In this guide
Radiation therapy: several ways to deliver treatment.
External-beam radiation
Radiation is directed at a planned area from outside the body. IMRT shapes the dose; image guidance (IGRT) helps verify positioning.
SBRT
Stereotactic body radiotherapy delivers treatment in fewer, larger fractions for selected patients. Suitability and preparation require radiation-oncology review.
Brachytherapy
Radiation sources are placed within the prostate. It may be used alone or as part of a combined approach in suitable patients.
Radiation can be a primary treatment, treatment after surgery, or a way to relieve symptoms from cancer deposits. Hormone treatment may be combined with it depending on the clinical setting.
Discuss urinary irritation, bowel symptoms, fatigue, sexual effects and possible later complications. Ask how treatment planning accounts for bladder and rectal position.
Further reading: American Cancer Society: radiation
Medicines that act throughout the body.
Hormone-sensitive disease
Androgen-deprivation therapy lowers testosterone stimulation. In suitable metastatic disease, additional treatment is usually considered rather than relying on ADT alone.
Treatment intensification
An androgen-receptor pathway inhibitor, and in selected situations chemotherapy, may be added. Fitness, disease pattern and other medicines affect selection.
Castration-resistant disease
This means cancer is progressing despite suppressed testosterone. Further options depend on previous treatment, scans, symptoms and molecular findings.
Hormone treatment can cause hot flushes, fatigue, sexual changes, muscle loss and effects on bones and metabolic health. Discuss exercise, bone assessment and cardiovascular risk as part of treatment.
Further reading: American Cancer Society: hormone therapy
What genetic and genomic tests can add.
Inherited testing examines changes you were born with and can have implications for relatives. Tumour testing looks for changes within the cancer that may help select medicines. These are different from commercial tests that estimate the behaviour of a localised tumour.
Some DNA-repair alterations can support the use of targeted treatments in particular clinical settings. A result needs expert interpretation: finding a mutation does not automatically mean a drug will help. Genetic counselling may be appropriate.
Further reading: NCI: biomarker testing
Theranostics: linking a scan to treatment.
PSMA-based theranostics combines imaging of a molecular target with treatment directed at that target.
Lutetium-177 PSMA radioligand therapy is an option for selected advanced cancers. Eligibility depends on the treatment setting, PSMA expression, previous treatment, blood counts and kidney function. Availability and approved indications vary by region.
Discuss fatigue, dry mouth, nausea, blood-count changes and kidney monitoring, as well as radiation-safety instructions. A PSMA-positive scan alone does not establish suitability.
Further reading: EAU: advanced prostate cancer
Treat symptoms. Protect everyday life.
- Bring symptoms into the conversationPain, poor sleep, urinary difficulty, fatigue and appetite changes deserve attention alongside cancer treatment.
- Maintain strength and functionAsk for an exercise and nutrition plan suited to your health, bone status and treatment.
- Review the plan togetherKeep an updated medicine list and ensure each specialist has access to the treatment history and recent results.
- Include supportive care earlySupport for symptoms, emotional wellbeing and family concerns can accompany active cancer treatment.
New leg weakness, numbness, loss of bladder or bowel control, or severe new back pain with prostate cancer needs urgent medical assessment.