Radiation Oncology

Radiation oncology uses high-energy X-rays or other types of radiation to kill cancer cells. It only affects cells in the area that is being treated and is an option for men with any stage of prostate cancer.

Radiation therapy is often used as the initial treatment for low-grade cancer that has not spread outside of the prostate or that only has spread to nearby tissue. Radiation therapy also may be used after surgery to destroy any cancer cells that are still present in the area or come back (recur) after surgery. In later stages of prostate cancer, radiation treatment may be used to help relieve pain when cancer has spread to the bone.

Doctors use two types of radiation therapy to treat prostate cancer. They are external beam radiation therapy and internal radiation therapy. Some men receive both types.

  • RapidArc® Radiotherapy

    This volume-modulated arc therapy is an advanced treatment technology that matches or improves dose precision while significantly shortening treatment times—two to eight times faster than IMRT. RapidArc delivers a precisely designed three-dimensional dose distribution using one or more dynamic arc rotations of the linear accelerator. It differs from other techniques because it efficiently delivers the dose continuously throughout the motion of the arc. Clinicians can now more quickly deliver a continuously-modulated dose to the entire tumor volume while still sparing normal, healthy tissue.

  • Calypso®, GPS for the Body

    Calypso provides real-time tumor tracking and enables caregivers to keep radiation focused to hit the tumor and not the surrounding healthy tissue. To use the technology, three transponders are implanted in a patient's prostate during an outpatient procedure. The Calypso System and transponders then work together to continuously communicate the exact location of the tumor each time the patient is in for radiation treatment. By using the technology, therapists are immediately alerted if the tumor moves outside of the radiation beam, and then can stop and adjust positions.

  • External Beam Radiation

    This method of delivering radiation therapy uses a machine outside the body to send radiation toward the prostate cancer. During a procedure, a patient lies on a table while a machine moves around his body and directs high-powered energy beams to the cancer cells.

    This painless treatment lasts only a few minutes, and is usually given five days a week for about six to eight weeks. Before treatments start, imaging studies, such as MRIs, CT scans, or X-rays of the pelvis, are done to find the exact location of the prostate gland.

    Several new techniques of external beam radiation allow doctors to give higher doses of radiation to the prostate gland while reducing the radiation exposure to nearby healthy tissues. These techniques have fewer side effects than standard external radiation therapy.

    They include:

    • Three-dimensional conformal radiation therapy (3D-CRT) – This procedure uses special computers to more precisely locate the prostate. A plastic mold resembling a body cast is used to keep the patient stationary to allow the radiation to be more accurate. Radiation beams are then shaped and aimed at the prostate from several directions, causing less damage to normal tissues.
    • Intensity modulated radiation therapy (IMRT) - This is an advanced form of 3D therapy which uses a computer-driven machine that moves the patient as the radiation is delivered from several different angles. The intensity or strength of the radiation can be adjusted to minimize the impact to normal tissue, allowing an even higher dose to reach the cancer.
    • Conformal proton beam radiation therapy - This technique uses protons (positive parts of atoms) to kill cancer cells. Protons release energy aimed at the cancer cells after traveling a certain distance. This causes less damage to the tissues they pass through before they reach the cancer cells and allows more radiation to be delivered to the prostate.
    • Stereotactic radiosurgery - This method, in which an external machine delivers radiation precisely to the tumor, is most commonly used to treat cancer that has spread to the brain.
  • Internal Radiation Therapy or Brachytherapy

    The administration of radiation from inside the body (internal radiation), is called brachytherapy. Brachytherapy is generally used only in men with early stage prostate cancer that is relatively slow growing. It also may be given with external beam radiation therapy for some patients with more advanced cancer.

    Brachytherapy may not be as effective in men with large prostate glands because it may not be possible to place the seeds into all of the correct locations.

  • Permanent, low dose rate (LDR) brachytherapy

    For this treatment, implants containing radiation called seeds are placed inside a patient’s prostate. Thin needles are first inserted through the skin in the area between the scrotum and anus (perineum) and into the prostate. The seeds are then injected through the needles to the prostate. The needles are removed, leaving the seeds in place where they administer a high quantity of low doses of radiation for several months.

    The seeds are so small that the patient does not feel them. They eventually stop giving off radiation and do not need to be removed once the radiation is gone. This method allows for less damage to the healthy tissue near the prostate.

  • Temporary, high dose rate (HDR) brachytherapy

    This is a newer technique that uses soft nylon tubes called catheters to administer the radiation. The catheters are placed inside hollow needles that have been inserted through the perineum into the prostate. The needles are then removed but the catheters stay in place. Radioactive material is placed in the catheters and administers treatment for approximately 5 to 15 minutes. Usually three brief treatments are given, and the radioactive substance is removed each time. The catheters are removed when the treatment is completed.

    HDR is often combined with external beam radiation. When combined, it is given at a lower dose than if used by itself. The advantage of this approach is that most of the radiation is concentrated in the prostate gland itself, sparing the urethra and the tissues around the prostate such as the nerves, bladder and rectum.

  • Permanent, low dose rate (LDR) brachytherapy

    For this treatment, implants containing radiation called seeds are placed inside a patient’s prostate. Thin needles are first inserted through the skin in the area between the scrotum and anus (perineum) and into the prostate. The seeds are then injected through the needles to the prostate. The needles are removed, leaving the seeds in place where they administer a high quantity of low doses of radiation for several months.

    The seeds are so small that the patient does not feel them. They eventually stop giving off radiation and do not need to be removed once the radiation is gone. This method allows for less damage to the healthy tissue near the prostate.

  • Temporary, high dose rate (HDR) brachytherapy

    This is a newer technique that uses soft nylon tubes called catheters to administer the radiation. The catheters are placed inside hollow needles that have been inserted through the perineum into the prostate. The needles are then removed but the catheters stay in place. Radioactive material is placed in the catheters and administers treatment for approximately 5 to 15 minutes. Usually three brief treatments are given, and the radioactive substance is removed each time. The catheters are removed when the treatment is completed.

    HDR is often combined with external beam radiation. When combined, it is given at a lower dose than if used by itself. The advantage of this approach is that most of the radiation is concentrated in the prostate gland itself, sparing the urethra and the tissues around the prostate such as the nerves, bladder and rectum.

  • Xofigo®

    Martha Jefferson Hospital offers Xofigo® (radium-223 dichloride), the latest treatment option for men with advanced prostate cancer. Xofigo® is used in treatment for men whose prostate cancer has spread (or metastasized) to their bones.

    Xofigo® binds with minerals in the bone allowing for the delivery of radiation directly to bone tumors. By doing this, normal surrounding tissue is spared from significant damage, which is a huge improvement from previous solutions.

    Xofigo® is given once a month for six months and is injected into a patient’s vein over one minute. A typical appointment for treatment lasts no longer than 15 minutes.

ExploreHealth With Sentara