Why You Should Consider Brachytherapy Treatment

Nav­i­gat­ing treat­ment options after a prostate can­cer diag­no­sis can seem like a daunt­ing task. As with any can­cer diag­no­sis, we always encour­age our patients to seek mul­ti­ple opin­ions and do their own research to decide the best course of action. We’re also com­mit­ted to arm­ing our patients and col­leagues with our wealth of knowl­edge on the sub­ject which brings us to our top­ic today: why you should con­sid­er brachyther­a­py treatment.

What is Brachytherapy?

LDR (low dose rate) Brachyther­a­py, also known as inter­nal radi­a­tion, involves using ultra­sound images to place tiny radioac­tive seeds in or near the can­cer­ous tumor. Radi­a­tion kills the tumor by destroy­ing the DNA with­in the can­cer cell. When the can­cer cell attempts to divide and repro­duce itself, it is unable to do so because the DNA is no longer intact and as a result, the prostate can­cer dies.

What is the his­to­ry of Brachytherapy?

Doc­tors used brachyther­a­py to treat prostate can­cer as long ago as the ear­ly 1900s. In fact, in 1906, Alexan­der Gra­ham Bell, inven­tor of the tele­phone, argued in sup­port of this very type of pro­ce­dure. In 1916, the first prostate brachyther­a­py pro­ce­dure was per­formed. Since then, tech­nol­o­gy has vast­ly improved with the inven­tion of mod­ern com­put­er sys­tems and ultra­sound imag­ing. This new tech­nol­o­gy allows doc­tors to be extreme­ly pre­cise with regards to where they place radioac­tive mate­r­i­al. The ben­e­fits of this have led to decreased side effects and less­ened the risk of dam­age to oth­er near­by organs such as the blad­der and rectum.

Who are the best can­di­dates for this type of prostate can­cer treatment?

The best can­di­date for brachyther­a­py treat­ment 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 treat­ment is also ide­al for patients with inter­me­di­ate or high-risk prostate cancer1. The seed implant is often per­formed in com­bi­na­tion with exter­nal beam radi­a­tion ther­a­py, plus or minus hor­mone ther­a­py. Your physi­cian will help guide you towards the most appro­pri­ate treat­ment plan for you based on your unique situation.

Are there side effects of Brachyther­a­py treatment?

Side effects of brachyther­a­py tend to only affect the small treat­ment area. We encour­age patients to dis­cuss poten­tial side effects with their doc­tor; how­ev­er, some ten­der­ness and swelling in the treat­ment area are what patients usu­al­ly expe­ri­ence. Stud­ies have shown that brachyther­a­py treat­ment is an effec­tive method for many types of prostate cancers.

What are the ben­e­fits of Brachyther­a­py treatment?

    1. Cure rates are equal or bet­ter. Cure rates in low-risk patients are equal to or bet­ter than surgery or exter­nal beam radi­a­tion ther­a­py (EBRT). For inter­me­di­ate and high-risk patients, brachyther­a­py com­bined with EBRT has result­ed in supe­ri­or out­comes when com­pared to surgery (1, 2).
    2. Brachyther­a­py is 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).
    3. Con­ve­nient sched­ul­ing. Since brachyther­a­py is an out­pa­tient pro­ce­dure, no hos­pi­tal stay is required. Patients are not required to take weeks off of work such as in surgery.
    4. Cost-effec­tive treat­ment. The com­mon alter­na­tives to brachyther­a­py are a sur­gi­cal removal (prosta­te­c­to­my) or many weeks of exter­nal beam radi­a­tion. When com­pared to both, Brachyther­a­py is the most cost effec­tive option (4).
    5. Less chance of uri­nary and bow­el irri­ta­tion. Stud­ies sug­gest that brachyther­a­py treat­ment incon­ti­nence rates are usu­al­ly less than 1% 5. These odds are vast­ly bet­ter than that of get­ting surgery which can pro­duce incon­ti­nence rates as high as 10% (6).
    6. Less impact on decreased sex­u­al func­tion. The prostate gland is a crit­i­cal com­po­nent of sex­u­al func­tions in men so it is not uncom­mon for treat­ments of all kinds to have some effect. Research sug­gests that approx­i­mate­ly 6 – 25% of patients who receive brachyther­a­py will expe­ri­ence a decrease in sex­u­al func­tion 7 ver­sus approx­i­mate­ly 50% of patients who under­go surgery 8. Erec­tile dys­func­tion med­ica­tions are quite com­mon these days and have proven to be very effective.

    Prepar­ing for the procedure

    A clear liq­uid diet and lax­a­tives are required the day before the pro­ce­dure and noth­ing should be eat­en by mouth after mid­night the day of. These rec­om­men­da­tions are for the patient’s safe­ty — min­i­miz­ing gas and pro­vid­ing bet­ter visu­al­iza­tion of the prostate gland. Patients are advised to arrive one hour before the sched­uled pro­ce­dure. While in the oper­at­ing room, the place­ment of nee­dles that con­tain the radioac­tive seeds is guid­ed by the use of ultra­sound and fluoroscopy.

    If you have been diag­nosed with prostate can­cer and would like to dis­cuss brachyther­a­py treat­ment, sched­ule an appoint­ment with our Brachyther­a­py provider today.

    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, N et 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. Quang et al. Tech­no­log­ic evo­lu­tion in the treat­ment of prostate can­cer. Oncol­o­gy (21) 13. 1598 – 1603.
    5. 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.
    6. 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.
    7. 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.
    8. 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.

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