What is external beam and what is used for?
External beam is the commonest form of radiotherapy. When it’s given these days, because of high level evidence it’s usually, in fact always, given with a period of hormone therapy. Which has now been shown to give a better outcome from a cancer point of view. So external beam radiotherapy will usually take up to 7 weeks. So that’s the patient going in Monday through Friday for a short burst of radiotherapy on each of those days for about 7 weeks. It also has been found to get improved results when you add hormone therapy to that.
What is hormone therapy and what is it used for?
Hormone therapy means getting an injection every 3 to 6 months, of an agent or a drug which will essentially knock out that man’s testosterone. And it’s been found that the 2 types of treatment seem to work together, in a synergistic fashion, to give a better outcome. Interestingly, hormone therapy has not been found to be of benefit in surgical patients. But it does seem to work better for patients with radiotherapy.
So complication rates of external beam radiotherapy, for erectile dysfunction, is certainly very similar, but they definitely have a lower complication rate for urinary incontinence. But there is also a risk of bowel and bladder dysfunction with external beam radiotherapy. So actually quite similar complications to brachytherapy, because after all we’re still delivering a radiation dose to the prostate. And although techniques have become much more accurate in terms of minimising dose to adjacent organs, there can still be, and sometimes there has to be in fact a little bit of dose that reaches those organs, especially for cancers that are on the periphery of the prostate.
I think getting a second opinion from a radiation oncologist or even another urologist, is a great idea with patients who have just been diagnosed with prostate cancer. It can be very overwhelming for a patient to one receive a diagnosis of cancer, and then have all of this information about what to do next dumped on them.
So I think getting an opinion from one person, you’ll often only take away one, or a few small parts or ideas from that consultation, and getting a different perspective, particularly from somebody who actually practises that type of treatment, is a really good thing to do. Not only to give that different perspective but even having a second consultation with the same person might also be a good idea, just from the [perspective of] the patient’s ability to retain information.