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Also known as
Radiotherapy, RT, RTx, XRT, Irradiation, X-ray therapy, Radiation treatment.
Definition
Radiation therapy, also called radiotherapy, is a type of cancer treatment that uses beams of intense energy (most often X-rays, but also proton radiation) to kill cancer cells by destroying their genetic material. Modern methods are precise, aiming beams directly at the cancer while protecting healthy tissues. It can be given externally (external beam radiation therapy) using a linear accelerator, or internally (brachytherapy) by placing a small solid implant in or near the cancer. Healthy cells can repair themselves more easily than cancer cells, which is why the goal is to treat the cancer while harming as few healthy cells as possible.1
Clinical Context
Radiation therapy is widely used in the treatment of various cancers, including prostate cancer. In the clinical context of prostate cancer, radiation therapy can be used as a primary treatment, before surgery (neoadjuvant therapy) to shrink the tumor, after surgery (adjuvant therapy) to eliminate remaining cancer cells, or in combination with other treatments like chemotherapy.1 It can also be used to relieve symptoms in advanced cancer cases.1
While effective, radiation therapy for pelvic cancers, such as prostate cancer, can lead to side effects affecting the urinary and sexual systems. Urinary incontinence is a known potential toxicity following prostate radiotherapy, although reported incidence rates can vary.2 Some studies suggest that while urinary function may initially worsen after radiotherapy compared to active surveillance, it can recover over time, though long-term issues like incontinence due to scar tissue buildup are possible.6 Radical prostatectomy has also been associated with urinary incontinence, and some research indicates that men treated with prostatectomy may experience worse long-term urinary incontinence compared to those treated with radiotherapy.5 However, other studies suggest that prostatectomy is associated with significant declines in urinary incontinence compared to radiation and active surveillance.3 The impact of radiation therapy on the outcomes of treatments for urinary incontinence, such as artificial urinary sphincter placement, has also been studied, with some meta-analyses indicating that radiation therapy may reduce the odds of achieving complete continence after such procedures.4
Erectile dysfunction (ED) is another potential side effect of radiation therapy for prostate cancer. Both urinary incontinence and ED are frequently observed in patients with localized and locally advanced prostate cancer, particularly after radical prostatectomy.2 While prostatectomy is often associated with worse ED outcomes, radiation therapy can also contribute to sexual dysfunction.7
Patient selection for radiation therapy depends on the type and stage of cancer, the patient’s overall health, and treatment goals.1 The specific procedure and expected outcomes, including recovery timeline and success rates, are highly dependent on the type of cancer being treated, the radiation technique used (e.g., external beam, brachytherapy), and individual patient factors. These details are typically planned carefully by a radiation oncology team, often involving simulation and planning scans to precisely target the radiation and minimize harm to surrounding healthy tissues.1