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After being diagnosed with prostate cancer, your urologist may recommend treatment with either surgery or radiotherapy. Both of these represent good treatment options for many men who are diagnosed with prostate cancer that has not spread outside the prostate. Additionally, for some men whose disease has spread, radiation therapy to the prostate may still be appropriate.

What is radiation therapy?

Radiation therapy is a cancer treatment that uses the effects of radiation (high energy rays or particles) to kill cancer cells and shrink tumors. In men with prostate cancer, radiation therapy may be used on its own or as part of a combination of the first treatment along with hormone therapy. It may be used after surgery for those men whose cancer is not removed completely or comes back. Finally, it can also be used to help control cancers and prevent or relieve symptoms for those with more advanced disease.

How is radiation therapy given?

Generally speaking, there are two main ways that radiation therapy is given for prostate cancer: external beam radiotherapy (also known as EBRT) and brachytherapy.

External beam radiation therapy focuses beams of radiation on the prostate gland and the tumor. The experience of receiving each treatment is kind of like having an X-ray or a CT scan. However, the radiation used is much stronger.

Over the last two decades, there have been major advances in the technology that radiation oncologists (radiation therapy doctors) can use to target the prostate and prostate cancer while avoiding the healthy normal tissues nearby. These approaches, called intensity-modulated radiation therapy (IMRT), are commonly used. They may also do repeated imaging before each treatment or use systems to track internal seeds or the surface of a patient’s skin, which is called image-guided radiotherapy (IGRT).

These treatments are often given over the course of weeks. More recently, radiation oncologists have focused on giving fewer, higher doses of radiation therapy for prostate cancer. This is a process called stereotactic body radiation therapy (SBRT). This may be appropriate for some men with prostate cancer but is not right for all men.

Each of the types of radiation therapy listed so far uses a “photon” to deliver energy from the radiotherapy machine to the prostate tumor. There also are machines that use “proton beams.” Proton beam radiotherapy is much more expensive and has less long-term evidence than photon radiotherapy. For prostate cancer, it is not clear that this approach gives better outcomes.

When you have external beam radiotherapy, the radiation therapist will take images to make sure that you are correctly positioned to target the treatment in the right place. Once you are positioned, the radiation therapist will begin treatment. This only takes a few minutes, but you will need to stay as still as possible. While you are being treated, the machine will not touch you and you should not feel anything. After treatment is done, you can leave the treatment center and return to your normal activities.

The second way of giving radiotherapy is called brachytherapy. This is a form of internal radiotherapy. Brachytherapy involves placing a radioactive source directly into the prostate gland and the tumor. These implants may be permanent (seeds that are left in the body; low dose rate brachytherapy) or temporary (high dose rate brachytherapy).

While external beam radiotherapy can be done while patients are awake, brachytherapy requires an anesthetic (either a general anesthetic or spinal) for the surgery to place the radioactive implants. Brachytherapy may be given by itself or in combination with external beam radiation.

Side Effects:


How do I choose?

There are pros and cons to each prostate cancer treatment. Radiation for prostate cancer can irritate the bladder and bowels. Symptoms can include:

  • Pain or a burning sensation when urinating (peeing)
  • The need to pee often
  • Blood in the urine (known as hematuria)
  • Feeling like you need to pee but very little comes out
  • Stomach bloating or cramps
  • Thin, watery, or loose stools
  • Blood in the stool
  • Feeling an urgent need to have a bowel movement

However, these symptoms don’t usually last long and only a small number of men have long-term problems with these issues after treatment.

Unlike surgery, radiation therapy doesn’t tend to affect sexual function right away. But, over time, sexual function may be affected as a man ages. This is because the same nerves that are affected after surgery are also affected long-term after radiotherapy). Some men also note fatigue when they are receiving radiation therapy.

There may be certain reasons that mean you are not able to receive specific kinds of radiation therapy. These can include the size of your prostate or other medical conditions or surgeries you’ve had or symptoms you are experiencing. You should meet and discuss your treatment options with your doctor and find out the details you need to make the right choice for you.

Zachary Klaassen, MD, MSc
Urologic Oncologist, Georgia Cancer Center, Augusta University, Augusta, GA, USA