Paul Berger, MD

I’ve 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?

Paul 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).

Brachytherapy
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 patients.

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 surgery.

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.

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