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Prostate Cancer Radiation Therapy

In the treatment of prostate cancer, internal or external radiotherapy can be used, but radiotherapy is the best known and most widely used. During the external radiation therapy sessions, the radiation source (linear accelerators) is placed outside the patient projecting its rays directly to the tumor. Radiation rays most currently used in radiotherapy are photons or very high energy X-rays, used in 90% of cases. More rarely, certain oncologists can recommend protons and other types of particles; carbon ions are being evaluated. While attacking cancer cells, unfortunately the rays also cause damage to the cells they enter in contact, whether cancerous or healthy. This explains the side effects of radiotherapy.   


During prostate treatment with radiation therapy, the doctor maximizes its effectiveness on the prostate while minimizing toxicity to healthy tissue and surrounding organs: rectum, bladder and the anal canal in particular. Therefore, it is important to focus as accurately as possible the irradiation on the volume of the prostate to avoid unnecessary physiological damage.  It is also important to determine, for each patient, the optimal dose of radiation capable of destroying the tumor but not surrounding healthy organs at risk. 


Generally, gray (abbreviated Gy) is used to denote or express the radiation dose. A dose of 1 Gy corresponds to an energy of 1 joule absorbed in a mass of 1 kg. The dose of radiation required to destroy a tumor depends on the type of cancer. The tolerance dose of organs at risk also varies according to the organs and the radiosensitivity of the patient. 


In the treatment of prostate cancer, doses usually delivered are 70 to 80 Gy for an exclusive radiotherapy. The doses are lower in case of radiation therapy performed after a radical prostatectomy. It is also necessary to consider the total duration of treatment and its division into several sessions allowing tissue to regenerate. During external beam radiation of prostate cancer, the radiotherapy sessions take place over several weeks, usually 4 to 5 sessions per week. 


Are you a candidate for radiotherapy? 


You are not a candidate for radiotherapy if you:  

  • previously had radiation therapy of the pelvis 
  • are suffering from a progressive, inflammatory rectal disease 
  • wear an indwelling Foley catheter 
  • suffer from moderate to severe chronic diarrhea 
  • suffer from ulcerative colitis 
  • have a urinary tract obstruction 
  • Have a very small bladder capacity.  

Prostate Cancer Radiation Therapy Side Effects 


By attacking the cancer cells of the prostate, it is impossible to completely avoid irradiating surrounding tissues, causing side effects. Prostate radiation therapy side effects vary widely from one person to another depending on the location and volume irradiated, the dose, radiosensitivity of the patient and his general health status. However, with advances in the medical field, the techniques of radiotherapy are more accurate and can minimize the occurrence of these side effects.  


There are side effects that occur during treatment and a few weeks – immediate, acute or early adverse effects - and side effects that may occur months or years after treatment - late effects or complications 


Acute Effects 


Inflammation of the bladder: among the adverse effects of radiotherapy of the prostate, inflammation of the urethra (urethritis) and bladder (cystitis) is common. This problem tends to lead to frequent urination (especially at night), difficulty urinating and burning when urinating. It is recommended to drink plenty of freshly made juice and water (about 1.5 liters per day) to reduce the risk of cystitis and the risk of urinary tract infection. To treat urinary problems, you may be prescribed alpha-blocker drugs.  


Inflammation of the rectum: After treatment, patients can experience an inflammation of the rectum (proctitis). Signs indicating this health issue often include more frequent and sometimes painful bowel movements, sometimes with "false needs" and burning sensation in the anus. Some patients may also have blood in the stool (hematochezia). These can also be rectal bleeding associated with hemorrhoids; therefore, see your physician before any conclusion. To find relief from the inflammation, you can take sitz baths, steroid creams or suppositories. 


Diarrhea: When the pelvis is irradiated, diarrhea is not out of the picture. To solve this problem, anti-diarrhea medications and prescription of a residue-free diet or a low residue diet are recommended to the patient. 


Late Side Effects 


All men do not experience late side effects of prostate radiation therapy. When they appear, these symptoms tend to appear a few months (minimum 3 months) after the end of treatment. They affect mostly the urinary tract, digestive and/or sexual organs.  


Urinary - Some late side effects are often similar to the immediate side effects: feeling a frequent urge to urinate or have difficulty passing urine, which can be treated with alpha blockers. Rarely, blood may be present in the urine (hematuria). More rarely, the occurrence of incontinence is present in certain men.  


Digestive – after prostate radiation therapy, some patients may experience rectalbleeding which appears in the stool (hematochezia), particularly in cases of constipation. Although very rare, some men may have bleeding outside of bowel movement. This requires immediate treatment to prevent complications.  


Sexual - sexual disorder is a fearful side effect of prostate radiation therapy. Unfortunately, the treatment causes it in certain patients. On average 50 to 70% of prostate cancer patients have impotence gradually, over months or even years. Apart from impotence, the effects of radiotherapy are now quite rare, less than one in ten patients.