Prostate Cancer Treatment

Prostate cancer is one of the most common cancers in men. Some prostate cancers grow slowly and may be safely monitored with active surveillance, while others are aggressive and need treatment. The treatment plan depends on PSA level, grade group, Gleason score, MRI findings, biopsy results, stage, prostate size, urinary symptoms, medical history, life expectancy, and patient goals.

At ROC, our goal is to treat the cancer effectively while protecting urinary, bowel, and sexual function as much as possible. Today’s technology allows us to shape the dose around the prostate and surrounding target areas while reducing unnecessary exposure to the rectum, bladder, bowel, and other tissues.

Radiation for Localized Prostate Cancer

For low-risk, intermediate-risk, and high-risk prostate cancer, radiation can be used with curative intent. Depending on the case, radiation may be delivered over several weeks or in a shorter course. SBRT, or stereotactic body radiation therapy, often uses about five treatments, while conventionally fractionated treatment may involve a longer schedule. The best schedule depends on the patient’s risk group, anatomy, urinary function, prostate size, and physician recommendation.

IMRT, or intensity-modulated radiation therapy, is the most common modern technique. It uses multiple beam angles and computer planning to shape the radiation dose. The prostate receives the prescribed dose, while the plan limits the dose to the rectum and bladder.

Daily image guidance is essential because the prostate can move from day to day. Bladder filling, rectal gas, stool, and natural organ motion can shift the prostate by several millimeters. Before each session, cone-beam CT or another imaging system checks alignment. Patients may be asked to follow a bladder and bowel routine, such as arriving with a comfortably full bladder and empty rectum, to make treatment more consistent.

High-Risk, Node-Positive, Metastatic and Recurrent Disease

For high-risk or node-positive prostate cancer, radiation is often combined with androgen deprivation therapy. Hormone therapy reduces testosterone signaling, which prostate cancer cells often rely on. This can improve the effectiveness of radiation in appropriate patients.

If prostate cancer returns after surgery, salvage radiation may be recommended when PSA begins to rise. Treatment may target the prostate bed and, in selected cases, pelvic lymph nodes. PSMA PET imaging can help identify recurrence earlier and guide whether treatment should include a visible lesion, lymph node, or bone site.

For metastatic prostate cancer, radiation can also be used to treat painful bone metastases, prevent fracture, manage spinal cord compression risk, or treat a limited number of metastatic sites with SBRT.

High-Dose-Rate (HDR) Brachytherapy for Prostate Cancer

HDR brachytherapy is a type of internal radiation therapy used to treat prostate cancer. During the procedure, temporary catheters are placed into the prostate, allowing a highly targeted source of radiation to deliver treatment directly to the prostate while limiting radiation exposure to nearby healthy tissues. The radioactive source is removed after treatment, so no radiation remains in the body. HDR brachytherapy may be used alone in select cases or in combination with external beam radiation therapy, depending on your cancer and treatment plan. Your radiation oncology team can help determine whether this treatment is right for you.

Rectal Spacers for Prostate Cancer Radiation Therapy

Rectal spacers such as SpaceOAR or Barrigel are temporary materials placed between the prostate and rectum to help protect the rectum during radiation therapy for prostate cancer. By creating additional space between these structures, rectal spacers can reduce the amount of radiation reaching the rectum and help lower the risk of certain bowel-related side effects. These spacers are typically placed using a minimally invasive procedure and are designed to be absorbed by the body over time. Your radiation oncology team can help determine whether a rectal spacer is an appropriate option for you.

Side Effects and How We Manage Them

Most prostate radiation side effects are related to nearby urinary and bowel structures. Many are temporary and improve after treatment.

Possible side effects may include:

• Urinary frequency or urgency
• Mild burning with urination
• Getting up more often at night to urinate
• Weaker urinary stream
• Temporary bowel looseness or rectal pressure
• Mild rectal irritation or bleeding in some cases
• Fatigue
• Erectile function changes over time
• Rare long-term bladder, rectal, or urethral complications

How we manage these effects:

• We use advanced radiation techniques and daily image guidance to reduce unnecessary doses to normal tissue.
• We provide bladder and bowel preparation instructions before and during treatment.
• We may prescribe medications to reduce urinary frequency, urgency, burning, or weak stream.
• We manage bowel symptoms with diet changes, hydration, fiber adjustment, and medication when needed.
• We discuss rectal spacer options for appropriate patients to increase distance between the prostate and rectum.
• We monitor symptoms weekly during treatment and at follow-up visits.
• We coordinate with urology when urinary obstruction, prostate size, or baseline symptoms need special attention.
• We discuss sexual health openly and offer referrals or medications when appropriate.

Call 847-698-0600 ext. 112 to schedule a consultation.