Prostate Cancer Treatments – What are your Options and how to Choose?

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 prostate cancer treatment 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.

Ultimately, the treatment you are recommended for prostate cancer will depend on how advanced and how aggressive it is. However, it is also very important to discuss the possible pros and cons of each treatment as well as potential side effects, as these may impact your lifestyle post-treatment.

Prostate Cancer UK is a great place to start to research your potential treatment options, which can range from no action (active surveillance or watchful waiting) to radical prostatectomy, or a full removal of the prostate.

And while it would be difficult to summarise all the treatment options and their pros and cons in full 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 effects 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 to 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 will 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. 

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 usually 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.

Your Choice is Key

While we have outlined two common treatments for prostate cancer here, it is also fair to say that your prostate cancer treatment options will depend on the hospital where you are being treated. Not all hospitals offer all treatments.

As such, if you are not fully sure that the treatment options you have been offered are right for you, it is important to research and ask for alternative treatment centres.

Scottish-born David Robb is one gentleman who took a lot of time to research his options, and turned down a few because he wasn’t happy with the potential side effects they might have on his lifestyle. Click here is his story.

Similarly, Alan Kerr from Stirling and Alan Wilson from Hertfordshire, also ended up choosing brachytherapy as their treatment option, despite not being offered it initially. Click here for his story.

The bottom line is, no matter how difficult a decision it may feel, it is worth taking time to research all options available to you. And it is always advisable to speak with your consultant or specialist nurse, and be open about any doubts and concerns you might have.

Ultimately, your journey to overcome your prostate cancer is yours – so the choice of treatment should also be yours.

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