Radiation Therapy for Prostate Cancer

Our radiation oncology team offers modern, highly precise radiation therapy options for patients with prostate cancer. We use the most advanced treatment options to target cancer cells, with minimal impact on surrounding healthy tissue. This leads to high success rates and fewer side effects.

Radiation therapy options include external beam radiation therapy (EBRT) and brachytherapy, also called internal radiation.

EBRT is a noninvasive treatment that delivers high doses of radiation from outside the body to target and destroy cancer cells. This is most commonly delivered in the form of X-rays, and in some cases through charged particles (protons) or other types of energy.

EBRT is highly precise, allowing doctors to target the cancer while sparing surrounding healthy tissue. Advancements in imaging technology have made radiation therapy more effective and safer, with fewer side effects.

Our doctors may use one of three types of EBRT to treat prostate cancer: image-guided radiation therapy (IGRT), stereotactic body radiotherapy (SBRT), and proton therapy.

Image-Guided Radiation Therapy

IGRT uses imaging technology to target and deliver precise radiation to cancerous tumors. This type of therapy uses CT or MRI scans or both to locate the tumor before and during treatment. This can help increase the accuracy of treatment and minimize the risk of damage to areas near the tumor.

Before treatment, our medical team may inject a gel called a rectal spacer between the prostate and rectum to lower the risk of radiation injury to the rectal area. The gel remains in place for approximately four months before it dissolves. Our doctors may also place several fiducial markers, pinhead-sized metallic devices, in the prostate to track its position during treatment and to ensure all treatments are precisely targeted.

Our doctors determine the appropriate intensity of each dose of treatment based on each patient’s needs. When used with conventional radiation therapy, this method involves daily treatments over approximately nine weeks. Our doctors typically recommend using moderate hypofractionated radiation, which provides a higher dose of radiation during each session over a shorter period of four to five weeks. This method has been shown to be as effective as conventional radiation therapy.

IGRT treatment sessions tend to take longer than other radiation therapies because the prostate’s position must be verified before treatment to ensure accurate delivery. Patients may also need to wait for image processing before each treatment session.

Stereotactic Body Radiation Therapy

SBRT delivers highly concentrated doses of radiation to destroy cancer cells. This option requires fewer treatments than other forms of radiation therapy. Our doctors take images (CT scans, MRIs, or X-rays) to map the exact location and size of the tumor. A specialized computer system then maps how the radiation beams will be delivered to the tumor. This allows us to directly target the tumor and minimize damage to surrounding healthy tissue, which helps reduce side effects.

Radiation oncologists at NYU Langone use different technologies to deliver SBRT treatments, including a CT-based linear accelerator, CyberKnife, and MR-LINAC (MRI-guided linear accelerator).

Linear accelerator SBRT uses high-energy X-rays or electrons to destroy the tumor. The machine rotates around the patient to deliver SBRT and limit damage to nearby healthy tissue. To ensure that treatments are delivered with precision, radiation oncologists use CT scans of the prostate and X-rays images of the fiducial markers to locate the prostate and track its movement.

CyberKnife uses a robotic arm attached to a linear accelerator that moves around the patient’s body to target the tumor with highly concentrated doses of radiation therapy. NYU Langone, the first hospital in New York to offer this treatment, has the largest CyberKnife center in the United States, providing a revolutionary, noninvasive treatment option for people with tumors confined to the prostate. CyberKnife delivers precise radiation therapy, minimizing side effects and improving outcomes for even the most challenging cases.

MR-LINAC, one of the most precise forms of radiotherapy, combines MRI imaging with a linear accelerator for unparalleled precision, allowing for real-time adjustments during treatment. This innovative technology continuously captures MRI images to map the prostate’s position in real time, enabling adaptive planning during each treatment session. It also uses highly sensitive motion tracking to ensure precise treatment delivery. Unlike a traditional MRI, MR-LINAC relies on a multidisciplinary team to collaboratively operate the system and monitor the treatment in real time.

We at NYU Langone have successfully treated more than 300 patients using MR-LINAC since September 2023. Our team is continuously refining treatment methods through clinical trials to deliver the best outcomes with MR-LINAC treatment for our patients.

Before treatment, a radiation oncologist or urologist places a rectal spacer to reduce radiation exposure to healthy tissue. They then conduct a mapping session to measure the prostate’s exact location and shape. During treatment, the patient lies on a table as the machine moves around the body. Radiation beams are precisely directed to destroy the tumor. Imaging technology helps ensure the tumor remains in the same position throughout the procedure. Because of the highly concentrated doses of radiation involved, SBRT is delivered in five sessions over 1 to 1.5 weeks.

SBRT is recommended for tumors that are localized, meaning confined to the prostate. Patients undergoing SBRT must remain completely still during treatment. You may be prescribed antianxiety medications to help manage any stress during the procedure.

Proton Therapy

Proton therapy, also known as proton beam therapy, uses energy from positively charged particles (protons) to kill cancer cells by disrupting their DNA and preventing new cell growth. Proton therapy can precisely target tumors without damaging nearby organs and tissue. It is often used in combination with other radiation therapies.

Before starting treatment, radiologists schedule imaging scans to map the tumor’s location and size. During each proton therapy session, patients are positioned on the treatment table and a large machine is aimed at the prostate to target the tumor. Proton therapy is usually painless and generally takes only a few minutes to complete.

Patients typically receive treatment five days a week for a total of 28 to 44 treatments.

Proton therapy can be an effective treatment option for prostate cancer at various stages, as well as for patients who have had a prostatectomy (the partial or complete removal of the prostate) or those with cancer that has spread to the lymph nodes. However, there is no evidence that proton therapy is more effective at eliminating prostate cancer or reducing side effects compared to other radiation treatments.

Salvage Radiation Therapy

Salvage radiation therapy (SRT) is a treatment option for people who experience a recurrence of prostate cancer after surgery. This is often indicated by rising PSA levels after surgery. The goal of treatment is to prevent further progression of the cancer while preserving patients’ overall wellbeing.

After a patient has a prostatectomy, PSA levels are closely monitored. SRT may be recommended if these levels do not drop or continue to rise. It may also be an option for patients whose cancer returns after other treatments, such as minimally invasive ablation.

SRT allows our doctors to precisely target and destroy any remaining cancerous cells. This enables patients to effectively manage recurrence.

Before starting treatment, imaging scans are performed to help map the treatment area and create a customized treatment plan. Our radiation oncologists use advanced imaging techniques to ensure precise positioning and targeting of the area where the prostate gland was removed. In many cases, surrounding lymph nodes are also targeted during treatment. The specific treatment depends on the patient’s condition and treatment plan.

Patients typically receive treatment five days a week for about seven weeks.

For patients facing prostate cancer recurrence, SRT provides an opportunity to take proactive steps with the support of experienced professionals. Our care team helps patients navigate their choices, ensuring they receive treatment that aligns with their health needs and goals.

The side effects of SRT are similar to those of other radiation treatments. Your care team discusses potential side effects with you and provides guidance on managing potential symptoms.

Brachytherapy uses wires, seeds, rods, or other small objects to deliver radiation internally, as close to the tumor as possible. This lowers the risk of damaging healthy tissue nearby and offers the highest chance of success. Brachytherapy is often combined with other forms of radiation, such as IMRT or SBRT, especially for advanced or high-risk prostate cancers. A study found that in patients with aggressive prostate cancer and high Gleason scores, combining a brachytherapy boost with EBRT improved long-term cure rates when compared to other treatments.

High-dose rate (HDR) brachytherapy is done as an outpatient treatment. Our radiation oncologists and urologists perform this procedure in a dedicated operating suite at Tisch Hospital.

During the procedure, patients are put under general anesthesia. Doctors then temporarily insert flexible needles into the prostate. During the procedure, physicists and planners work with the physician to create a computer-generated plan that maximizes radiation delivery to the tumor while minimizing exposure to healthy tissue. At NYU Langone, we intensify the dose to specific areas within the prostate for greater tumor cell destruction. This is often followed by a course of five targeted sessions of SBRT approximately two to three weeks after treatment.

For patients undergoing low-dose rate (LDR) brachytherapy, seeds are permanently implanted to slowly release radiation.

HDR or LDR brachytherapy is completed in a single session. Patients receiving HDR brachytherapy have no residual radiation and face no restrictions on being near children or pregnant women. Patients undergoing LDR treatment may emit radiation from their bodies because of implanted devices. Radiation doses diminish over time. However, it may be best to limit time spent around children or people who are pregnant.

At Perlmutter Cancer Center, we prioritize patient comfort, offering advanced treatments with fewer side effects and providing supportive services to manage every aspect of recovery. Our care team can recommend techniques or prescribe medications to minimize the effects of radiotherapy at every stage of treatment.

Common Side Effects of Radiation Therapy for Prostate Cancer

Radiation therapy can lead to side effects, and they vary based on the type of treatment, the dose delivered, and individual factors. Many side effects are temporary and improve after treatment ends, but a very small percentage may be long-lasting. These are some potential side effects:

• Urinary issues, such as frequent urination, or a burning sensation while urinating, occur in about half of patients, and symptoms are usually resolved within a few weeks after treatment. Medications can help improve urine flow. Serious issues such as blockage requiring a catheter, incontinence, or blood in the urine are rare, affecting less than 2 percent of those treated.
• Bowel issues, such as more frequent bowel movements. Less common symptoms may include diarrhea, rectal bleeding, pain or discomfort during bowel movements, or the urge to defecate. Our doctors may recommend dietary changes, medications, and supportive care to manage such side effects.
• Sexual dysfunction, including erectile dysfunction (ED). This occurs in 20 to 40 percent of patients, and reduced semen volume affects nearly 80 percent. Medications like sildenafil (Viagra) may be prescribed during and after radiation to lower the risk of impotence. To address such concerns, we may also offer treatments and therapies, including other medications or counseling.
• Skin reactions, such as redness, irritation, or dryness, are uncommon. Doctors may recommend gentle skincare products and techniques for managing skin health if they occur.
• Fatigue and tiredness are common during treatment, particularly in patients receiving hormonal therapy along with radiation. Our doctors may recommend pacing activities, dietary changes, and light exercise to combat these symptoms.