Among your treatment options for prostate cancer, your oncologist may recommend radiation therapy. Especially when used along with hormone therapy, radiation therapy has proven very effective for treating prostate cancer. For some people, it can provide a cure.

Keep reading to learn how radiation therapy works, when it’s used, the different types, and what to expect — including potential side effects.

What Is Radiation Therapy?

Also known as radiotherapy, radiation therapy uses high-energy beams like X-rays to kill cancer cells by damaging their DNA. With damaged DNA, the cancer cells can’t divide. Tumors can’t grow, and the cancer cells eventually die. Radiation therapy is carefully planned and very precise. The goal is to destroy the tumor with minimal damage to nearby healthy cells.

Most forms of radiation therapy are noninvasive. This means they don’t involve surgery. You and your doctor will discuss the goals you have for your radiation treatment. These often include:

• Curing the cancer
• Slowing or stopping the growth of tumors
• Relieving symptoms of spreading cancer, such as bone pain

Radiation Therapy May Be Combined With Other Treatments

Along with radiation therapy for prostate cancer, your oncologist may recommend additional treatments to help prevent cancer from returning. For instance, hormonal therapy may be used to lower your levels of testosterone and dihydrotestosterone. These hormones can make the cancer grow faster, so your team may recommend medications to reduce their effects temporarily.

Types of Radiation Therapy Used for Prostate Cancer

Several types of radiation therapy can treat prostate cancer. Each type works in a slightly different way to target cancer cells. Understanding these options can help you and your care team choose the approach that best fits your diagnosis and treatment goals.

External Beam Radiation Therapy

External beam radiation therapy (EBRT) is the most common form of radiation therapy used for cancer treatment. EBRT is entirely noninvasive. You’ll lie on a table while a machine directs radiation beams at your tumor. Treatments are painless and usually take only a few minutes.

Your schedule for radiation therapy will depend on your diagnosis. Often, people receive treatment every day for several weeks. Your doctor will recommend a schedule for your treatment plan.

Brachytherapy

Brachytherapy is a type of internal radiation to kill cancer. During the procedure, a radiation oncologist will place small, radioactive implants directly into the prostate. These implants sit very close to the tumor and release enough radiation to kill the cancer. There are three major types of brachytherapy:

• Low-dose rate — Temporary implants with low levels of radiation are removed after one to seven days.
• High-dose rate — Temporary implants with high levels of radiation are removed after 10 to 20 minutes.
• Permanent implants — Permanent implants with low levels of radiation are designed to gradually become inactive, but stay in the body forever.

Permanent low-dose rate brachytherapy is used more often for prostate cancer. Brachytherapy is most effective if the cancer is in the early stages and hasn’t spread anywhere else.

Proton Beam Therapy

Proton beam therapy uses radiation made from high-energy particles called protons instead of X-rays. This is a newer technique. The benefit of proton beam therapy is that the machine can deliver radiation directly into the tumor with much less damage to healthy tissue than other radiation therapies. However, it’s more expensive and only available in a few cancer centers worldwide.

Radiopharmaceuticals

Radiopharmaceuticals can deliver radiation directly to cancer cells anywhere in your body. These drugs are more often used if your cancer has metastasized (spread to other parts of your body). Some of these medications can find and destroy prostate cancer cells that have metastasized to the bones. These drugs can also be used in diagnostic imaging to identify cancer sites, allowing doctors to guide targeted therapy and deliver personalized treatment.

When Is Radiation Therapy Recommended for Prostate Cancer?

Radiation therapy may be recommended at different stages of prostate cancer, depending on details about the tumor and your overall health. Doctors use it both as a primary treatment and in specific situations, such as if cancer recurs (comes back).

Localized or Early-Stage Prostate Cancer

Radiation therapy may be recommended as the only treatment for localized or early-stage prostate cancer. It may also be an option for people who prefer to avoid surgery or who aren’t ideal surgical candidates.

Treatment After Surgery

Sometimes radiation therapy is used after surgery for prostate cancer, which is called adjuvant therapy. If the surgeon was able to remove all of the tumor but wants to reduce the risk of the cancer coming back, radiation therapy can be used to kill any remaining cancer cells.

If the surgeon wasn’t able to remove all of the tumor, or if cancer returned after an initial surgery, radiation therapy can be used to kill these cells. When used in this way, radiation therapy is known as salvage radiation therapy.

Recurrence or Metastatic Disease

For more advanced tumors that have spread or come back after prostate cancer treatment, radiation therapy is often included in the treatment plan. In these cases, radiation is typically used in combination with other therapies. The goal in these situations is to control tumor growth and relieve symptoms.

What Happens After Radiation Treatment?

After radiation therapy is finished, you can expect to attend regular monitoring and follow-up appointments. Every person’s follow-up plan looks different, but you may expect to go to follow-up appointments every three to four months for one to two years. You’ll likely get regular physical evaluations and blood tests.

Hormone therapy is often paired with radiation to ensure that your hormones don’t cause your tumor to keep growing during treatment. You may need to continue hormone therapy after radiation therapy is finished to lower the risk of recurrence. If cancer cells show signs of mutations (changes) in certain genes like BRCA, hormone therapy may be paired with targeted therapy drugs. These drugs help find and destroy these mutated cancer cells.

If prostate cancer returns after radiation, progresses despite treatment, or develops certain mutations, immunotherapy may be used to target cancer cells with specific gene mutations. If prostate cancer metastasizes after radiation therapy, radiopharmaceuticals may help target cancer cells anywhere in the body.

Potential Side Effects of Radiation Therapy

Radiation therapy is both safe and effective at treating prostate cancer. However, the treatment is associated with both short-term and long-term potential side effects. Common side effects include:

• Problems with urination such as frequent urination or difficulty starting to pee
• Fatigue (tiredness that doesn’t improve with rest)
• Skin irritation
• Sexual side effects such as erectile dysfunction
• Bowel problems such as diarrhea, bloody stool, or frequent bowel movements

Radiation therapy can also raise the risk of developing secondary cancers later on.

Read more details about possible side effects of radiation therapy for prostate cancer. Talk to your cancer care team about your individual risk for side effects and ways to manage them if they occur.

Join the Conversation

On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.

If you’ve had radiation therapy, what advice would you share with someone who will start this treatment? Let others know in the comments below.