How Does Radiotherapy Work?
Radiotherapy aims to destroy prostate cancer cells while minimizing damage to healthy cells. External beam radiotherapy (EBRT) uses high-energy X-ray beams directed at the prostate from outside the body. These X-rays damage the cancer cells, stopping them from growing and spreading. While Radiotherapy permanently damages and kills cancer cells, healthy cells can repair themselves and recover quicker.
Who Can Have Radiotherapy?
Radiotherapy is suitable for various stages of prostate cancer:
- Localised Prostate Cancer: Suitable if the cancer hasn’t spread outside the prostate.
- Locally Advanced Prostate Cancer: If the cancer has spread just outside the prostate.
- Recurrent Prostate Cancer: If the cancer returns after initial treatment aimed at curing it.
Are there different types of Radiotherapy?
1. External Beam Radiotherapy (EBRT):
- Intensity-Modulated Radiotherapy (IMRT): Most common type in the UK, it uses precise radiation doses to target cancer cells while sparing healthy tissue.
- Stereotactic Ablative Radiotherapy (SABR): Delivers high doses of radiation over fewer sessions. Machines like CyberKnife® are used for this precise treatment.
- Proton Beam Therapy: Not used for prostate cancer in the UK because standard Radiotherapy is equally effective or better.
2. Brachytherapy: This involves placing radioactive seeds directly into the prostate, offering a high dose of radiation to the cancer.
What are the Advantages and Disadvantages of Radiotherapy?
Advantages:
- Aims to eradicate localised or locally advanced cancer.
- Allows continuation of normal activities, including work and driving.
- Non-invasive and painless treatment sessions.
- Suitable for patients not fit for surgery.
Disadvantages:
- Requires frequent hospital visits over several weeks.
- Possible side effects include bowel, urinary, and erection problems, as well as fatigue.
- Risk of secondary cancers is slightly increased.
How do you prepare for Radiotherapy?
Preparation involves ensuring the bladder is full and the rectum is empty to keep the prostate in a consistent position for accurate targeting. This may include dietary adjustments and hydration routines. Enemas are typically prescribed.
What to Expect During Treatment
Treatment typically involves daily sessions, five days a week, over several weeks. Each session lasts about 10 minutes, but the total time at the hospital may be up to two hours for preparation.
After Radiotherapy: Monitoring and Side Effects
Follow-Up:
- Regular PSA tests to monitor progress.
- Follow-up appointments to address any side effects and assess treatment efficacy.
Short-Term Side Effects:
- Urinary problems: Frequency, urgency, burning sensation.
- Bowel problems: Diarrhoea, urgency, rectal bleeding.
- Fatigue and skin irritation.
Long-Term Side Effects:
- Chronic urinary and bowel issues.
- Erection problems: May develop up to two years post-treatment.
- Increased risk of hip and bone problems, especially if combined with hormone therapy.
- Small risk of secondary cancers (bladder or bowel).
What are the treatment options after radiotherapy failure?
If prostate cancer recurs, options include hormone therapy, surgery, more Radiotherapy, or treatments like high-intensity focused ultrasound (HIFU) and cryotherapy.
