Radiation therapy employs the use of powerful ionizing rays that can kill cancer cells. Today, radiation therapy is sophisticated and aimed at precise parts of the body. The more precise the treatment, the less severe are its side effects.
The individual receives radiation therapy daily 5 days a week for about 6-8 weeks. Each treatment sessions lasts anywhere from 7-15 minutes. There is no anesthesia, pain or any need for intravenous hydration. Prior to the treatment, the rest of the body is usually protected with lead shields.
The most common side effects of radiation therapy for prostate cancer include:
- Increased urgency and frequency of urination. These problems usually occur right after the radiation therapy is started and are temporary. In some cases, however, side effects may persist for a few weeks after the treatments have stopped.
- Bleeding from the rectum and diarrhea are common after radiation therapy. Some people even have mild pain while going to the bathroom. Unfortunately, the rectal pain and diarrhea may persist for sometime after the treatments have stopped. Development of ulcers is also a common occurrence after radiation therapy. A number of individuals require surgery to excise the ulcers.
Even though radiation therapy does not affect erectile dysfunction, for some unknown reason many people have diminished libido after treatment.
To ensure that the radiation is more specific and directed towards the prostate, small rice sized grains of radiation particles have been developed. These implants can be placed in and around the prostate and deliver high dose of radiation. Known as brachytherapy, this type of treatment is useful in men with moderate-size prostates and low-grade cancer. The implants require surgery and are placed in and around the prostate using ultrasound guided needles.
The surgery can take anywhere from 60-90 minutes and requires general anesthesia. Once the radioactive seeds have stopped emitting radiation, they do not require removal. Radioactive seeds do not emit radiation far from the body, but it is recommended that pregnant women and children should not come near the individuals for at least one year.
The typical side effects of brachytherapy include:
- Slow and painful urination is a common complaint in most men. The chief complaint is the inability to pass urine and many men require intermittent catheterization of the bladder. These particular side effects are more common and severe than with external beam radiation.
- Many men who have seed implants also experience erectile failure.
- Diarrhea and pain during bowel movements occurs less frequently with brachytherapy.
Because testosterone is known to promote the growth of prostate cancer, a large number of anti testosterone drugs have been developed to treat this disease. These drugs block the synthesis or action of testosterone in the prostate. Hormone therapy can be used to either shrink the prostate or can be combined with radiation or surgery to destroy the prostate cancer.
The types of drugs available to reduce testosterone levels include Luteinizing hormone (LH) agonists that can block the effects of LH on the testicles. Typical anti LH drugs include Lupron, Goserelin and Viadur. The drugs are injected into the muscle every 2-4 months.
Other drugs that can block the action of testosterone on the prostate include drugs like bicalutamide and nilutamide. These pills are taken daily for a few months.
Because all types of hormonal drug therapy for prostate cancer develops resistance over time, the drug therapies must be stopped intermittently and the PSA levels measured. If the PSA levels are low, the drugs can be withheld.
The common side effects of hormonal drug therapy include:
- Breast enlargement
- Decreased libido
- Erectile difficulties
- Hot flashes
- Weight gain
- Reduction in muscle mass
- Osteoporosis and bone fractures
Nausea, vomiting, lethargy and fatigue are common with most hormonal type drugs. There are reports that hormonal drug therapy can increase the chance of a heart attack; thus, it is important that you follow up with a physician during the treatment period. As protective measures against a heart attack, individuals should stop smoking and ensure that blood pressure and/or diabetes are well controlled.
Because the testes produce testosterone, there are some physicians who recommend removal of the testes to eliminate testosterone production. While the surgery can be effective, most men are unwilling to have their testes removed. A major benefit of the surgical removal of the testes is that no more expensive hormone injections are required after the surgery. Testicle removal is a simple procedure that can be done under local anesthesia.
Some men undergo removal of the entire prostate to treat prostate cancer. In this procedure, the surgeon also removes the adjacent lymph nodes. There are two basic types of radical prostatectomy. Both types are major undertakings and can take anywhere from 3-5 hours.
The surgery is also associated with a number of complications that include:
- Persistent dripping of urine or incontinence. The incontinence can vary from mild to severe. Sometimes the incontinence can occur with laughing or coughing thus causing changes in lifestyle. In many men, urinary incontinence is so severe that another surgery is required to correct the problem.
- Erectile Disfunction: The majority of men who undergo prostatectomy are not able to achieve an erection. This is chiefly due to damage to the adjacent nerves. Even though nerve sparing procedures have evolved, this complication still persists. Individuals who have difficulty achieving an erection prior to surgery typically have the most severe problem.
ROBOTIC ASSISTED PROSTATECTOMY
Today, robots have been devised that can help the surgeon remove the prostate through small incisions. Robotic surgery is rapidly evolving and there is a steep learning curve for surgeons. The surgery is only done at major cancer centers. The one major advantage of robotic assisted surgery is that the incision is small but the outcomes and complications appear to be no different compared to traditional surgery.
In some individuals the PSA may be mildly elevated and the prostate may not show significant signs of a malignancy. In these individuals, observation with serial ultrasound and measuring PSA levels may be a good option. Observation may also be prudent for individuals who are very old or in poor health. Watchful waiting is an accepted form of therapy, provided the individual understands the facts and consistently attends follow-up appointments.
Other Treatment Options
The use of chemotherapy for prostate cancer is still evolving. This treatment is generally used for disseminated prostate cancer and has multiple side effects. Chemotherapy is generally given to men who are resistant to hormonal therapy or have shown no response to radiation therapy.
Cryotherapy involves the use of a cold probe to kill cancer cells. Today, the technique is refined and is often combined with ultrasound to localize the prostate mass. Recent availably of fine probes has limited the damage to nearby tissues. Most people need multiple sessions of Cryotherapy. Along the same lines of treatment, a variety of other probes (radiofrequency, heating) have been developed to kill the prostate cancer cells.
Research spanning the past few decades indicates the possibility of using gene and immune targeted therapy to treat prostate cancer.