Brachytherapy refers to the use of radioactive sources for the treatment of cancer. In these procedures radioactive sources are temporarily inserted or permanently implanted inside or next to the area requiring treatment, delivering a radiation dose that is highly conforming to the tumor.
Prostate Seed Implantation
If diagnosed early, prostate cancer is typically confined to the prostate, which makes it a good target for brachytherapy. Technically, it is possible to deposit radioactive seeds in the prostate with a low chance of complication.
Prostate seed implantation was first developed as a procedure in the 1970s, but was abandoned because of problems with accurate seed placement. Today, with the use of a transrectal ultrasound probe, the urologist and the radiation oncologist can accurately measure the size of the prostate to better determine the number of and location of seeds to be inserted. The actual seed placement is now easier and more accurate.
Statistically, brachytherapy for early prostate cancer offers an 80 to 95 percent cure rate. Patients who had the procedure 10 years ago still show no signs of recurrence, which is comparable to radical surgery.
Before the advent of prostatic specific antigen (PSA) testing that is now offered routinely to men over 55, patients frequently did not seek treatment for prostate cancer until the disease was too far advanced. Today, patients have a very favorable prognosis also because the cancer is detected early and the disease is localized.
Physicians at LifeBridge Health began performing the procedure for older patients who were not good candidates for surgery for a number of medical reasons. The traditional treatment for younger patients suffering from prostate cancer has been surgery, but encouraging long-term results mean more patients are choosing brachytherapy as the preferred treatment for early-stage prostate cancer. Younger patients can potentially have a better chance to preserve the ability to have an erection and remain sexually active, which is a major consideration.
Prostate brachytherapy is a convenient outpatient procedure conducted with the radiation oncologist and urologist working as a team. The patient receives general anesthesia, and the radioactive seeds are inserted with a needle directly into the prostate, thus the radiation is concentrated in the area of the cancer. While the target organ receives a much higher dose than that which can be achieved by external radiation treatments, the surrounding normal structures are exposed to only a small fraction of that dose.
The procedure does not interrupt one’s lifestyle. The most common side effects are increased urinary frequency and urgency that subside after a few months. They are not incapacitating. Most patients are able to resume normal activities within a few days.
One month following the procedure, a computed tomography (CT) scan of the implanted area is performed. The information is transferred to a computer that helps to determine the final dose distribution. After the procedure, patients continue to be seen at regular intervals by the urologist and radiation oncologist. Repeated PSA tests are obtained to monitor the progress of recovery.
High Dose Rate Remote Afterloading
High dose rate (HDR) remote afterloading is a form of brachytherapy that places a high-energy radiation source inside the body, near the tumor, for brief periods of time. HDR is used to treat gynecologic, breast and other accessible tumors. Treatments are performed on an outpatient setting and take five to 15 minutes. The advantages of HDR over other brachytherapy procedures includes the ability to kill tumor cells more effectively.