External beam radiation for prostate cancer

Overview: 

External beam radiotherapy is a commonly used standard procedure for the treatment of prostate cancer. It includes the usage of high-energy waves or beams, which are similar to X-rays, to kill cancer cells. 

The procedure involves using a machine that generates and focuses these beams of energy at the prostate gland. This machine is called the linear accelerator, and the external radiation beam helps to destroy cancer cells by targeting the genetic material of the cells that are responsible for their growth and division. The treatment aims at killing cancer cells and avoiding the healthy surrounding tissues as much as possible, but some healthy cells that are in the line of the beam do get affected, and this causes certain side effects. The therapy is used for prostate cancer that returns even after surgery.  

 Indications For Use:  

 The use of radiation therapy depends on which stage the prostate cancer is in. 

• Radiation therapy is the first option for treatment for men who are identified as low-risk and whose cancer has not spread and is still in the prostate gland.  
• The therapy is used in combination with hormone therapy for the high-risk group whose cancer may or may not have passed on to nearby tissues. 
• It is applied for patients for whom the surgery hasn’t been able to eliminate the cancer entirely or if the cancer has returned. 
• If the cancer is advanced and has spread to the bone, the procedure helps keep the cancer in control and reduce the symptoms.  

Types Of External Beam Radiation Therapy: 

• 3DCRT (Three-Dimensional Conformal Radiation Therapy):  3DCRT uses CT scanning to identify the anatomy of person e.g. the difference between the structures in the pelvis to determine the radiation dose and where it needs to be targeted without affecting the bladder and the bowel.  
• IMRT (Intensity-Modulated Radiation Therapy):  IMRT involves the usage of high-tech computer software to create a 3-dimensional picture of the prostate tumor. This type of therapy enables the team to modulate the intensity of each wave or beam and helps target a particular region with alternative high and low doses as required. This way, high doses can be targeted to the tumor, and for the healthy cells that are in the line, the doses can be minimized, causing fewer side effects and less collateral damage. 
• IGRT (Image-Guided Radiation Therapy):  This type of therapy offers a lot of flexibility as the radiologist can obtain the precise position of the prostate each day. This is important because the exact location of the prostate may change by a centimetre depending on how full the bladder and rectum are. This procedure is also helpful for patients who have lost weight, as it allows them to adapt the treatment accordingly by comparing the scans. 
• TomoTherapy/helical TomoTherapy: This type of therapy sends out radiation in a spiral-like pattern. During treatment, the patient moves through a machine that resembles a donut while the radiation surrounds them, and the energy beams are targeted toward the tumor.  

What Do The Energy Beams Consist Of: 

• Photons (X-rays and gamma rays): Photons are the building blocks of energy. They have the ability to go deep into the tissue to destroy the cancer cells. Most external beam radiation therapies use photons. 
• Protons: Protons are positively charged particles that send out a burst of radiation that offers penetration into the cancer cells and avoids affecting the healthy cells and tissue in the surrounding areas, leading to fewer symptoms. 
• Electrons: Electrons are negatively charged particles. The however cannot penetrate deep into the cells like the photons and protons, hence they are used for skin cancers or tumors that are located superficially.  
• Most types of external beam radiation therapy deploy the linear accelerator machine to send out the particles to cancer cells. Proton therapy involves the usage of a machine called a particle accelerator. 

The Procedure: 

The procedure begins with a planning process, which is carried out to ensure that the radiation can reach the exact location of the cancer in the body. 

The process includes: 

• The first is preparing for radiation simulation. During this step the team of radiologists helps the patient to settle down in a comfortable position preferably lying down as the person is required to be still during the radiation. 
• Additionally, certain immobilization devices are also used to help the patient be still in a single position, and the team marks the spots on the body where the radiation can be given.  
• The radiation therapy team carries out computerized tomography (CT) scans to find out and finalize the exact section of your body to be treated. 
• The next step included deciding the type of radiation and the dose depending on the health of the person and what stage the cancer is in. 
• The linear accelerator machine is used to send out the radiation beams in the body. Since the person is unable to move, the machine moves around to send out the radiation from multiple angles and delivers the exact dose of radiation fixed by the team. 
• The radiology team stays present in an adjacent room with video and audio connections to be in touch with the patient at all times just in case if they feel any pain or discomfort. 
• This therapy is given five days a week for many weeks, and the duration of each session is less than an hour, with the radiation lasting only for a couple of minutes.  
• Once the therapy is over, there will be follow-up sessions to see how the therapy has worked on the cancer. 

Risks Involved: 

There are certain side effects to the treatment that are dependent on the dose administered and how many healthy cells were exposed during the procedure. 

They include: 

• Frequent urination, which is painful. 
• Presence of blood in the urine. 
• Urinary incontinence. 
• Cramps in the abdomen. 
• Diarrhea. 
• Painful bowel movements. 
• Bleeding and leakage in the rectum. 
• Tiredness. 
• Hair loss. 
• Erectile dysfunction and reduction in the semen volume. 
• Reactions on the skin. 
• Possibility of secondary cancers in the surrounding tissues where radiation is given. 

Certain long-term complications include proctitis (rectal inflammation), cystitis (bladder inflammation), narrowing of the rectum or urethra and development of an ulcer in the rectum.   

 The duration of many of the side effects is for a couple of months to a year and most of them are mild. 

Conclusion: 

External beam radiation therapy (EBRT) as a therapy has evolved as compared to the earlier forms of radiation therapy. It includes precision methods to target the cancer cells and destroy them, helping people to eliminate prostate cancer. Patients must consult the doctor before any procedure, and it is crucial to get a deep understanding of the advantages and the risks after asking detailed questions before making a decision.

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