There are numerous treatments for prostate cancer – and when newly diagnosed, trying to find out which may be the right one for you can be confusing. Not only are you and your family dealing with the fact that you have been diagnosed with cancer, and all of the questions and fears that raises, but often decisions around treatments options have to be made in a relatively short space of time. In addition, sifting through lots of reading material, while trying to get your head around medical terms that will be entirely new, can be a daunting task. While it would be difficult to summarise all the treatment options and their pros and cons here, we offer to compare two options that are frequently recommended as being similar and can easily be confused: brachytherapy and radiotherapy.

What is radiotherapy?

Radiotherapy, also known as radiation therapy, is an effective form of treatment that kills prostate cancer cells by using high energy rays or particles. Radiotherapy can be delivered in multiple ways, including brachytherapy and external beam radiotherapy (EBRT).

Radiotherapy treatments can be used to treat both early- to middle-stage prostate cancer, where the cancer is contained within the prostate gland and / or where it may have spread slightly beyond the prostate.

It can be used as a standalone treatment, or in conjunction with other treatments such as hormone deprivation. And it may be used to treat men with limited, slow-growth prostate cancer to reduce the size of the tumour and improve survival and overall quality of life.

It is a highly viable alternative to surgery (prostatectomy) to remove the prostate gland altogether.

External Beam Radiotherapy

External Beam Radiotherapy (EBRT) is the most common type of radiation therapy. It is, as the name suggests, a form of external radiotherapy that uses high energy beams to kill the cancer cells. During the treatment, the high energy beams are generated by a machine called a linear accelerator that aims the beams at your prostate gland from outside the body.

Typically, EBRT involves 20 lots of 10 minute treatment sessions over four weeks. You will usually have one treatment a day, five days a week, with a rest over the weekend. One of the benefits of this treatment is that many men can carry on with most normal activities, including going to work and driving.

Because EBRT treats the whole prostate and some of the surrounding area, it may cause some damage to healthy cells, as well as killing the cancerous cells. While the healthy cells will repair themselves and recover, side effect may occur.

Typically, these may include bowel, urinary and erection problems, as well as tiredness and fatigue. Treatments are usually available to help manage these.

More information on External Beam Radiotherapy is available here.

Brachytherapy

Unlike EBRT, brachytherapy is a form of internal radiotherapy. Brachytherapy allows your consultant will deliver higher doses of radiation to very targeted areas of the prostate.

There are two types of brachytherapy: high-dose and low-dose. In high-dose rate brachytherapy (or temporary brachytherapy), thin tubes are inserted into the prostate aligned to the location of the tumour. A source of radiation is passed through the tubes for a few minutes in high intensity (hence the name) to destroy the cells. The tubes are then removed, along with the source of radiation.

Typically, men are in hospital for one or two days for treatment; recovery is quick so you can return to normal activities within a week. More information can be found here.

With low-dose rate brachytherapy (also known as permanent brachytherapy), your consultant to insert a number of tiny seeds – about the size of a grain of sand – precisely around the cancer cells. Over a period of approximately six months, these seeds will slowly emit a dose of radiation to kill off the cancer cells. Because the radiation doesn’t spread more than a millimetre or so from each seed, there is minimal damage to the surrounding healthy tissue, reducing the potential side effects compared with EBRT and other treatment options, including high-dose rate brachytherapy.  

Low-dose rate brachytherapy is typically a same-day procedure, though depending on the time of the treatment an overnight stay may be necessary. As with high-dose rate brachytherapy, recovery is quick and men normally return to normal activities within a week.

In both cases, high-dose and low-dose brachytherapy, due to the fact that you are receiving surgery in a very sensitive part of the body, some men may experience side-effects such as urinary, bowel or erection problems. However, many men experience no long-term issues at all.

For more information on low-dose rate brachytherapy and patient stories, click here.

If you’re not sure if any of these treatments is available to you, it is always advisable to speak with your consultant of specialist nurse. We do encourage all men and their families to discuss all their treatment options before deciding, however difficult it may seem.