Brachytherapy: Questions and Answers

Posted on: January 17th, 2015
by: Jennifer


Second to skin cancer, prostate cancer is the most common form of cancer in men; approximately 300,000 men in the United States are diagnosed with prostate cancer every year. The exact cause of prostate cancer is unknown. According to the American Cancer Society, an average American man has a one in six chance of being diagnosed with prostate cancer during his lifetime.

Located just below the bladder and in front of the rectum, the prostate is a walnut sized gland that is part of the male reproductive system. The urethra, which is the tube that urine flows through, runs through the center of the prostate gland. The prostate gland produces prostatic fluid which, when mixed with sperm, produces semen.

Prostate cancer occurs when the prostate gland develops malignant cells. “Localized” prostate cancer is when the cancer remains inside the prostate. However, it is possible for the cancer to grow to surrounding tissue, or spread (metastasize) to the lymph nodes or bone. As with many forms of cancer, early detection provides the greatest chance of cure. For this reason, it is important for all men over the age of 50 (age 40 if you are African American or have a family history) to have regularly scheduled annual screening exams which include a prostate specific antigen (PSA) blood test and digital rectal exam (DRE).

If prostate cancer has been diagnosed, graded and staged, there is much to consider before reaching a prostate cancer treatment decision. Patients often feel that they must make a decision quickly. However, it is essential that a patient allows adequate time to educate himself, and reaches a well-informed decision regarding his options. A patient should ask questions of his cancer care team.

Ideally, seeking a second opinion is worthwhile. Prostate cancer is a complex disease, and physicians may differ in their opinions. Some types of prostate cancer treatment are as follows, Seed Brachytherapy, Surgery, External Beam Radiation Therapy, Proton Therapy, HIFU, HDR Brachytherapy, Cyrosurgery, Hormone Therapy and Watchful Waiting.

Chicago Prostate Cancer Center specialized in Low Dose Rate Brachytherapy.

A. What is Brachytherapy?

Brachytherapy, also referred to as seed implants or seeds, brachytherapy is a one-time, minimally invasive procedure usually performed in an outpatient setting under general anesthesia. The procedure itself involves the placement of tiny radioactive seeds inside the prostate using ultrasound equipment.

The seed implants immediately emit radiation and kill the malignant cells

inside the prostate. The time it takes for the radiation to deliver its total dose depends on the seed (isotope) used. There are currently 3 isotopes commonly used in prostate brachytherapy: Cesium131, Iodine125, and Palladium103. Brachytherapy seeds themselves are compatible with human tissue. After the procedure, patients are taken to recovery and are typically discharged a few hours later. Most patients resume normal activities within 24-48 hours. The most common side effect of brachytherapy is temporary urinary irritation including frequency and urgency. These symptoms will last from a few weeks to a few months.

 

B. When is Brachytherapy Appropriate?

Typically, the best candidate for brachytherapy is someone with a prostate tumor confined to the prostate gland that has a very low risk of spreading to other parts of the body.

Brachytherapy is not appropriate in patients whose cancer has already spread beyond the prostate and into other areas of the body. Patients who have had a transurethral resection of the prostate (TURP) may have brachytherapy, however, they will need to meet certain criteria.

 

C. How Much Radiation Is Enough?

The total amount of radiation the prostate gland will receive depends upon the amount of radiation in each seed and the total number of seeds deposited. A typical implant usually requires approximately 60 to 100 seeds, depending on the size and shape of a patient’s prostate gland. The extent of treatment that a patient requires is dependent upon the risk that his cancer is confined to the prostate. As a rule, low-risk patients require one treatment, such as permanent seed implant. Hormone therapy in this group of patients may be used to reduce the overall size of a large prostate gland.

It is often recommended that men at intermediate risk for cancer that has spread undergo more aggressive treatment. At a minimum, this means a combination of hormone therapy plus a seed implant. In some cases, even more aggressive measures, such as adding five weeks of external beam radiation therapy (EBRT) to a seed implant, may be indicated. The purpose of the additional EBRT is to kill any cancer cells that may have escaped the prostate and are in the tissue around the prostate. High-risk patients can also benefit from brachytherapy, but this is usually done in combination with EBRT and hormone therapy.

While the physical properties of radioactive isotopes will remain the same, prostate brachytherapy will only improve as technology evolves. Furthermore, as clinical studies mature and the data is analyzed, physicians in the field will be better prepared to identify more precisely the specific criteria that will allow even better patient selection for prostate brachytherapy.

 

D. What are the Advantages of Brachytherapy?

The rise in the number of men diagnosed with prostate cancer has led to a growing need for improved treatment options that can offer excellent cure rates with minimal side effects at a low cost. Brachytherapy has numerous advantages over other treatment options.

Cure rates:

Cure rates in low risk patients are equal to or better than surgery or external beam radiation. For intermediate and high-risk patients, brachytherapy combined with EBRT has resulted in superior outcomes when compared to surgery.1, 2

Minimally invasive:

With the seed implant, there are no incisions or stitches required such as in the case of surgery. Furthermore, there is minimal, if any, post-operative pain.3

Urinary Function:

When looking at urinary side effects, incontinence rates are usually less than 1%4. For surgery, rates can be as high as 10%5.

Sexual Function:

Approximately 6-25% of patients who receive brachytherapy will experience a decrease in sexual function6 versus approximately 50% of patients who undergo surgery7. Erectile medications and other aids have proven to be very effective.

Bowel Function:

When compared to EBRT, patients undergoing prostate brachytherapy experience much lower rates of bowel irritation with prostate brachytherapy8.

Convenience:

Since brachytherapy is an outpatient procedure, no hospital stay is required. Furthermore, the seed implant is complete in one visit whereas a number of months are required to complete a course of external beam radiation. Patients are not required to take weeks off of work such as in surgery. As we see younger and younger patients with full-time jobs, it is important that they do not interrupt their work schedule for a prolonged period of time. Patients are able to resume normal activity within a day.

Blood loss:

Blood loss during an implant is minimal when compared to surgery9.

Cost:

When compared to prostatectomy (surgical removal) or many weeks of external beam radiation, prostate brachytherapy is the most cost-effective treatment10.

References:

  1. Klein, E. Cleveland Clinic Localized Prostate Cancer Registry. In low-risk prostate cancer, quality of life is key to treatment choice. Urology Times, August 1, 2008.
  2. Bittner, Net al. Interstitial brachytherapy should be standard of care for treatment of high-risk prostate cancer. Oncology. August 2008, p. 995-1017.
  3. Moran BJ, Gurel MH, Visockis J, Geary P. Post-operative pain and prostate brachytherapy. Int J Radiat Oncol Biol Phys 2003; 54: Issue 2 Supplement 0.
  4. Feigenberg SJ, Lee WR, Desilvio ML, et alL Health-related quality of life in men receiving prostate brachytherapy on RTOG 98-05. Int J Radiat Oncol Biol Phys. 2005 Jul 15;62(4):956-64.
  5. Steineck G, Helgesen F, Adolfsson J, et al: Quality of life after radical prostatectomy or watchful waiting. N Engl J Med. 2002 Sep 12;347(11):790-6.
  6. Robinson JW, Moritz S, Fung T. Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma. Int J Radiat Oncol Biol Phys. 2002 Nov 15;54(4):1063-8.
  7. Frank, SJ et al. An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol. 2007 Jun;177(6) 2151-6.
  8. Zelefsky MJ, Fuks Z, Hunt M, et al: High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1111-6.
  9. Rassweiler J, Hruza M, Teber D, et al: Laparoscopic and robotic assisted radical prostatectomy–critical analysis of the results. Eur Urol. 2006 Apr;49(4):612-24
  10. Quang et al. Technologic evolution in the treatment of prostate cancer. Oncology (21) 13. 1598-1603.

 

Chicago Prostate Cancer Center is committed in providing a comprehensive treatment for prostate cancer using LDR Brachytherapy( radioactive seed implant). We pride ourselves on being a patient-centric facility that utilizes its experienced, friendly staff and state-of-the-art equipment to ensure that our patients undergo a stress-free and comfortable prostate cancer treatment. To receive a free brochure and DVD please go to http://prostateimplant.com or contact us at 630-654-2515.

 

 

Facebooktwittergoogle_pluspinterest