With advances in medical science, cancer treatment is no longer limited to a single approach. Even within radiotherapy, there are brachytherapy and External beam radiation therapy (EBRT) treatment options designed to improve precision while minimising damage to healthy organs. According to Clinical Oncologist Dr. Chow Yi Ler Daryn, radiotherapy can broadly be divided into external (far-distance) and internal (near-distance) treatments, with the latter playing an increasing role in prostate tumour management.

Overview of Radiotherapy

Radiotherapy uses high-dose radiation to damage the DNA of cancer cells, leading to tumour control. Treatment selection depends on tumour location, disease spread and the patient’s overall condition.

External Beam Radiotherapy

External beam radiotherapy uses a linear accelerator to generate high-energy radiation that penetrates the skin from outside the body and targets the tumor directly. This method offers a wide coverage area and a relatively uniform dose distribution, making it a very common treatment option in clinical practice.

Generally, the treatment course lasts for an extended period, such as five sessions per week, and is completed over six to seven consecutive weeks.

Brachytherapy: Sealed and Unsealed

A key feature of brachytherapy is placing the radiation source “close to” the tumor site to minimize the impact on surrounding healthy tissue. It is primarily divided into the following two categories:

Sealed Brachytherapy

In sealed brachytherapy, radioactive material is enclosed in small containers that are implanted into or near the tumor site under anesthesia. The position is confirmed using CT or MRI scans, and radiation is released directly at the local site to control the tumor. This type of treatment is commonly used for gynecological tumors or certain head and neck tumors.

Unsealed Brachytherapy (Oral or Intravenous)

In unsealed therapy, radioactive substances are formulated into oral medications or administered via intravenous injection, allowing the medication to circulate through the bloodstream and take effect within the body. This method can be considered a form of “targeted radiation therapy” and is commonly used for certain types of metastatic tumors, including prostate cancer. Taking intravenous administration as an example, patients typically receive treatment at the hospital for about half an hour, followed by several hours of observation. They are discharged once the radiation levels in their body have dropped to a safe range. Compared to daily external beam radiation therapy, the intervals between these treatment sessions are usually longer.

Key Applications in Prostate Cancer Treatment

Take prostate cancer as an example: tumor growth is closely linked to male hormones. Initial treatment typically focuses on surgery or hormone-blocking medications, but over time, some tumor cells may develop resistance to these treatments. At this point, targeted brachytherapy becomes another treatment option.

Before treatment, the doctor will review the patient’s medical history in detail, order basic blood tests, and use imaging studies to confirm whether the tumor has suitable “targets” to determine if the treatment is appropriate.

Post-treatment Precautions

After completing targeted radiation therapy, doctors generally advise patients to:

•  Get plenty of rest for one to two weeks following treatment

•  Temporarily avoid close contact with pregnant women or young children

•  Avoid prolonged close physical contact and sexual activity

Overall, the side effects of this treatment are manageable, but individual responses vary, so the attending physician must conduct a personalized assessment.

Whether it is external beam radiation therapy or brachytherapy (sealed or unsealed), each has its own role and indications. For patients with prostate cancer, treatment is not a “one-size-fits-all” approach; rather, the most appropriate plan is flexibly tailored based on the disease stage, treatment response, and individual circumstances. Most importantly, all treatment options should be conducted under the evaluation and guidance of an oncologist.

If necessary, patients are advised to consult their treating oncologist in detail to understand the treatment plan best suited for them.

 

More information about prostate cancer: Prostate Cancer Treatment & Care Team | OncoCare

---

Frequently Asked Questions Q&A

Q1: Which is better, external beam radiation therapy or brachytherapy?

A: Neither is inherently better; the choice depends on the tumor’s location, extent, and treatment goals, and is determined by the doctor’s assessment.

Q2: Is brachytherapy always necessary for prostate cancer?

A: Not necessarily. It is typically considered when other treatments have led to drug resistance or when systemic control is required.

Q3: Is brachytherapy a permanent cure?

A: The primary treatment goals are disease control and symptom relief; actual outcomes vary from person to person.

Q4: If the cancer recurs after treatment, can the same course of therapy be repeated?

A: This currently depends on individual circumstances and the doctor’s judgment; not all patients are suitable for repeat treatment.