Prostate Cancer

You may be at increased risk for developing prostate cancer if you have:

• Advancing age (especially over 50)
• A family history of prostate, breast, or ovarian cancers
• African American ethnicity
• Certain genetic mutations (e.g., BRCA1/2)

Men with a strong family history may benefit from genetic testing. Ongoing studies continue to explore how diet and lifestyle may influence risk.

Prostate cancer often produces no symptoms in its early stages and is commonly detected during:

• A PSA blood test (Prostate-Specific Antigen)
• A Digital Rectal Exam (DRE)

When suspicion is raised by abnormal results, men are typically referred to a urologist. Further evaluation may include:

• Repeat PSA/DRE
• Multi-parametric MRI (a detailed, noninvasive scan of the prostate)
• Prostate biopsy (12-core sampling ± MRI-guided fusion biopsy)

Diagnosis is confirmed by a pathologist, who assigns a Gleason Score to describe the cancer’s aggressiveness and reports on microscopic features such as:

• Perineural invasion
• Cribriform pattern
• Extracapsular extension
• Intraductal carcinoma

Additional testing—such as a PSMA PET scan or molecular profiling—may be performed to further stage the disease and guide treatment planning. Patients are typically referred to a radiation oncologist, urologic surgeon, and sometimes a medical oncologist to explore all treatment options.

Treatment depends on the cancer’s stage, Gleason score, PSA level, imaging findings, and patient health. Options include:

• Active surveillance
• Surgery (robot-assisted radical prostatectomy)
• Radiation therapy
• Hormone therapy

While surgery can be effective, it may carry risks like urinary incontinence and erectile dysfunction. For many patients, radiation therapy offers an equally curative alternative with fewer long-term side effects.

ARC offers advanced, image-guided radiation therapy tailored to each patient. As part of Specialty Alliance, the largest urology medical group in the U.S., our team is deeply integrated with leading urologists and provides seamless, high-quality care. We emphasize precision, comfort, and long-term quality of life.

External Beam Radiation Therapy (EBRT)

Delivered from outside the body using a linear accelerator, EBRT uses advanced planning and delivery systems to target the prostate while minimizing exposure to nearby organs like the bladder and rectum.

IGRT with Fiducial Tracking

Image-Guided Radiation Therapy (IGRT) uses gold markers (fiducials) implanted in the prostate to guide treatment with sub-millimeter accuracy. IGRT is the “scope,” ensuring we see the prostate clearly every day.

IMRT & VMAT (RapidArc)

Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) shape and adjust the radiation dose in real time. VMAT, also called RapidArc, delivers the treatment in just 90 seconds, with options for:

• 45-48 sessions (standard course)
• 28 sessions (moderate hypofractionation)

This “gentle” technique helps preserve healthy tissue and reduces long-term side effects.

SBRT (Stereotactic Body Radiation Therapy)

Also known as “CyberKnife” or “ultra-hypofractionated therapy,” SBRT treats prostate cancer in only 5 sessions. It delivers high-dose radiation with exceptional precision and has shown outcomes comparable to longer-course therapy for select patients.

Brachytherapy (Seed Implantation)

Brachytherapy involves placing radioactive seeds inside the prostate. This internal radiation delivers continuous, targeted treatment with limited impact on nearby tissues.

Adaptive Radiotherapy

ARC physicians are actively studying adaptive radiotherapy, which dynamically adjusts the treatment plan based on daily anatomical changes, improving safety and effectiveness.

Often combined with radiation, androgen deprivation therapy (ADT) lowers testosterone levels to slow cancer growth and sensitize the tumor to radiation. This can enhance long-term outcomes and is commonly used for intermediate and high-risk cancers.

Short-Term Effects (during or shortly after treatment):

• Urinary frequency, urgency, or nighttime urination
• Looser stools or mild rectal irritation
• Fatigue (typically mild)

These effects usually resolve within 4–6 weeks after completing treatment.

Long-Term Risks:

May include persistent urinary or bowel changes, but are significantly minimized using ARC’s technologies like:

• IGRT and VMAT
• Rectal spacing balloon (placed to protect rectum from radiation)

Patients meet weekly with their radiation oncologist to monitor response, discuss side effects, and make any necessary adjustments.

Consultation

Your care at ARC begins with a comprehensive consultation. During this initial visit, you and your family will meet with one of our experienced radiation oncologists to review your diagnosis and medical history. Together, you’ll explore the most appropriate and effective radiation treatment options tailored to your individual needs. The discussion will also include treatment expectations, potential side effects, and available alternatives to ensure you are fully informed and confident in your care plan.

Simulation (Your Treatment Planning Session)

Once radiation is recommended, you’ll begin with a session called a simulation—a detailed planning appointment that lasts about 45–60 minutes.

During this session:

• We help you get into the best position for your treatment, sometimes using a custom mold to ensure you’re positioned the same way every day.
• Tiny, freckle-sized tattoos may be placed on your skin to help us align your body accurately before each treatment.
• A special imaging scan is performed to pinpoint exactly where the cancer is, so we can target it while protecting nearby healthy tissues.

The Planning process (Behind the Scenes)

After your simulation, your care team—which includes your radiation oncologist, medical physicists, and dosimetrists—will work together to create a custom radiation plan just for you. Using advanced 3D computer software, they map out how to deliver the exact amount of radiation to the right place, while minimizing exposure to healthy areas.

This planning process usually takes 1 to 2 weeks, and it results in a detailed “blueprint” that guides your daily treatments.

Daily Radiation Treatments

Radiation is typically given once a day, five days a week for several weeks. Treatments are done using a machine called a linear accelerator, which delivers invisible, high-energy radiation beams to the cancer.

Here’s what you can expect:

• Each visit takes about 10–15 minutes, with most of the time spent getting you into position. The actual treatment only lasts a few minutes.
• You won’t see or feel the radiation, and there’s no pain during treatment.
• The treatment room is spacious and not claustrophobic.
• In some cases (such as prostate treatment), you may be asked to drink water before your appointment to help move the bladder away from the treatment area.
• Most patients feel well enough to drive themselves, go to work, exercise, and continue their daily routines.

Your radiation oncologist will let you know if there are any specific precautions or changes you should make during treatment.

Weekly On-Treatment Physician Review

During your treatment course, you’ll have weekly visits with your radiation oncologist. These short check-ins help us:

• Monitor how you’re feeling
• Check for any side effects
• Adjust medications if needed
• Answer any questions you have

These visits are an important part of your care and help us support you every step of the way.

Completion of Therapy and Follow-Ups

At the end of your treatment, you’ll meet with your radiation oncologist to talk about:

• What to expect in the coming weeks
• How side effects should improve
• Whether any additional treatment or follow-up is needed

Regular follow-up appointments are essential after radiation to monitor your recovery and watch for any signs of recurrence. We’ll be here to support you long after your final treatment.

If you ever have questions or need guidance along the way, don’t hesitate to reach out. Our team is here to help you feel informed, confident, and cared for throughout your journey.