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Prostate cancer patients who want to pursue radiotherapy, also called external radiation therapy, as their first
line monotherapy should have these characteristics:
- Gleason
score of 6 or lower
- PSA
level of 10 or lower
- Disease confined to the prostate
gland
- No extensive abdominal scar tissue from other surgeries
- No history of bowel disorders, including ulcerative colitis and diverticular disease
- No history of poorly controlled diabetes
Not meeting all of these criteria does not eliminate radiotherapy as a prostate
cancer treatment option. Read on to see who else is opting for radiotherapy and why. Then speak with a qualified radiation oncologist to see if radiotherapy could be right for you.
Radiotherapy as First Line Monotherapy for Prostate Cancer
Newer forms of external beam radiation therapy include three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), intra-operative radiation therapy (IORT), proton beam radiation therapy (PBRT), and hypofractionated radiation therapy. Other forms of radiation are available and include systemic radiation therapy and radioimmunotherapy (RIT). Radiotherapy is completely non invasive and works by aiming high energy particles at the diseased tissue. External beam radiation therapy may be a good option for patients who do not want to undergo a more invasive treatment.
Patients who undergo radiotherapy as a prostate cancer treatment should have a Gleason score that is 6 or lower and a PSA score that is 10 or lower. These numbers indicate that the prostate cancer is still localized within the prostate gland. An ideal radiotherapy treatment would eradicate the prostate cancer and leave the surrounding organs and tissues completely untouched. 3D-CRT, IMRT, IGRT, IORT, and PBRT are prostate cancer treatments that can help a radiation oncologist come close to this ideal. Cancer that has spread outside of the gland either is more difficult to treat adequately or poses greater risk to the surrounding tissue. In cases such as this, radioimmunotherapy may be considered a viable treatment option.
Radiotherapy and Patient
Age
Prostate cancer patients who are considering brachytherapy,
cryotherapy,
and radical
prostatectomy, may also want to consider radiotherapy as a possible primary monotherapy. Those who do not wish to pursue any type of invasive procedure, even a minimally invasive procedure, may want to consider brachytherapy. If a doctor feels a patient will not be able to tolerate another procedure either due to age or health, the doctor may recommend external beam radiation therapy.
Minimizing Radiation Damage to Healthy Tissue
Conventional external radiation therapy has the potential to expose healthy tissue of the rectum and bladder to the effects of radiation. If a patient has had previous surgery in the abdominal area, the scar tissue from the surgery will cause the colon and the intestines to be exposed to additional radiation. Therefore, these patients may wish to pursue other types of treatments. Also, patients who have had prior radiation treatment to the pelvic area usually cannot receive radiotherapy again.
Salvage Treatment
Brachytherapy is a form of internal radiation therapy. Patients who undergo brachytherapy do not typically receive external radiation as salvage prostate cancer treatment because the prostate gland has already been treated with an extremely high and concentrated dose of radiation. It is unlikely that radiotherapy could destroy what brachytherapy failed to destroy. Patients who would otherwise be good candidates for prostate brachytherapy, but suffer from benign
prostatic hyperplasia (BPH), may want to consider radiotherapy.
Cryotherapy is sometimes recommended as a salvage treatment for when radiotherapy fails. Cryotherapy uses freezing temperatures to destroy prostate cancer. Where radiation fails, the different attack method of freezing may succeed. Patients who have advanced stage prostate cancer with bone metastasis may be candidates for radiotherapy. Radiotherapy can help alleviate the pain that is associated with bone metastasis. Radiotherapy usually cannot destroy high-grade, aggressive cancers by itself. In fact, most treatments for prostate cancer cannot, by themselves, destroy advanced prostate cancer. If a patient wishes to pursue radiotherapy, he should speak with a physician about the advantages and disadvantages to his health.
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