Like radical prostatectomy, radiation treatment for prostate cancer is not a new idea. In fact, it wasn’t too long after urologist Hugh Hampton Young did that first radical prostatectomy (see Chapter 5) that he and another colleague at Johns Hopkins pioneered radiation therapy in this country (it had been developed a few years earlier in Europe). The treatment was primitive by today’s standards, involving special radium applicators placed in tissue surrounding the prostate—the urethra, bladder and rectum.

But the next few decades laid the groundwork for some of today’s radiation therapies: X-ray treatments were introduced, followed by radon “seeds” that could be inserted in the prostate tumor.

These fledgling attempts at curing prostate cancer, however, were not distinguished by astounding success. Radiation treatment, therefore, was only palliative—it could relieve pain and symptoms, but it did not eradicate the cancer.

In the 1940s, the impact of hormones on the prostate was discovered, and radiation was all but abandoned in favor of castration and hormonal drugs. But radiation’s exile was not long, thanks largely to scientists who revolutionized the field, using an exciting new machine called a linear accelerator. They produced penetrating, high-powered beams that could target radiation doses to a specific site without harming surrounding tissue. And suddenly, radiation was off the bench and back in the ballgame as a major player—a treatment that could actually cure localized cancer, not just relieve the symptoms of advanced disease.

In the decades since then, radiation therapy has been refined and made even more powerful. There are two standard approaches—sending radiation into the tumor from the outside, with external-beam therapy, and implanting radioactive seeds directly into the tumor (this is called interstitial brachytherapy). Also, within the last few years, a new technique called three-dimensional con-formal therapy has come on the scene. It increases external-beam therapy’s potential by maximizing the dose of radiation to the prostate tumor while keeping the risk of damaging nearby tissue to a minimum.


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