Prostate cancer is the most common malignancy in American men.

  • In 2003, more than 220,000 men were diagnosed as having prostate cancer, making it the number one type of cancer in men.
  • Nearly 29,000 men died from prostate cancer in 2003.
  • More than 75 percent of prostate cancer is diagnosed in men over age 65.

Risk Factors For Prostate Cancer

Incidence of prostate cancer increases with age.

  • Median age at diagnosis in Caucasian males is 71.
  • African-American men have the highest incidence of prostate cancer in the world.
  • Heredity accounts for 5 to 10 percent of cases.

Screening For Prostate Cancer

According to the American Cancer Society, men aged 50 or older should be offered a digital rectal exam (DRE) and a PSA blood test. However, it is a good idea to visit your doctor earlier to establish a baseline PSA level so you can monitor changes.

  • Prostate specific antigen (PSA) is a valuable marker for prostate cancer although BPH or infection may also cause a rise in PSA.
  • Normal range is 0-4, however, a PSA above 3 in men younger than 60 may be considered abnormal.
  • African-American men and men with a family history of prostate cancer should be examined beginning at an earlier age.

Diagnosing Prostate Cancer

Prostate cancer is most often diagnosed through a blood test measuring the amount of prostate specific antigens (PSA) in the body. However, signs and symptoms of prostate cancer can include:

  • Changes in urinary flow: Frequency, urgency, hesitancy
  • Frequent nighttime urination
  • Painful urination
  • Blood in urine

Other conditions that may cause these symptoms include an enlarged prostate (benign prostatic hypertrophy or BPH) or infection.

Radiation Therapy Options for Treating Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options with a radiation oncologist and a urologist. Radiation therapy treatment options to cure prostate cancer include:

  • External beam radiotherapy
  • Prostate brachytherapy

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the prostate.

There are two principal methods for delivering external beam radiation.

  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the prostate. Tailoring each of the radiation beams to accurately focus on the patient’s tumor allows coverage of the prostate cancer while at the same time keeping radiation away from nearby organs such as the bladder or rectum.
  • Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This technique allows more precise adjustment of radiation doses to the tissues within the target area, potentially allowing an increased radiation dose to the prostate and reduced doses to nearby normal tissues. Higher doses to the prostate translate into a greater chance for cure, while lower doses to surrounding organs mean fewer side effects.

Both types of external beam radiation therapy are acceptable treatment; IMRT offers advantages for some but not all prostate cancer patients. With either type of therapy, painless radiation treatments are delivered in a series of daily sessions, each under half-hour in duration, Monday through Friday for seven to ten weeks overall.

Potential side effects, including fatigue, increased frequency or discomfort of urination, and loose stools, typically resolve within a few weeks after completing treatments. Impotence is also a potential side effect of any treatment for prostate cancer. However, many patients who receive radiation therapy for prostate cancer are able to maintain sexual function.

Prostate Brachytherapy

Prostate brachytherapy, better known as a seed implant, is often done in the operating room.

There are two methods of delivering internal radiation for prostate cancer:

  • Permanent seed implants
  • High-dose rate temporary seed implants

These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia. Isotopes of iodine or palladium are most commonly used. The seeds are approximately four millimeters long and less than a millimeter in diameter. In certain situations, both prostate brachytherapy and external radiation may be recommended to combat the tumor.

The side effects from seed implants are similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.

Proton Beam Therapy

In a few parts of the country, proton beam therapy is being used to treat prostate cancer.

Proton therapy is administered much the same way as external beam therapy, but it uses protons rather than x-rays to irradiate cancer cells.

Hormone Therapy

Certain patients may benefit from hormone therapy in addition to radiation. In some patients, hormone therapy works with radiation therapy to improve cure rates.

Prostate Cancer Care in the Carolinas

The prostate is part of a man’s reproductive system, located in front of the rectum and under the bladder. It surrounds a tube called the urethra, through which urine flows from the bladder. The prostate is responsible for making part of the seminal fluid that helps carry sperm during intercourse. Prostate cancer in its early stages rarely causes symptoms, though patients can have alterations in their ability to urinate from enlargement of the prostate, or have blood in the urine, or have changes in their erection capability.

99%

The 5-year relative survival rate for all stages of prostate cancer is 99%

60%

60% of prostate cancer cases occur in men who are over the age of 65

29K

Approximately 29,000 men will die from prostate cancer this year

164K

This year, over 164,000 men will be diagnosed with prostate cancer

How Does Someone Get Prostate Cancer?

It is important to understand prostate cancer risk factors. Talk to your doctor about prostate cancer screenings, and be mindful of the following risk factors:
  • Age
  • African-American descent
  • Family history
  • Obesity
  • Poor diet
  • Lack of exercise
  • What are the Symptoms of Prostate Cancer?

    Some of the most common symptoms when it comes to prostate cancer is difficulty or pain while urinating. It’s important to recognize the symptoms of prostate cancer and to act if they ever occur to you. Be sure to consult a doctor if you experience any prostate cancer symptoms.

    Since prostate cancer may not show symptoms in its early stages, it is recommended that men take a prostate-specific antigen (PSA) test, which subsequently leads to a biopsy. Prostate cancer is expected to affect over 164,000 men in the United States this year, According to the American Cancer Society. Fortunately, a large percentage of prostate cancer is found in the early stages, when it is very curable with local treatments such as surgery or radiation therapy. Patients are generally seen by a surgeon and by a radiation oncologist to help determine the best treatment for them.

    • Frequent urination
    • Weak or uncontrollable urination
    • Painful urination
    • Erectile dysfunction
    • Blood in urine or semen
    • Pressure in rectum
    • Painful ejaculation

    How is Prostate Cancer Treated with Radiation?

    Radiation therapy is a type of treatment used for many patients with prostate cancer. It uses high-energy radiation beams, usually X-rays, that are powerful enough to kill cancer cells and stop them from growing or to slow their spread elsewhere in the body.

    There are two main types of radiation therapy for prostate cancer treatment:

    1. External beam radiation, in which a machine called a linear accelerator emits high-energy radiation beams and directs them directly at the prostate gland
    2. Internal radiation, sometimes called brachytherapy, which uses implantable “prostate seeds” or pellets that emit specific doses of radiation to the prostate from inside the body

    Radiation therapy is considered a standard treatment for prostate cancer and has several specific goals. The main goal is to kill or slow the growth of prostate cancer cells while preserving surrounding healthy tissue. Radiation therapy is so effective that it may be considered a cure for some early stage prostate cancers. Radiation therapy may also help alleviate symptoms of advanced prostate cancer, such as pain, if curing the cancer isn’t possible. Even if radiation therapy can’t completely destroy all prostate cancer cells, it can still shrink the tumors.

    Radiation therapy is sometimes the only treatment recommended for prostate cancer if the cancer is detected in its early stages. It may also be used in combination with other treatments. Some doctors also recommend radiation therapy after surgery to prevent or treat cancer that may return post-operatively.

    Southeast Radiation Oncology Group staffs many centers where quality radiotherapy can be delivered, with facilities in North and in South Carolina.

    External Beam Radiation

    External beam radiation therapy for prostate cancer treatment with a machine called a linear accelerator consists of an 8 to 8 ½ week course of therapy, with treatments delivered Monday through Friday.

    Intensity Modulated Radiotherapy

    A special type of radiation planning and targeting, called intensity modulated radiotherapy (IMRT), is utilized at all of our facilities, to minimize radiation dose to surrounding organs much better than we could even 10 years ago. Because of the ability to tailor the dose closely to the prostate, patients often receive the therapy with little or no ill effects, though some patients will get irritation to urinate, some fatigue or loose stool by the end of their treatment course. Fortunately, these symptoms are usually readily treated with medications, and are self-limited, reversing over 2-4 weeks.

    Nurse and elderly man spending time together

    Stereotactic Body Radiosurgery

    In 2013, the national organization for radiation oncologists, the American Society of Therapeutic Radiation Oncology (ASTRO), publicized a notice that in select prostate cancer patients, utilization of a very short course of radiotherapy for curative treatment of prostate cancer had enough clinical follow up as to be deemed a reasonable option to offer patients. This short course of treatment is also called stereotactic body radiosurgery (SBRT). It consists of a total of 5 treatments given over 2 to 3 weeks. The dose given at each treatment is higher than the standard dose given in an 8-week course of therapy, but the extraordinary accuracy allows for even less of a margin of normal tissue inclusion within the beams, allowing this therapy to be done safely. Southeast Radiation Oncology has had several years of experience using this technology at one of our facilities with a special linear accelerator called the CyberKnife, and we are pleased to offer this as yet another cutting-edge method of treatment for prostate cancer patients.

    Radioactive Implant Therapy

    Some patients are best served with a radioactive implant of the prostate using small radioisotope pellets that are implanted into the prostate, with or without supplemental external beam treatment. These implants are done under anesthesia, and several of our facilities offer this. These are done in partnership with our urologic physician colleagues. The results from treatment with a single radiation implant for appropriate patients with prostate cancer have been excellent, in excess of 90% cures reported. This type of therapy has over 15 years of follow-up information in the medical literature, assuring us that these treatment outcomes are permanent.

    Focal Radiation Beam Therapy

    Radiation also has value in treating patients with advanced prostate cancer that has spread to other sites in the body. The initial treatment for patients with spread of prostate cancer is anti-testosterone hormone administration, a shot given every one to six months, administered by the urologist. If prostate cancer spreads or is advanced at diagnosis, the cancer tends to travel to bone. Focal radiation beam therapy for a short course, one to ten treatments to an area of pain, is often effective at reducing or eliminating pain.

    Injectable Intravenous Radium-223

    Patients can also benefit from a new treatment with injectable intravenous Radium-223, that has been used to treat the bone sites of cancer spread by traveling by the bloodstream to the areas of disease in bone. This very targeted therapy has a minimal effect on blood counts. One of the radiation therapy facilities staffed by Southeast Radiation Oncology has been on the forefront of use and research of this agent and has been recognized as a national leader with the experience gained with Radium-223.

    Brachytherapy

    SERO physicians in Charlotte, NC and surrounding locations have performed prostate seed implants since the mid-90s working with our urologic peers. SERO continues to manage a robust prostate seed implant program at most of the centers and have over 10 physicians trained in this technique. Since inception of the prostate seed implant program at SERO, thousands of patients have enjoyed the good results discussed above at a lower cost of care. All prostate cancer patients deserve a Multidisciplinary Approach as recommended by the American Urologic Society and Commission on Cancer which should include a direct evaluation by a radiation oncologist who is skilled in this procedure.

    What are the Side Effects of Radiation Therapy for Prostate Cancer?

    The side effects of radiation for prostate cancer include:
    - Urinary leakage or incontinence
    - Frequent, difficult, and/or painful urination
    - Bloody urine
    - Diarrhea
    - Stomach cramps
    - Bleeding or leaking from the rectum
    - Painful bowel movements
    - Fatigue
    - Skin reactions that may look like a sunburn
    - Lymphedema, or swollen lymph nodes, especially in the groin area
    - Sexual dysfunction, such as decreased semen volume or erectile dysfunction

    Most side effects are mild, however. Using more advanced radiation technologies that can deliver a high targeted dose of radiation to prostate cancer cells, while sparing surrounding healthy tissues, may help reduce the severity and duration of radiation side effects.

    How Long Do Side Effects of Prostate Radiation Therapy Last?

    Side effects of radiation for prostate cancer can last from days to weeks, and occasionally longer. Issues, such as bowel and urinary incontinence, typically persist for up to six weeks following the last radiation treatment. In rare cases, side effects may arise months after treatment.

    What is the Success Rate of Radiation Treatment for Prostate Cancer?

    Both of the main types of radiation treatment for prostate cancer, including brachytherapy and external beam radiation, have a five-year survival rate of about 90 percent. Success rates are even higher in patients who have only localized prostate cancer, in which the cancer hasn't spread to other areas of the body. Radiation is considered a highly effective prostate cancer treatment.

    How Long is Radiation Treatment for Prostate Cancer?

    Radiation treatment for prostate cancer generally lasts for one to two months, at a frequency of about five days per week. External beam radiation usually takes less than one hour per session. The total number of treatments needed depends on individual factors, including how large the prostate cancer is, whether the cancer has spread to other parts of the body, and the patient’s overall health.