Page 201 - Urological Health

In some cases of localized recurrence, it’s even possible to completely cure the disease through
radiation therapy alone or in combination with hormone therapy.

Patients with slowly progressing recurring cancer, either localized or distant, may be good
candidates for intermittent hormone therapy.

If the recurrence appears to be localized, slow-growing and not particularly worrisome in any
other respect, your doctor may recommend that you forego treatment altogether. For example, in a
case where PSA levels begin to rise five years after an operation, there will likely be no metastasis for
another 10 or 15 years.
Every case is unique, and you must weigh the pros and cons carefully in close consultation with
your doctor.

Radiotherapy
Radiation of the prostate can be given in two forms: external beam radiotherapy and brachytherapy.

1. External beam radiotherapy
The aim of radiation is to kill cancer cells with radioactive rays. CAT scans and computers allow more
precise targeting of the prostate, while minimizing the exposure of adjacent tissue to radiation. Each
UNDER REVIEW
treatment takes a few minutes and does not require an anesthetic.
The total dose is typically given five days a week over seven weeks. Hormonal therapy may be
given along with radiation for a period of two to three years if you have high-risk disease. The cell-
killing effects of radiation continue after the treatments, and therefore it may take as long as a year to
evaluate success, even longer if you’re also taking hormonal therapy.

Unlike prostatectomy where PSA is expected to become undetectable, the PSA after radiation falls
over time. Recurrence of cancer is usually diagnosed when the PSA starts to rise from the lowest level
attained after the radiation.
Despite our best efforts and technology, it is difficult to entirely avoid radiation to organs around
the prostate, such as the bladder, the rectum and the erection nerves. Side effects include frequency
and urgency of urination, blood in the urine, diarrhea, and blood in the stool. Erection difficulties can
also occur, although they generally develop over time and not at the time of treatments.

2. Brachytherapy

Brachytherapy or seed implant is when your doctor places radioactive pellets directly in the prostate.
It is a day-procedure typically done under a spinal or a general anesthetic. Brachytherapy is offered to
patients with low-risk, non-aggressive disease. Patients with large prostates or significant lower urinary
tract symptoms are usually not candidates for this option. The seed implantation causes swelling in
the prostate, which may lead to difficulty urinating.

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