For treatment to be effective in patients who have more aggressive or advanced stages of prostate cancer, it must be directed at both the prostate and the surrounding areas where cancer cells may have spread. To accomplish this, a prostate seed implant is typically combined with a few weeks of external radiation and/or a temporary hormone blocking medicine to actually give cure rates similar to those seen in patients seen with early stages of cancer.
The seed implant delivers a high dose of radiation to the prostate, where most or all of the cancer cells reside. It gives minimal radiation to the surrounding areas. The hormone therapy and IGRT (external radiation) not only treat the cancer in the prostate, they also attack cancer cells that may have spread outside the prostate.
IGRT (or intensity modulated radiation therapy) delivered from a high-energy linear accelerator can help treat just outside the prostate, where the prostate cancer cells may reside. IGRT is the latest and most advanced system for the delivery of external radiation. This technique allows for maximum radiation to be delivered to the prostate and the surrounding areas at risk for harboring cancer cells, while minimizing radiation to the normal areas, such as the bladder and rectum. When combined with a seed implant, this part of the treatment is typically a few minutes a day, five days a week, for five weeks.
The radiation treatment is completely painless and non-invasive. During treatment, the most commonly reported side effects are slight fatigue and having to go to the bathroom more frequently. You should NOT develop any nausea, abdominal pain or loss of hair on your head. You will NOT lose your ability to control your bowels or bladder. You will be able to continue working full-time and should enjoy all of your regular activities.
Hormone Blocking Therapy
Prostate cancer typically feeds on testosterone, the male hormone. A combination of a shot (Lupron or Zoladex) that you receive every few months from your Urologist, and pills (Flutamide or Casodex) that you take daily can temporarily block all of the testosterone in your body. By cutting off the “food supply” to the cancer, several helpful things happen:
- After a few months, your prostate will shrink 30-40% in size. In men with large prostate glands, it becomes easier to distribute the seeds for the implant and fewer seeds are required. An added bonus is that you will probably notice that it is easier to urinate because your prostate is smaller.
- Some cancer cells outside the prostate may actually die, or “starve to death.”
- The remaining cancer cells can be made more sensitive or vulnerable to the upcoming radiation and thus more likely to be killed.
While hormone-blocking treatment alone will not permanently rid the body of the cancer, it has been shown to improve cure rates with radiation in men with more advanced stage cancer. It also has the ability to make the seed implant procedure possible in men with very large prostates that would have otherwise been technically too difficult to implant. When administered, men typically take the hormone blocking treatment for two to three months before beginning radiation, and continue the treatment until after the seed implant. Common side effects from the hormone blockers include temporary hot flashes, fatigue, and loss of libido.