What is the treatment?
Men with prostate cancer have a choice between treatment with surgery, or non-invasive treatment with radiation. It is important for patients to meet with both a radiation oncologist and a urologist to understand their treatment options.
How is radiation delivered?
Prostate cancer requires a high dose of radiation to effectively eradicate tumor cells. The challenge is that the prostate is located deep within the pelvis, behind the bladder and in front of the rectum, so getting the proper radiation dose to the cancer requires accuracy and precision.
It would be too dangerous to deliver that high dose all at once so treatments are given over the course of 5-8 weeks. You will receive a fraction of the dose daily, Monday through Friday, and meet with your Radiation Oncologist weekly to review side effects and assess your progress.
There are two ways to deliver radiation for prostate cancer:
External Beam Radiation
You will lie on a treatment table while a machine called a linear accelerator or “linac” for short, rotates around you and delivers the radiation.
Treatment itself is painless and takes around 15 minutes. You will not feel the radiation entering or leaving your body. You will be positioned on your back using a specific mold that is fitted to your body.
Radioactive seeds are placed inside the prostate and deliver radiation. The seeds can be placed permanently and decay over time (LDR) or they are placed temporarily over the course of 2-3 weeks (HDR) and then removed after each radiation treatment.
External beam radiation allows your radiation oncologist give a low dose of radiation each day.
However can take up to 40+ treatments or “fractions”. If you have a very large prostate or there is concern for microscopic disease in the pelvic lymph nodes around your prostate, then you will need this type of treatment. External beam radiation is also a good option if you have other medical conditions, such as lung or heart problems that make it too risky for you to undergo a procedure.
If you only have a small amount of tumor in the prostate and meet certain criteria, brachytherapy is a good way to get high dose radiation to the prostate and avoid any of the surrounding organs like the bladder and rectum. Brachytherapy typically requires a trip to the operating room to place the seeds so you have to be healthy enough to undergo anesthesia and recover from an invasive procedure.
At Erlanger, Dr. Gullett is able to deliver the same high dose of radiation to the prostate as in brachytherapy, but can avoid having to take you to the OR, by using the Cyberknife®. With the Cyberknife, the same high dose of radiation can be delivered to the prostate while avoiding the bladder and the rectum. Prostate cancer treatment with the Cyberknife is done in 5 treatments delivered every other day. Many men work during the entire treatment with minimal side effects. In addition, radiation treatment is non-invasive and there is no risk of nerves being cut which often leads to erectile dysfunction in men who undergo surgery.