radiation. Other seeds that contain an even more potent substance, called indium (i-RID-ee-um), are left in only temporarily.

An ultrasound probe inserted into your rectum guides the doctor in placing the seeds throughout your prostate, without missing any areas. A template attached to the outside of the probe and held up against your perineum guides and steadies the needles loaded with seeds.

Iodine and palladium seeds generally emit radiation only a few millimeters beyond where they're implanted. Although this type of radiation isn't thought to escape your prostate area, doctors recommend that for the first couple of months you stay at least 6 feet away from children and pregnant women, who are especially sensitive to radiation. Within a year, all radiation inside the pellets is generally exhausted.

Because seed implantation is new, its long-term effects are unknown. But encouraging short-term results suggest that this could become a common form of prostate cancer therapy in the decade ahead. According to early studies, radioactive seeds control cancer growth for 5 years in 90 percent of men, and for 10 years in 85 percent of men. In 2 out of 3 men, the seeds destroy the cancer.

Seed implants generally produce fewer side effects than external beam radiation. Impotence occurs in about 1 out of 6 men, com- pared with 1 in 2 for beam radiation. Incontinence is rare.

Are you a candidate for radiation?

• Your cancer can't be cured by surgery because it has spread outside the prostate.
• Your cancer is confined to the prostate and is a low- or medium-grade.
• You don't want surgery.
• You expect to live longer than your cancer would allow you to live.

What are the benefits?

• For cancer confined to the prostate, radiation is nearly as effective as surgery over a 10-year period.
• The procedure is generally done on an outpatient basis. With seed implantation, you may need to spend one night in the hospital.
• Radiation doesn't entail the trauma and recovery associated with surgery.

What are the disadvantages?

• Radiation can affect your sexual function. Over time, it can damage the nerves that control erections and the arteries that carry blood to your penis. Most men don't have problems with erections or intercourse in the early months after radiation therapy. But eventually most men suffer some complications. Only about half of men who had normal sexual function before radiation retain it after therapy. The percentage is higher for seed implantation therapy. The younger you are, the better your chance of retaining the ability to have normal sexual relations. • Beam therapy can sap your energy and appetite. Both should return within a couple of months after treatment.

• Some men have intestinal problems from external beam therapy, including nausea, diarrhea, rectal bleeding, a burning feeling around the anus, and a sense that you need to have a bowel movement. The symptoms generally subside when the treatments are over. But for about 5 percent of men, they continue.

• Beam therapy produces urinary problems in approximately 3 out of 4 men. The most common complaints are constantly feeling as if you have to urinate, blood in your urine, painful urination with a burning sensation, and urine leakage. About 5 percent of men experience severe symptoms and need to be hospitalized. Less than 1 percent of those hospitalized require surgery to correct the problem.

[The chapter continues with "Freezing cancer cells (cryotherapy)"]


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