Radiation Therapy for Prostate Cancer. Part 1

View Nomogram that is part of this article.

Before discussing radiation therapy for prostate cancer, let’s discuss the prostate itself. The prostate is a gland and is responsible for producing some of the seminal fluid that feeds the semen.

The prostate needs the male hormone, testosterone, to function. The prostate is about the size of a walnut and is located in the front of the rectum, behind the base of the penis and below the bladder. The prostate surrounds the upper part of the urethra. The urethra is the tube that carries urine and semen out of the penis. A thin membrane known as the capsule surrounds the prostate.

Cancer can begin in any portion of the prostate, but most seem to occur on the posterior portion adjacent to the rectum. The first tests to rule out prostate cancer are usually the digital rectal exam and the PSA. Digital rectal exams are important because physicians can feel approximately 80-percent of all palpable tumors.

The other important tool in diagnosing prostate cancer is the Prostatic Specific Antigen (PSA) blood test. This test measures a substance emitted by both normal prostate tissue and prostate cancer. Very little escapes the normal prostate so the PSA usually measures 0-4. When the PSA begins to rise it can be a sign that prostate cancer is present. If cancer is suspected, an ultrasound-guided biopsy is performed and the cancer is diagnosed.

Once cancer has been diagnosed the headache really begins. Anyone who has ever talked to a man newly diagnosed with prostate cancer will find someone confused and frustrated, AND RIGHTFULLY SO! How can a patient decide on a course of treatment when the medical community cannot even agree? Each medical specialty — surgeons, radiation oncologists etc., favor their own approach. Consultations are filled with one specialist politely refuting in faux-respectful terms, the advice of the previous specialist. Surgeons want to operate, and radiation oncologists push for radiotherapy. Each may be a viable option, but it is ultimately up to the patient to decide their course of treatment.

My goal is to educate you on radiation therapy. Radiation therapy always took a back seat to surgery in the treatment of prostate cancer. Early studies show clearly that patients who underwent surgery fared better than patients receiving radiation therapy when compared at five years post-treatment. In fact, studies went so far as to say that the radiotherapy accelerated the cancer because the radiotherapy patients had much more metastases (distance spread) after treatment. The studies haunted radiation oncologists for years until the patient’s pretreatment stages were studied more closely. The patients that were given surgery had the earliest stages of the disease. Of course, these patients did well because the disease hadn’t broken through the capsule. The group of patients that were placed in the radiation therapy protocol had stages II to IV with greatly elevated PSAs. Some PSAs were as high as 200! Obviously, the study was slanted towards surgery and many men had it performed when it would not have been indicated.

In fact, radiotherapy is a valuable tool in the fight against prostate cancer, and recent advances have made it equal to surgery for early-stage cancers and the treatment of choice for later stages.
to be continued…