What You Should Know About Prostate Cancer Radiotherapy Treatment: Expert Corner with Dr. Mazen El Bassiouni

In Ireland, almost 4,000 new cases of prostate cancer are diagnosed each year, with incidence increasing after the age of 50. Regular Prostate-Specific Antigen (PSA) testing plays an important role in early detection, as it measures the level of PSA in the blood, which can indicate changes in the prostate. While PSA testing is typically recommended for men over 50, anyone experiencing unusual symptoms, such as changes in urination habits, should visit their GP. 

If you have been diagnosed with prostate cancer, radiotherapy is one of the treatment options available to you.

What advice would you give to men regarding prostate cancer? 

It is important to pay attention to changes in urination habits, such as waking up during the night to urinate, increased frequency during the day, or a slower urine flow. If you notice these symptoms, speak with your GP. 

Many men are hesitant about seeking medical advice out of concern for a potential prostate cancer diagnosis. However, early detection is crucial, as it allows treatment to begin sooner and significantly increases the chances of curing the cancer. If you develop new symptoms, do not delay seeking medical advice. Acting quickly by consulting your GP can provide clarity and guide you towards the next steps in your care.  

How is prostate cancer diagnosed? 

Prostate cancer can often be detected early using a PSA test and a digital rectal exam. While an elevated PSA level does not always indicate cancer, as it can be caused by an enlarged prostate, a digital rectal exam can help determine whether further testing is necessary.  

Patients are typically referred by their GP to see a urologist in the National Rapid Access Prostate Clinic if they have symptoms related to urination, an elevated PSA level, or abnormalities found during the rectal examination. At the clinic, further tests are conducted, including repeat PSA testing, digital rectal exam, prostate MRI scan, and a biopsy. Once all results are available, they are reviewed at a multidisciplinary meeting to confirm or rule out prostate cancer. 

What are the treatment options for prostate cancer? 

Once prostate cancer diagnosis is confirmed, treatment recommendations will be presented to the patient. There are generally two treatment pathways to choose from – surgery and radiotherapy. The consultant and/or care team will discuss the advantages and disadvantages of both treatments. Whether patients choose to go ahead with surgery or radiotherapy is up to them and will depend entirely on what they are more comfortable with. Some patients may wish to avoid surgery, while others may prefer surgery over undergoing radiotherapy over several weeks. A urologist will explain the surgical option, while a radiation oncologist will provide detailed information on radiotherapy, ensuring they have the necessary understanding to make an informed decision.  

Radiotherapy

Radiotherapy, also called radiation therapy, is a highly targeted, highly effective way to destroy cancer cells. Radiotherapy uses high-energy rays to damage cancer cells and stop them from growing and dividing.

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What happens during prostate cancer radiotherapy treatment? 

If radiotherapy is chosen as the preferred treatment pathway, a computed tomography (CT) scan is conducted to map the cancer site and develop a tailored treatment plan. The radiation oncologist uses the scans to outline the areas requiring treatment while protecting surrounding organs from unnecessary exposure. 

Small markers are inserted into the prostate to track its position before each treatment session, ensuring the radiation is accurately delivered. In some cases, a biodegradable gel may be placed between the prostate and the bowel to reduce radiation exposure to the bowel, minimising the risk of bleeding as a long-term side effect.  

What are the side effects of prostate cancer treatment? 

Before beginning radiotherapy, the potential side effects will be discussed with you. Side effects are generally classified as acute, which occur during or shortly after treatment, and long-term, which may develop over time.  

Acute side effects are typically experienced during treatment and for a few weeks afterward. These may include: 

• Fatigue: you may feel more tired during and following treatment.
• Urinary issues: increased frequency or discomfort while urinating.
• Bowel issues: diarrhoea, rectal discomfort, or rectal bleeding.

Long-term side effects may include: 

• Erectile dysfunction: achieving or maintaining an erection can become more challenging.
• Rectal bleeding: while oftentimes rectal bleeding stops on its own, in cases where it persists, a laser vaporisation treatment may be recommended. One to three sessions are usually effective in managing symptoms. 
• High-grade toxicity: very rare. 

Side effects vary between individuals. If you experience any side effects, discussing them with your clinical team can provide reassurance and guidance. Generally, radiotherapy treatment for prostate cancer is well tolerated by most patients.  

About the Mid-Western Radiation Oncology Centre 

Established in 2005, the Mid-Western Radiation Oncology Centre in Limerick is the only specialist radiotherapy treatment centre in Limerick. Operated by Mater Private Network, our expert team offers a wide range of radiotherapy treatment options. We deliver personalised care, looking after the needs of all our patients.

The above content was reviewed by Dr. Mazen El Bassiouni, Consultant Radiation Oncologist at the Mid-Western Radiation Oncology Centre in Limerick. 

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