Radiation & Brachytherapy for Prostate Cancer

This is a traditional radiation technique that encompasses the entire prostate. For those at high risk of the disease spreading, the radiation therapist also delivers radiation to the pelvic lymph nodes.

Conformal External-Beam Therapy

This type of therapy creates 3D representations of the prostate, most often from a CT scan. The machine then designs a high radiation dose that conforms to the specific shape of the prostate.

Conformal therapy allows radiation therapists to safely use doses above traditional levels without significant increases in serious side effects or affecting nearby healthy tissue.

Intensity-Modulated Radiotherapy (IMRT)

Intensity-modulated radiotherapy (IMRT) is a refinement of conformal external-beam therapy. It uses a highly flexible beam to target the radiation with extreme precision according to the bodily structure.

Besides permanent implants — which deliver low-dose-rate (LDR) radiotherapy — specialists use brachytherapy for prostate cancer using temporary, high-dose-rate (HDR) devices. Specialists typically use HDR devices for those with disease in an advanced stage that hasn’t yet spread.

In this technique, the radiation therapist delivers a high dose directly to the prostate over the course of an hour. You’ll receive several treatments on multiple days. Most people who receive radiation with an HDR device also have external-beam radiation for about five weeks.

If you have locally extensive prostate cancer (stages T3 to T6), your care team may suggest large fractions of radiotherapy using HDR interstitial techniques in combination with external-beam radiation treatment.

In some cases, the prostate care team may recommend androgen ablation, then external radiation. Androgen ablation is hormone therapy that blocks the body’s production of the male hormone androgen.

There are multiple combinations of drugs that prostate specialists can use to completely block the production of androgen.

We offer brachytherapy (seed implants) as an alternative treatment to men with early-stage prostate cancer. In this treatment, the prostate specialist implants between 40 and 100 radioactive seeds into the prostate gland. The implants remain in place permanently but become inert (no longer useful) after a few months.

This therapy allows the radiation therapist to deliver a high dose of radiation to the prostate with limited damage to surrounding tissues. Care teams sometimes use the seeding technique with external-beam radiation for an effective combination.

BIDMC is Boston's only hospital that offers CyberKnife stereotactic radiosurgery for prostate cancer care. This highly precise, advanced form of radiation therapy drastically reduces the number of treatments. What’s more, CyberKnife results are equal to or better than those of traditional radiation therapy.

Quality of Life After CyberKnife

After CyberKnife radiotherapy, very few (close to zero) men experience incontinence. In terms of sexual function, if a patient under age 65 had good erections prior to treatment, there is an 80% chance he will continue to do so after treatment. Of the 20% who experience erectile dysfunction, about 80% respond to Viagra. The success rate for Viagra decreases under these conditions:

• Being over age 65
• Having diabetes, vascular disease and certain other conditions
• Smoking
• Taking beta blockers, anti-depressants and some other medications