Therapies

There are 2 main types of radiotherapy – external and internal. They can be used to treat any stage of prostate cancer. In early stage prostate cancer, radiotherapy can be used either in place of surgery or after surgery to destroy any remaining cancer cells. Radiotherapy may also be recommended in advanced stage prostate cancer to help with pain relief.

External radiotherapy. This means a sophisticated machine is used to deliver the radiation and a computer is used to pinpoint the radiation to target the prostate. Treatment is usually given 5 times a week over a number of weeks. Each radiotherapy session only lasts a few minutes.

Brachytherapy. This form of treatment involves inserting either dozens of radioactive seeds into the prostate using needles or several tubes into the prostate which are loaded with radioactive material.

There are two types of brachytherapy. Low Dose Rate (LDR), which is the insertion of radioactive seeds via a day/overnight procedure, and HDR (High Dose Rate), which means tubes are temporarily placed in the body, and loaded with radioactive therapy for up to five treatment sessions. HDR is not conducted in South Africa as yet.

The seeds give off radiation for a few weeks or months and then remain in the prostate permanently once the radiation wears off. The seeds can be implanted as an outpatient procedure, meaning you will not need to stay in hospital and you will probably be able to resume normal activities within a few days. You may be concerned about how the radioactive material in your body could affect you or those around you. Although the majority of the radiation seeds only emit radioactivity within 2.5cm of the seed it’s worth taking note of the following precautions:

You should limit prolonged close contact (less than 2 metres) with pregnant women, those who may be pregnant, or children, for 2 months after the seeds have been implanted

If you have seeds implanted you must avoid allowing children to sit on your lap for prolonged periods, for 2 months after the seeds have been implanted

You’ll be given a lead container in which to place any seeds you might pass in your urine. You should pick these up with a spoon or a pair of tweezers, place them in the lead box and return them to your radiation oncologist who dispose of them safely.

You should avoid sexual intercourse for 2 weeks after the seeds have been implanted as you may pass a seed when you have an orgasm

You should wear a condom when you have sex for 2 months after the seeds have been implanted

The tubes are loaded with radioactive material during a treatment session that lasts a few minutes and then the radioactive material is removed. This process can be repeated up to 5 times and you’ll have to stay in hospital for about 1 to 2 days. The tubes will be removed before you leave the hospital.

You may experience side-effects such as diarrhoea, rectal pain, urinating more often and a burning pain when you empty your bladder. These side-effects should go away gradually

Prostate cancer cells rely on testosterone to help them grow. Therefore, hormone or anti-androgen therapy is used to stop your body from producing testosterone in the hope that cancer cells will die or grow more slowly.

Hormone therapy can be used in a number of scenarios:

For advanced prostate cancer, to shrink or slow the growth of tumours

For early-stage prostate cancer to shrink tumours before radiotherapy and to ensure radiotherapy is a success

After surgery or radiotherapy to slow the growth of any cancer cells left behind

If you are to have hormone therapy to treat your prostate cancer the following options may be available to you:

Luteinising hormone-releasing hormone (LH-RH) agonists. These drugs prevent the testicles from making testosterone. These types of drugs are usually given by an injection into a muscle or under the skin.

Anti-androgens. This group of drugs blocks the action of male hormones on cancer cells. You’ll probably be given an anti-androgen along with an LH-RH agonist or before starting on an LH-RH agonist. Anti-androgens are available in tablet form.

Castration. There are two types of castration: surgical castration and chemical castration. Surgical castration is the removal of the testes, in a procedure called a bilateral orchiectomy. Chemical castration is an alternative to surgical castration through treatment with luteinizing hormone-releasing hormone agonists and/or anti-androgens. The result of both these methods is to reduce or remove the source of testosterone in the body.

Other drugs may be given to prevent the adrenal gland from making testosterone.

Side-effects associated with hormonal therapies include: erectile dysfunction, hot flushes, weakened bones, reduced sex drive and weight gain.

Chemotherapy is reserved for patients with stage IV prostate cancer. The effectiveness of this treatment method depends on specific medical circumstances of men affected by prostate cancer.

Chemotherapy is a very effective method of cancer treatment that’s helped save millions of lives, but it does cause side effects. The medicines used in chemotherapy can’t distinguish between fast-growing cancer cells and other types of fast-growing cells, such as blood cells, skin cells and the cells inside the stomach.

This means most chemotherapy medications have an effect on the body’s cells and tissues causing problems including:

Fatigue and weakness

Feeling and being sick

Diarrhoea

Hair loss

Some chemotherapy side effects are mild and treatable, while others can cause serious complications if not recognised immediately and corrected. Frequently, people only have minimal side effects, but for some people, a course of chemotherapy can be unpleasant and upsetting.

Living with and adapting to the side effects of chemotherapy can be challenging. However, it’s important to realise that most, if not all, side effects will disappear once the treatment is complete. There’s no risk of the side effects of chemotherapy being passed to other people, including children and pregnant women, if they’re in close contact with someone having chemotherapy.

You’ll be monitored regularly to check for side-effects and to check on your general health. It’s possible for some of your side-effects e.g. nausea or diarrhoea, to be managed with other medications.

New treatment options are becoming available that can be used in men whose cancer has failed to be managed by radiotherapy, surgery and hormonal therapy. This type of advanced stage prostate cancer is known as castration-resistant prostate cancer and, until now, there have been very few available treatment options for use at this stage.

In addition to these therapies, other therapies are under investigation which offer more promise in the treatment of prostate cancer.

Prior to deciding on any form of therapy, discuss with your doctor the pros and cons.

1. American Cancer Society. Initial Treatment of Prostate Cancer, by Stage and Risk Group. https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html. Accessed on 22 October 2021.
2. Cansa.org. Fact Sheet on Prostate Cancer. https://cansa.org.za/files/2021/04/Fact-Sheet-on-Prostate-Cancer-NCR-2017-web-March-2021.pdf. Accessed on 22 October 2021.
3. Mayo Clinic. Hormone therapy for prostate cancer. https://www.mayoclinic.org/tests-procedures/hormone-therapy-for-prostate-cancer/about/pac-20384737. Accessed on 22 October 2021.
4. American Cancer Society. Chemotherapy for prostate cancer. https://www.cancer.org/cancer/prostate-cancer/treating/chemotherapy.html. Accessed on 22 October 2021.
5. Urology Care Foundation. Advance Prostate Cancer. https://www.urologyhealth.org/urology-a-z/a_/advanced-prostate-cancer. Accessed on 25 October 2021.
6. NCBI. How do we define "castration" in men on androgen deprivation therapy? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523606/. Accessed on 20 January 2022.