Radiation vs. Chemotherapy for Prostate Cancer

There are some options of treatment for prostate cancer, a common cancerous tumor that affects men especially elderly men. The stage, PSA level, and Gleason score are some major variables that determine the way of how the treatment plan should go. Both radiation and chemotherapy can help treat this cancer, and each treatment has drawbacks and potential benefits.

Radiation therapy (often called as radiotherapy)

It is a kind of treatment that uses the energy of radiation to kill and destroy cells of cancer. There are two major ways to deliver the radiation, ‘internal and external’.

Internal radiation therapy

In this procedure, the radiation is radiated from inside the body (particularly from inside of the prostate gland). In other words, there is special device (radioactive seeds) inserted into the specific area of the body (into the prostate gland) to release radiation and hit the target locally!

When do you need to take it?

Since it works locally, it is commonly not used when the cancer has spread. It is more likely to be used for ‘low and intermediate risk’ of localized prostate cancer.

The word ‘localized’ means that the cancerous cells have not spread yet and they are only found within the prostate gland.

The low risk of localized prostate cancer means the cancer tends to grow very slowly, even it is very unlikely to develop or progress after many years. Many men with this type are often recommended to only have an active monitoring, a procedure of when you are only recommended to regularly check the progression of your cancer.

In the active monitoring, the treatment can be ‘not immediately necessary’ until your doctor think that there is a risk your cancer might start to become aggressive.

For intermediate risk localized stage, this means that there is greater chance for the cancer in the localized stage to grow within a few years. For this case, the treatment is more likely to become ‘immediately necessary’ particularly true if the disease affect younger men.

From these explanations, it seems that internal radiation is only effective for cancer that has not spread. The reason is because it cannot effectively hit the cancerous cells in another part of the body.

Again, it works locally. Even it is commonly not used for high risk localized prostate cancer, a condition of when some cancerous cells might have grown slightly away from the prostate gland and the use of internal radiation may not hit them all.

In addition, it also can be used to treat one or two areas of bone cancer (either primary or secondary bone cancer). Secondary means that the cancer in the bone comes from another part of the body, such as from cancer in the prostate. See also cancer of prostate that spreads to the bones!

Side effects

A few days after the treatment, you may experience bruising and soreness especially in the area where the small needles were inserted. These needles are used to put the small radioactive seeds into the gland of the prostate.

image_illustration276Difficulty passing urine is the most common kind of side effect. But typically, it is temporary and lasts about a few days or weeks. Other side effects may include:

  1. Constipation, you might also like to read the link between prostate cancer and constipation!
  2. Bowel problems, such as discomfort feeling to open bowels more often than you get used to it.
  3. Sometime, you may notice blood in urine or discolored semen. This usually lasts about a few days /weeks.

The major reason of these side effects is due to internal radiation can cause swelling. And if you do experience the side effects, you find their peak level about 4-6 weeks after you take the treatment.

And since the radiation hit the cancer locally, ED and diarrhea (common side effects when you take external radiation) are less likely to occur.

It seems that most of the symptoms are usually temporary and settle gradually. But in a few cases, some symptoms could be permanent or last longer than usual – these may include inflammation in the rectum, difficulty passing urine, and ED.

Other drawbacks may include:

  1. Again, it doesn’t work effectively for cancer that has spread slightly away from the original site (prostate gland) since it works locally, as noted before.
  2. If compared to external radiotherapy, you need to take one /two anesthetic before taking internal radiation. And taking anesthetic could carry some side effects, too.
  3. It may take some time before eventually you and your doctor know whether the treatment has worked successfully.

Benefits

  1. Though some side effects could be permanent, but this risk is relatively much smaller if compared to other kinds of treatments for prostate cancer.
  2. The radiation can hit the target more accurately, better in reducing the risk of hitting the wrong target so thus there should be less damage to the nearby healthy tissues or other organs
  3. The procedure is pretty quick. In general, you may only need to stay in the hospital for only about 1-2 days. The same goes for the recovery, most men can get back to work or do their daily routines a few days after the treatment.

External radiation

In this method, the radiation is delivered externally – as the name suggests. So there is no any device inserted into the body. In other words, the radiation is directed from outside the body.

The use of external radiotherapy can be combined with hormone therapy. But it is commonly not used before prostate cancer removal surgery!

When should you use and take it?

It can be suggested to help treat all kinds of localized cancer (low risk, intermediate risk, and high risk of localized prostate cancer), and for locally advanced prostate cancer, too.

Locally advanced stage means the cancerous tumor has broken through the capsule surrounding the gland of the prostate. So in general, external radiation therapy can be used for T1 to T3 of prostate cancer.

In addition, it is also one of common treatment options to treat secondary bone cancer, too.

Side effects

You may not feel any pain during treatment, but it can carry some side effects. Like in internal radiotherapy, the side effects are divided into two major groups; short term and long term.

And the long term side effects could become permanent or chronic in a few cases. For in-depth information about the side effects of external radiation therapy, visit this section!

The following are other drawbacks:

  1. It can take more time. There are several ways to give the treatment, but mostly you will take it once a day (each session takes about 10-20 minutes) for 5 days (such as from Monday to Friday) per week – and it can take about 6-7 weeks.
  2. The successful of the treatment cannot be evaluated quickly, it usually take some time to see the improvement.
  3. If you take external radiotherapy for your first treatment and if it fails to work or the cancer comes back & spread, the option for surgery might be impossible.

Benefits

  1. Though you need to take it for several times, but typically you will still able to do your days-to-days routines during treatment and you don’t have to stay in the hospital.
  2. This treatment can be an alternative option if you cannot take surgery due to certain reason. See also radiation vs. surgery for cancer of prostate!
  3. Painless during treatment.

Chemotherapy

In this treatment, there is no any radiation and surgery. Chemotherapy means you take pills containing anti-cancer properties that can help shrink and kill the cancerous cells.

There are several medicines for chemotherapy, these include: Docetaxel (Taxotere), Estramustine, Epirubicin, Paclitaxel, and Mitoxantrone. Among these choices, Docetaxel is the most popular choice. And each type of these chemotherapy medicines carries the risk of side effects.