Paul Berger, MD
been diagnosed with prostate cancer. I know there are a lot of options for
treatment, but I’m leaning toward radiation. What are the advantages
and disadvantages of radiation?
Berger, MD, chief of Radiation Medicine at Bridgeport Hospital, responds:
Besides radiation, treatment options for prostate cancer include watchful
waiting, surgery, chemotherapy, and hormones. Which is best for you depends
on your age, the stage of the cancer, and any other medical conditions you
may have. Be sure to discuss all of your options with your physicians.
Here are the basics of the two most common forms of radiation therapy.
External Beam Radiation
Using a machine that produces high-energy rays, or beams, radiation oncologists
can, from outside your body, target and kill cancer cells quite precisely,
leaving most of the surrounding healthy tissue unaffected. This is called
external beam radiation.
Advantages: Anesthesia is not required during
external beam radiation. More importantly, side effects for external beam
radiation rarely include incontinence (inability to control urine), which
is certainly an advantage.
Disadvantages: The radiation is delivered in brief
sessions, usually once a day for eight weeks, and this may be inconvenient
for you. More seriously, impotence (inability to have an erection) eventually
occurs in about 40-50% of men treated with external beam radiation. About
8% of men have long term side effects in the rectum (bleeding, diarrhea) and/or
bladder (frequent urination).
In this highly effective form of radiation, ultrasound guidance is used to
image the prostate. A urologist or radiation oncologist positions hollow needles
at predetermined sites. The radiation oncologist then implants tiny radioactive
seeds through these needles into the prostate gland.
These seeds, because they are placed in the prostate, can deliver higher
doses of radiation than external beams can. The procedure is called brachytherapy.
(Brachy = short, referring to the short distance between the seeds and the
cancer.) Usually these seeds remain in place indefinitely, though they lose
their active effect in six to nine months.
Advantages: The one-time procedure, performed
with regional anesthesia to numb the area, takes about 1 1/2 to 2 hours; you
can go home the same day, and recovery time is shorter than for surgery. Most
importantly, studies show that incontinence happens to only 1.5% of brachytherapy
Disadvantages: The chance of impotence is probably
comparable to external beam radiation. Other side effects, such as problems
with bowel movements and urinating too often or too slowly, may occur. Also,
seed implants are not recommended when the cancer has spread to other areas
of the body, or for those who have had, or may in the future need, prostate
Combined Radiation Therapy
Seed implants may be combined with external beam therapy. This combination
can be an effective way to target cancer cells
Advantages: Using both forms of radiation can
be a more aggressive way to treat the cancer. It can be used to give a higher
dose to the area outside the prostate as well as within the prostate
Disadvantages: Combining the two forms of radiation
is likely to increase the chances of the side effects mentioned above.
Your urologist, working jointly with colleagues specializing in radiation
therapy and other appropriate medical specialties, will determine which treatment
or combination of treatments will be best for you.
the name of an expert physician associated with Fairfield County’s most-preferred
hospital, call our Physician Referral Program, 888-357-2396.
Find an expert physician using our online Find a Physician search form.
To help diagnose prostate cancer, The American Cancer Society recommends
the PSA (prostate-specific antigen) blood test and a digital rectal exam
every year for men age 50 and older, according to Arthur Pinto, MD, chief
of Urology at Bridgeport Hospital. For men at high risk (African Americans
and men with a close relative with prostate cancer) screenings should begin
at age 45. Your urologist or general practitioner can discuss the PSA test
and order this simple screening for you.