Mack Roach III of the University of California, San Francisco talks with Prostatepedia about the pros and cons of different forms of radiation for prostate cancer. (Download Prostatepedia’s August issue to read the interview.)
Different forms of radiation are typically used in different situations.
Localized radiation is used if you only have local disease. If you have low-risk, or favorable intermediate-risk disease, you don’t need to use hormone therapy with radiation therapy.
If you have T3 disease, we need to use external beam radiation with or without brachytherapy and hormonal therapy. We might want to treat the pelvic lymph nodes. We will definitely add hormone therapy.
From a practical standpoint, surgery is almost always the same. The only difference is that the surgeons might, for example, decide to do a lymph node dissection in a patient with more unfavorable features or we might decide to radiate a bigger area in patients with more unfavorable features.
The selection of which form of radiation to use also depends on the expertise of the doctor, how extensive the patient’s disease is, and patient consideration. For example, some patients are not good candidates for brachytherapy, because they’re not candidates for anesthesia or their prostate is too big or they have pubic arch interference. There are specific things that make us favor one treatment or the other.
The bottom line is that patient selection is part of the art of medicine.