Prostate Cancer – Radiation
i. External radiation
Most men have only mild side effects, which disappear shortly after the end of treatment.
Most do not have problems with erection or sexual intercourse immediately after irradiation but can cause such side effects at a later time due to the delayed mode of action of the tissues.
Most of these patients will respond to treatment with drugs used for erectile dysfunction. The younger the patient is, the greater are the chances to maintain sexual function. During treatment can some men experience problems with urination. The most common signs and symptoms include urinary urgency and urinary frequency.
These problems are usually transient and resolve a few weeks after the treatment. Long obstructive problems with urination may occur after the prostate is not removed but remains.
In such persisting cases, usually one surgery (transurethral prostatectomy) is required. Problems of the rectum – like e.g. soft stools, rectal bleeding, discomfort during bowel movement and urgent feeling to defecate – may occur during treatment. When treatment is completed these problems usually disappear.
Some men may still have such problems of the rectum for months after the completion of radiation. Most of the long term problems of the rectum dissapear after irradiation with improved drugs.
Rarely some men have persistent bleeding or ulcers in the rectum after irradiation. In such case, surgical treatment is performed.
Radioactive implants are gaining ground in recent years in the treatment of prostate cancer. The implants, known as brachytherapy, are placing greater radiation dose to the prostate than does the external radiation for a longer time.
During the placement of implants 40 to 100 in size implants rice grains placed in the prostate with the aid of special needles and ultrasonic guidance. The exact number of implants used, depend on the size of the prostate.
This treatment consists of men with small or medium-sized prostates and low-grade cancers. Sometimes, before the implant placement, hormone therapy is provided to shrink the prostate in size.
These implants may contain one of the following radioactive isotopes – iodine or palladium. The effects of the implants are different from those of external radiation. Implants carry a greater radiation dose to the urethra, causing urinary problems and symptoms such as frequent and painful urination weak in almost all men.
The urinary symptoms after the implants tend to be more severe and last much longer than after external radiation. Symptoms but rectally can be rarer and less severe.
Some men have erectile dysfunction due to the placement of radioactive implants.
iii. High dose brachytherapy (High-Dose-Rate Brachytherapy)
In patients with more advanced or more aggressive cancer types, high-dose brachytherapy may be used which carries the prostate within three or four minutes such a high dose, while low dose brachytherapy would take weeks whole.
The high-dose brachytherapy is always combined with external radiation that lasts 5-6 weeks. Despite the complications of radiotherapy, almost half of patients have shown to be permanently exempted from cancer. Often PSA screening is then enough.
Only PSA screening and recording of how it decreases – with the lowest price to be characterized as “PSA nadir” – is often enough. If though it starts coming up in three consecutive measurements, it is assumed that radiotherapy has failed.