There are several available options for the management of your prostate cancer. At the time of your consultation your radiation oncologist will help you decide which option might be best for you.

Some but not all prostate cancers may be slow growing and therefore, some patients decide to watch or wait the progression of the disease. With this type of “observation” approach you may avoid potential side effects or complications from surgery or radiation therapy. However, it is possible that your cancer may spread beyond a stage at which it can be successfully treated, which could cause significant symptoms or even death. Radiation therapy is used to treat about one million cancer patients in the United States each year and is very effective in destroying cancer cells. In prostate cancer treatment the most common side effects arise when the radiation beam irradiates adjacent healthy organs causing complications like impotence, urinary incontinence and rectal bleeding. Our doctors take rigid measures to guard against damaging healthy tissues that surround the tumor caused by misalignment and unpredictable tumor motion. There are many different radiation treatments that may be prescribed.

Three-Dimensional Conformal Radiation Therapy (3-D CRT)
This approach gives radiation from the outside of your body from several different directions, with the use of a linear accelerator. With the use of a CT scan the treatment area is shaped to your particular anatomy.

Treatments are given five days a week and last approximately 10-15 minutes per day. Most men are able to continue their normal activities including working and driving. Potential side effects may include fatigue, frequent urination, loose bowel movements, rectal irritation, and possibly diarrhea. Although not likely to happen, long-term complications can occur which, will be reviewed by your radiation oncologist at the time of your visit.

Intensity-Modulated Radiation Therapy (IMRT)
This approach is an advanced form of 3-D conformal radiation therapy and also delivers radiation externally from a linear accelerator. However, instead of the 4-6 beams used with 3-D CRT, approximately 60-70 beamlets are utilized with IMRT, allowing the same or higher dose to the prostate gland while keeping the dose to the nearby bladder and rectum minimal. The side effects and potential complications are similar to 3-D CRT, although they may occur less frequently.

Image Guided Radiation Therapy (IGRT)
The prostate gland moves up to an inch each day depending on the fullness of the bladder and rectum. Image guidance is used together with either 3DCRT or IMRT.

There are three types of IGRT used at the ROC: The Calypso® 4D Localization System which enables RAS' radiation oncologists the ability to pinpoint a prostate tumor's location with accuracy and continuously monitor its position in a real-time fashion during radiation treatment; One type uses a special ultrasound probe placed on the outside of the abdomen to assist in targeting the prostate. A third type uses marker seeds placed in the prostate gland, which are imaged just prior to treatment using digital x-rays. All three of these methods ensure that the prostate is treated precisely and accurately each day while minimizing radiation delivered to the bladder, rectum and other tissues.

Brachytherapy

Permanent Seed Implants
This procedure is performed in the hospital under anesthesia and involves the placement of approximately 100 radioactive seeds permanently into the prostate gland. Seed implants are used alone or in combination with external beam radiation depending on how advanced your cancer is. The side effects and potential complications are again similar to those seen with 3-D CRT.

High Dose Rate Temporary Implant (HDR)
This procedure is also performed in the hospital under anesthesia and involves the temporary placement of approximately 20-25 plastic tubes into the prostate gland under ultrasound-guidance. A radioactive source is then placed in the tubes for a short period of time. This procedure involves an overnight hospital stay. It is then followed by a shortened five-week course of external beam radiation therapy given as an outpatient. The potential for side effects and complications are similar to that of 3-D CRT.

Hormonal Therapy
Prostate cancer is usually stimulated by the male hormone testosterone. Decreasing the amount of testosterone produced in the body or blocking its effects can kill some prostate cancer cells and also slow its overall growth. Hormonal therapy does not generally get rid of a prostate cancer entirely by itself. It is sometimes used in addition to radiation therapy, especially for less favorable prostate cancers. It is usually administered in the form of a shot given every 1 to 4 months and sometimes in the form of taking pills.

Other Treatments

Proton Therapy
Like IMRT, proton therapy is a type of external beam radiation that reduces the dose of radiation to the bladder and rectum compared to 3DCRT. It generally cannot use image guidance and is available in only a few locations throughout the US.

Cryotherapy
This procedure involves the freezing of the prostate using a probe or probes under the guidance of a urologist. Although a promising approach, there are no long-term results yet available for cryotherapy showing comparable effectiveness to standard surgical or radiation approaches.

Clinical Trials
Clinical trials, sponsored through the Radiation Therapy Oncology Group (RTOG) and the National Cancer Institute, may be available for you. By participating in a clinical trial, you may be able to receive newer types of treatment that might not otherwise be available. In addition you will be helping out those in the future who face prostate cancer. You may ask your radiation oncologist if you are eligible.

Surgery
Radical prostatectomy involves the surgical removal of the prostate gland. Your urologist, who is a surgeon, can tell you whether you are a candidate for this procedure, as well as inform you of the risks and benefits of this approach.

As a full-service radiology provider, we are able to integrate cutting-edge diagnostic imaging including CT and MRI. Your physician will order the appropriate exam based on your individual needs.

PET/CT is widely used to establish a cancer treatment plan that includes radiation therapy. Additionally, PET/CT is often recommended to evaluate the extent of the cancer throughout the body and/or to measure the effectiveness of adjuvent therapies such as Chemotherapy.