External beam radiation therapy

External beam radiation therapy (EBRT) involves aiming beams of radiation at the tumor from outside the body. It is a treatment option for men with localized prostate cancer (stage T2) or locally advanced disease (stage T3). Although no randomized trial has directly compared radical prostatectomy with radiation, available evidence suggests that, for patients with cancer confined to the prostate, either approach is associated with a good chance of being cancer free five to 10 years after treatment.

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External beam radiation therapy is also used as a palliative treatment (a treatment aimed at relieving pain and limiting disease complications, rather than curing a disease). For a patient with prostate cancer that has spread to the bones, radiation therapy can reduce pain and lessen the likelihood of bone fractures. It can also be used to treat neurological symptoms resulting from compression of the spinal cord if cancer has spread to the spine.

Complications of radiation therapy mostly involve adverse effects on the urinary tract and bowel, and usually disappear days to weeks after completing treatment. The risk of long-term urinary complications, such as blood in the urine, bladder problems, or narrowing of the urethra, is about 8 percent. The risk of long-term rectal complications, such as bleeding, ulceration, rectal inflammation, narrowing of the rectum, or chronic diarrhea, is about 3 percent. The risk of erectile dysfunction becomes more likely with time. In one recent study of 434 men, 86 percent were potent 15 months after treatment but only 50 percent were potent six years later. Younger men and those with normal sexual function before radiation therapy are the most likely to maintain potency.

This section also includes information on advanced alternatives to standard EBRT.