For patients with early stage limited prostate cancer, radical prostatectomy is a classic treatment that has been used for more than 100 years. Simply put, radical prostatectomy is the surgical removal of the prostate gland to completely eliminate the cancer cells hidden inside the prostate gland, hence the medical term “radical prostatectomy”.
However, some patients cannot tolerate surgery because they are old and sick, and their tumors are likely to progress, making them unsuitable for “watchful waiting”.
In fact, radiation therapy can be an effective, less invasive, and well-tolerated way to kill tumors, making it an appropriate option for patients who are too early to tolerate surgery.
What is radiation therapy?
Tumor radiation therapy (or radiotherapy for short) is the treatment of cancer with radiation. Radiotherapy is a method of killing tumors using radiation, such as alpha, beta, and gamma rays produced by radioisotopes, and x-rays, electrons, proton beams, and other particle beams produced by various types of x-ray therapy machines or gas pedals. The role and status of radiotherapy in tumor treatment is becoming increasingly prominent, and it has become one of the main tools in the treatment of malignant tumors.
In the past, radiotherapy to the prostate involved irradiating radiation to the pelvis, which, in addition to killing prostate cancer cells, also affected adjacent organs, such as the rectum and bladder, causing problems with urination and defecation.
Since the early 1980s, with the advent of linear gas pedals and the use of conformal and image-guided technologies, the precision of radiotherapy has been greatly improved, improving tumor control while significantly reducing damage to normal tissues and organs.
What types of radiotherapy are available?
There are currently 2 types of radiotherapy for prostate cancer:
- external beam radiotherapy (EBRT), or external radiotherapy, which uses radiation to treat the tumor from outside the body;
- brachytherapy, in which radioactive particles are placed inside the prostate for internal irradiation.
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Radical external radiation therapy without incision
The therapeutic purposes of external radiotherapy can be divided into 3 categories, namely radical radiotherapy, postoperative radiotherapy, and palliative radiotherapy.
- Radical radiotherapy: This is the treatment for patients with limited and locally progressive prostate cancer, and it can be used to achieve a radical cure, known as “radical surgery” without surgery.
- Postoperative radiotherapy: It is mainly used for high-risk patients to prolong survival and delay tumor recurrence through postoperative adjuvant radiotherapy.
- Palliative radiotherapy: For patients with advanced or metastatic prostate cancer, pelvic pain, constipation, swelling of lower limbs, ureteral obstruction or hydronephrosis can result from pelvic spread of prostate cancer or lymph node metastasis. Palliative radiotherapy can effectively improve the above symptoms and improve the quality of life of patients, but endocrine therapy is preferred for patients with distant metastases.
Because of the different treatment goals, external radiation therapy can be used to treat patients with all stages of prostate cancer, including limited prostate cancer, progressive prostate cancer, and advanced metastatic cancer, and is therefore also known as a “radical cure for prostate cancer without surgery.
The process of external radiation therapy
Step 1:
- Your radiologist will delineate the area to be irradiated, which generally includes the prostate, seminal vesicles and a small amount of surrounding tissue.
- A spiral CT thin-layer scan is applied to map the geometric model of the irradiated target area and normal tissues and to create a digital reconstruction.
Step 2:
- Simulated by CT simulator, the 3D radiation dose analysis is performed by the radiotherapist and then combined with your situation to determine the total irradiation dose so that the external irradiation is highly conformal (increasing the local irradiation dose to the prostate cancer patient’s tumor while minimizing the irradiation dose to the surrounding normal tissues and organs) and reducing the possibility of complications.
Step 3:
- Regular radiation therapy according to the protocol developed for you by your radiation therapist.
- Outpatient radiotherapy is available 5 days a week for about 7 to 8 weeks, with each session taking about 15 minutes (plus pre-treatment prep time, you will need about 1 hour to complete each session)
Short-range irradiation promises to be another radical treatment for limited prostate cancer
Short-range irradiation therapy includes intracavitary irradiation and intertissue irradiation, in which a radiation source is sealed and placed directly into the body’s natural cavity or into the tissue being treated for irradiation.
Prostate cancer brachytherapy includes brief insertion therapy and permanent particle implantation therapy.
Permanent particle implantation therapy, also known as intertissue implantation of radioactive particles, is a relatively common modality that aims to increase the local dose to the prostate while decreasing the radiation dose to the rectum and bladder by implanting radioactive particles into the prostate after accurate localization with a three-dimensional treatment planning system, ensuring treatment efficacy while reducing complications.
The most commonly used radionuclides for permanent particle implantation are iodine-125 and palladium-103, which are implanted trans-perineally under rectal ultrasound guidance. Based on CT or ultrasound, the precise location of the particles is determined, and images are then obtained to calculate and accurately evaluate the dose to the prostate and surrounding tissue. The precise particle implantation intertissue irradiation technique results in high dose irradiation to the target area with little to no effect on normal tissue.
Intralesional radiation therapy is effective and less invasive, especially for elderly prostate cancer patients who cannot tolerate radical prostate cancer surgery, and promises to be an additional radical treatment for limited prostate cancer.
Sometimes physicians will recommend a combination of external and internal radiation therapy to achieve treatment goals while reducing complications from radiation therapy and alleviating patient pain.
Radiotherapy can be used to treat early-stage prostate cancer, but it can also be used for postoperative adjuvant therapy for patients such as those found to have positive cut margins after radical surgery, as well as salvage therapy for patients with biochemical recurrence. As to whether the patient’s condition is suitable for treatment, the doctor will make a comprehensive judgment based on the pathological grading of the prostate cancer as well as the patient’s tolerance and physical condition.
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