Radiation for Prostate Cancer Radiation therapy, or radiotherapy, uses various forms of radiation to safely and effectively treat prostate cancer. Learn more about the many options for radiation to treat prostate cancer. Jump To Jump To External Beam Radiation Therapy (EBRT) Internal Radiation Types of radiation Radiation therapy can be given externally (directed from outside the body) or internally (placed inside the body). External Beam Radiation (EBRT) EBRT involves treating the prostate and the pelvic region with radiation in daily doses. Most EBRT is delivered using x-ray photons (with the exception of proton beam therapy). This radiation is the same kind used for an X-ray or CT scan, except that the amount of energy used is much higher. Internal Radiation Therapy Internal radiation therapy comes in two types: brachytherapy and radiopharmaceuticals. Although they both involve placing radioactive materials inside the body, they are different options, used for different stages of the disease. Both low and high dose brachytherapy are used for localized prostate cancer. Radiopharmaceuticals are a medicine used to treat prostate cancer that has spread, or metastasized, often to the bone. External Beam Radiation Therapy (EBRT) Expand All How does EBRT work? All external beam radiation therapy (EBRT) is done on an outpatient basis. EBRT uses a machine to direct high-energy X-rays at the cancer in daily doses. Using software, your treatment team controls the size and shape of the beam as well as how it is directed at your body to most effectively treat your tumor and minimize damage to surrounding normal tissue.Treatments are typically given five days a week over a period of several weeks, depending on the type of EBRT. New technology allows the radiation to target the tumor more precisely. This reduces radiation exposure to nearby healthy tissue while allowing a higher dose of radiation sent directly to the tumor. Who should consider EBRT? In most cases, EBRT is used to treat localized prostate cancer (confined to the prostate). Radiation can be used in conjunction with surgery if the surgery did not completely remove the cancer or the cancer came back in the prostate area after surgery.Sometimes it is used in more advanced cases. It can be used along with hormone therapy for tumors that have grown outside the prostate and into nearby tissues. It is also sometimes used to relieve pain from bone metastases. Types of EBRT Many of the techniques noted below use technology to direct the treatment to target the cancer. Each type of external beam radiation starts with a scan to “map” your body and custom tailor the radiation to your specific anatomy. Special computers are then used to plan radiation treatment to deliver an adequate dose to the prostate while sparing nearby organs, such as the rectum and bladder, as much as possible.Three-Dimensional Conformal Radiation Therapy (3D-CRT)3D-CRT uses imaging tools like CT or PET scans to precisely map the tumor before treatment. Photon radiation is then delivered to effectively target the tumor, but may affect a small amount of normal tissue such as the bladder or rectum. Therefore, 3D-CRT tends to be less favored today due to newer techniques that may result in fewer side effects.This type of EBRT can also be used to relieve pain and other symptoms in metastatic prostate cancer.Intensity Modulated Radiation Therapy (IMRT)IMRT allows for the radiation dose to conform more precisely to the tumor by controlling or modulating the intensity of the radiation beam. The radiation beams can be broken up and their strength adjusted individually. This allows doctors to safely deliver a higher dose of radiation to the tumor directly, while delivering lower doses to the healthy tissue nearby. Internal markers to track the prostate during treatment (called fiducials) may be used, such as Calypso. Your body may be immobilized in order to keep you from moving during treatment.There are several types of IMRT available from various LINAC manufacturers, such as Tomotherapy (Accuray) and volumetric modulated arc therapy (VMAT; Varian and Electa).Image Guided Radiation Therapy (IGRT)IGRT is a form of IMRT. With IGRT, CT scans are taken both during the planning process and just before treatment begins. Comparing the two images allows doctors to adjust treatment as needed, since tumors can move between treatments. This allows precision targeting of the cancer while avoiding nearby healthy tissue. In some cases, doctors will implant tiny markers (called fiducials) in or near the tumor to pinpoint it for IGRT to account for organ/tumor motion even if the body is immobilized.Calypso is another form of IGRT where the prostate can be tracked during the treatment.Stereotactic Body Radiation Therapy (SBRT)SBRT, also called Stereotactic Ablative Radiotherapy (SABR), is a form of IGRT. SBRT is used to deliver high doses of radiation to a precise area in the prostate using specialized techniques not achievable by standard conventional radiation therapy. This allows the total dose of radiation to be given in 5 treatments over 1-2 weeks rather than the typical 20-44 treatments over several weeks used for other types of EBRT.The radiation beam needs to be extremely accurate in order to limit the side effects on healthy tissue. During treatment, the body immobilization used is often more restrictive than with IMRT due to the high doses of radiation. Fiducials, or internal prostate markers, are often used in this type of treatment.Cyberknife and Truebeam are two types of LINACs used for SBRT treatment of prostate cancer.Proton Beam Radiation TherapyProton therapy is a very precise cancer treatment that uses a different type of radiation than the other types of EBRT. Instead of photons, this type of radiation uses protons. Protons act like a “depth charge” in that at a certain depth in the body they release a high dose of radiation. The radiation does not go beyond this depth (no “exit dose”) which may decrease exposure to normal tissues.Clinical trials to evaluate proton beam radiotherapy are still ongoing. It is often viewed as experimental, and insurance companies may not cover it.MRI-Guided Radiation Therapy (MRgRT)A recent development is real-time MRI-guided radiation therapy (MRgRT). MRI provides prostate visualization for accurate and precise dose delivery to the tumor and avoidance of radiation to surrounding healthy tissue. MRI visualization eliminates the need for implanted fiducial markers and enables the use of MRgRT for SBRT in 5 or fewer sessions.With MR-guided radiation therapy, a new MRI scan is acquired for each treatment, and a personalized plan is developed to fit the patient’s anatomy that day.MRIdian is a type of MRI-guided radiation therapy. When the prostate or nearby sensitive organs like the rectum and bladder change position during treatment, MRIdian automatically turns the radiation beam off. When the organs return to the correct position, the radiation beam automatically turns back on, and treatment continues. Side effects of EBRT As with most prostate cancer treatments, EBRT can also cause side effects. The severity can depend on the type of radiation, dose size, length of treatment, and area of treatment.These side effects may include:Frequent urinationDifficulty urinating or pain during urinationBlood in the urineUrinary Incontinence (inability to control the bladder, such as leakage)Abdominal crampingDiarrheaPainful bowel movementsRectal bleedingRectal incontinence (inability to control the bowels, such as rectal leaking)FatigueErectile dysfunctionReduced sperm production (usually temporary, months to years, but a permanent reduction, or infertility, is possible)Skin irritationBone weakening or lossSecondary cancers in the region of the radiation (sometimes, but rarely, new cancers develop due to radiation) Space OAR is a hydrogel product for men choosing radiation therapy that can reduce the radiation received by the rectum during treatment. This can help decrease the chances of developing rectal complications such as the inability to control your bowels. The hydrogel is injected between the prostate and rectum where the gel solidifies and creates a space before radiation begins.If you are considering prostate cancer treatment with a form of EBRT, talk with your radiation oncologist to discuss options, potential side effects, and how those side effects will be managed. Internal radiation Expand All Types of internal radiation Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside.Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer.Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Learn more about radiopharmaceuticals. Who should consider brachytherapy? Brachytherapy is used for men with localized prostate cancer, or cancer that is confined to the prostate. Radiation can be used in conjunction with surgery if the surgery did not completely remove the cancer or the cancer came back in the prostate area after surgery. How does brachytherapy work? Brachytherapy involves implanting small, permanent radioactive seeds or temporary needles into the cancerous prostate. There are two different types of brachytherapy one can receive.Permanent or low-dose rate (LDR) brachytherapyIn this procedure, small metal seeds are placed into the prostate. These seeds gradually deliver the radiation to the prostate over several months. Once the radiation is lost, the seeds remain in the prostate. They are harmless and should not bother you.There are different types of radioactive seeds used, such as I-125 (radioactive iodine) and Pd-103 (radioactive palladium), which release radiation at different rates.Temporary, or high-dose rate (HDR) brachytherapyIn this procedure, catheters are placed into the prostate while the patient is under anesthesia. After a scan of the prostate is used to plan the radiation treatment, small radioactive sources are moved through each of the catheters. Once the treatment is complete, the tubes are removed.This type of brachytherapy is generally given over several treatments. Once treatment is over, there is no radioactivity left in your body. Unlike in permanent/low-dose brachytherapy, there is no need to take special precautions around others after treatment.After you are identified as a good candidate for brachytherapy, an ultrasound is used to guide the placement of needles into the prostate. Depending on whether you and your doctor have chosen permanent/low-dose brachytherapy or temporary/high-dose brachytherapy, these needles are then used to either put in permanent seeds or temporary radiation sources.Placement of seeds is a minimally invasive procedure and does not require incisions. Men undergoing the procedure can return to full activity in less than a week. This is done as an outpatient procedure. Side effects of drachytherapy Side effects of brachytherapy can include:Frequent urination, urinary retention, or burning with urinationErectile dysfunction (ED)Urethral stricture or narrowing of the urethraDiarrhea or blood in the stoolSecondary cancersIf you choose permanent or LDR brachytherapy, for the short time that the seeds are giving off larger amounts of radiation, you should avoid close proximity to children or pregnant women. Make sure to talk with your radiation oncologist or oncology nurse for instruction about radiation safety and exposure for family members or pets.If you are traveling through an airport following brachytherapy treatment, there is a chance that radiation detectors will be set off. Talk to your radiation oncologist and ask for a note to indicate you’ve just had radiation treatment. Learn More Videos & Webinars Side Effects of Prostate Cancer Treatments, Risk Mitigation, and Treatment Advances Prostate cancer treatments can result in a variety of side effects, including loss of sexual, urinary, and bowel function. Thankfully, new side effect risk reduction and treatment strategies exist. The Future of Radiation in Prostate Cancer The landscape of prostate cancer treatment is evolving, but Dr. Michael Greenberg of Jefferson Health breaks some of it down for us. In this enlightening video, we explore the cutting-edge advancements and promising innovations in radiation therapy for prostate cancer. Discover how state-of-the-art technologies, precision medicine, and novel techniques are revolutionizing treatment outcomes, minimizing side effects, and shaping a brighter future for Radiation & Side Effect Mitigation Want to know radiation therapy for cancer treatment and the crucial strategies for mitigating potential side effects? Dr. Eric Shinohara provides a comprehensive understanding of how advanced radiation technologies, coupled with personalized care, can minimize discomfort and enhance the overall quality of life during and after treatment. Explore the science and practices behind effective side effect management, empowering you with knowledge for a smoother and more comfortable journey through radiation therapy.