Beam Radiation Therapy

Candidates: Any man of any age, even if he is not in good health, has a life expectancy of less than ten years, or has cancer that has spread beyond the prostate. Not appropriate for very large prostates unless initially shrunk by hormone therapy, nor for men with chronic bowel disease.

Chance of cure: Good, if cancer has not spread beyond the prostate.

Convenience: Depends on the proximity of the hospital or treatment unit, since it requires daily outpatient treatment five days a week for five to nine weeks. No anesthesia, no surgery, no hospi-talization, and no pain. No restriction on activities.

Sexual side effects: Initially minimal, but impotence slowly increases over several years to 40 to 60 percent. Rate higher if combined with seed or hormone therapy.

Urinary side effects: Incontinence rate lower than for surgery but still a small risk. Irritative urinary symptoms and bleeding may be severe and persistent.

Bowel side effects: Frequency, urgency, cramping, and bleeding occur in 10 to 20 percent of cases and may be persistent.

Other side effects: Occasional loss of pubic hair. Fatigue during treatment common. Rectal fistulas now rare.

Follow-up treatment if needed: Surgical treatment difficult because radiation distorts anatomical landmarks and causes scarring of tissues; other options open.

Uncertainties: Provides little information on extent of cancer and possible spread. Posttreatment PSA ambiguous as a predictor of recurrence, especially with PSA bounce.

Unknown: Chances of residual prostate cancer in remaining prostate cells; likelihood of another form of cancer secondary to radiation effects; chances that the cancer has already spread beyond the prostate.

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