Other Treatments

Prostate Cancer Choices – Regular screening facilitates early intervention – and early cures


Radiation therapy, also called radiotherapy uses powerful X-rays and other high-energy rays to kill cancer cells using a machine called a ‘linear accelerator’. Damaging the cancer cells means that they cannot grow or multiply and so they die. Normal cells are also damaged in this procedure but usually recover.

In general, radiotherapy is suitable if the cancer is still in the prostate gland and has not spread to other areas of the body.

A number of tests will be carried out to see if radiation therapy will help, including:

  • Checking pathology reports
  • Doing a PSA test
  • Chest X-ray
  • CAT scans of abdomen and pelvis
  • Bone scans

There are three steps before you start radiation therapy, these help the radiation therapy team plan and work out the best way to deliver the treatment to your prostate while limiting radiation to the bowel and bladder.

Simulator Planning Session
A catheter is placed into the penis and rectum and small amounts of dye are put into these to help find the exact position of your prostate gland (which varied slightly between men).

While lying face down on a couch, measurements will be done by taking X-rays from the front and side. Four small tattoos will be used to mark the areas to be treated, while other marks will also be drawn on your skin with ink.

This procedure requires no special preparation and is not painful.

Planning CT scan
This takes place about a week after your simulator session and is similar except that catheters will not be used. You will lie on a couch as a CT scanner takes pictures of the prostate gland.

With both these sessions it is important to try not to empty your bladder beforehand.

The radiation therapy team will use the information collected during your simulator session and CT scan to work out the best way to deliver your treatment.

With both these sessions it is important to try not to empty your bladder beforehand.

Side effects
The bowel and bladder lie next to the prostate gland and during radiotherapy some of the normal cells of the bowel or bladder may be damaged due to their proximity to the prostate. Although care is taken so that radiation does not affect these areas, sometimes it is unavoidable.

Short-term side effects may include:

  • A burning feeling when urinating or the need to urinate more often.
  • Bowel movements may become looser and more frequent, and there may be spots of blood and discomfort when emptying the bowel.
  • Many people may also feel a loss of energy and increased lethargy during radiation therapy but this should remedy soon after treatment.
  • For most people side effects settle down within a month of completing treatment, although it may prolong for some.
  • Long-term side effects may include:

A small number of men may develop long term complications from radiation therapy such as frequent rectal bleeding or other bowel problems. Some men may find that treatment affects their sexual function, including erectile dysfunction and discomfort or a lack of fluid during ejaculation.

Side effects of radiation therapy differ between men and so it is impossible to determine who will have what side effects.
If you suffer any side effects, it is important you let your doctor know as soon as possible so that appropriate help can be given.

The Cancer Council’s booklet Understanding Radiotherapy talks about ways to manage side effects. Phone 13 11 20 for a copy.


Prostate brachytherapy involves the placement of radioactive material directly into the prostate gland. These implants can be in the form of wires or radioactive iodine ‘seeds’.

The seeds are about the size of a grain of rice and are inserted into the prostate through hollow needles placed through the skin bellow the scrotum. This procedure is generally performed under a general anaesthetic and is called an implant.

Slowly over a few months the seeds deliver a dose of radiation to the prostate cancer.

Criteria for prostate brachytherapy

There are strict guidelines that determine whether you are suitable for brachytherapy. These criteria include:

  • Your level of fitness
  • Your symptoms
  • The size of the prostate gland
  • The local extent of the cancer within the prostate- the cancer must be confined to the gland
  • The aggressiveness of your cancer cells

If brachytherapy is not suitable there are other options for managing your malignancy including external beam radiotherapy and hormone therapy that may be more suitable. Discuss these options with your doctor.

Compared to radical prostate surgery, brachytherapy is simple, less invasive, has a shorter recovery time and is less likely to affect urinary incontinence.

Compared to external beam radiotherapy, brachytherapy is less likely to cause long term rectal problems or erectile dysfunction and involves fewer visits to hospital.

If your urologist and radiation oncologist have decided that you are suitable for brachytherapy, they will first need to plan your treatment.

Firstly, you will need an ultrasound examination of the prostate. By showing the size and position of the prostate gland, the ultrasound shows precisely where to put the radioactive seeds.

You will then need to return to the hospital in about six weeks after your ultrasound to have the seeds implanted. You will be admitted to the hospital for at least one night after the procedure to ensure that there are no problems with urination.

About three weeks after the implant you will need a CT scan of the prostate; the scan allows doctors to determine the exact dose of radiation given to the prostate.

You will then be followed up every few months when examinations and PSA tests will be done to assess how effective the treatment has been.

Side effects
It is important to realise that side effects may occur from all treatments.

When undergoing the procedure, you will need to undergo at least one general anaesthetic and stay in the hospital at least one night.

The level of radiation emitted by the seeds is very low, but as a precaution it is advised that pregnant women and young children maintain a distance of a metre from you (except for short periods – hugs and cuddles) for the first month after the procedure.

Initially you may have slight bleeding from the needle puncture sites and have swelling or bruising around the scrotum. Applying an ice pack can bring relief and reduce the swelling.

There may be some blood in your urine after your implant, but this generally settles down within a few days. Some men may develop short or long term urinary problems such as obstruction or incontinence. This is more common in men who already have severe urinary difficulties and is why these men are excluded from brachytherapy.

For a few weeks after treatments you may experience some bowel irritation, this may include frequent or loose motions and/or light bleeding from the rectum. These symptoms nearly
always recover.

Also, follow-up tests may indicate that the brachytherapy implant has not adequately treated the gland, thus additional external beam radiation therapy would be recommended.