NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
4 Overview of cancer treatments
photon radiation beams. Photon beams are a stream
of particles that have no mass or electric charge.
In recent years, some cancer centers have built
radiation machines that use proton beams. Proton
beams are a stream of positively charged particles
that emit energy within a short distance. Some
doctors think that proton treatment is better than
x-ray–based treatment. One benefit would be less
severe side effects.
To date, research hasn’t shown that proton treatment
is any better or worse for treating cancer or causing
side effects. Well-designed research on IMRT and
proton treatment is ongoing. Thus, NCCN experts
advise that proton treatment can be an option if
received at cancer centers with the proper equipment
herapy) is a newer
technique. It treats cancer with very precise, high-
dose beams. Receiving SBRT is much like getting
other EBRTs except treatment is finished in about 5
Research thus far has shown that SBRT and IMRT
are alike in treating cancer and causing side effects.
However, well-designed research of SBRT to assess
long-term results is needed. Thus, NCCN experts
advise that treatment with SBRT be carefully decided.
If chosen, it should be received only at cancer centers
with the proper equipment and experience.
Brachytherapy is another standard radiation therapy
for prostate cancer. This treatment involves placing
radioactive seeds inside your prostate. Brachytherapy
is also called interstitial radiation—a seed treatment.
Brachytherapy may be used alone or combined with
EBRT, ADT, or both.
The seeds are about the size of a grain of rice. They
are inserted into your body through the perineum
and guided into your prostate with imaging tests.
Treatment planning is done beforehand to design the
best course of treatment. You will be under general
or spinal anesthesia when the seeds are placed.
Brachytherapy can be given either as permanent LDR
ate) or temporary HDR (
LDR brachytherapy uses thin needles to place 40
to 100 seeds into your prostate. Placement of the
seeds is done as an outpatient procedure. The
seeds usually consist of either radioactive iodine or
palladium. They will remain in your prostate to give
low doses of radiation for weeks or months. The
radiation travels a very short distance. This allows for
a large amount of radiation within a small area while
sparing nearby healthy tissue. Over time, the seeds
will stop radiating.
For LDR brachytherapy, seed placement is harder if
you have a very large or small prostate, your urine
flow is blocked, or you’ve had TURP (
esection of the
ostate). Moreover, your chances
of side effects are higher. If your prostate is large,
you may be given ADT before LDR brachytherapy
to shrink it. After the seeds are implanted, your
doctor should measure the radiation dose for quality