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37

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

4 Overview of cancer treatments

Radiation therapy

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

and experience.

SBRT (

s

tereotactic

b

ody

r

adio

t

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

visits.

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

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

(

l

ow-

d

ose

r

ate) or temporary HDR (

h

igh-

d

ose

r

ate)

brachytherapy.

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 (

t

rans

u

rethral

r

esection of the

pr

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

assurance.