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Brachytherapy


Who is suitable for brachytherapy?

Like surgery, brachytherapy is a treatment for organ-confined prostate cancer, and is best suited for those whose prostates are not over-enlarged and for those who have few, or mild urinary symptoms. Where there is a possibility of spread, a short course of radiotherapy is sometimes offered beforehand. The general advice is that PSA should be no more than 20, the Gleason score no more than 7, and the cancer stage should be T1 or T2.

Low dose rate brachytherapy

Low dose rate brachytherapy, unlike external beam radiotherapy, treats the cancer by permanently inserting radio-active seeds of Iodine-125 (or similar) directly into the prostate.

What is involved?

The process is done in three visits:

  • An outpatient appointment will assess your suitability for the treatment, and will consist of some simple tests, which would typically include a DRE examination and a trans-rectal ultrasound examination.

  • The first stage of the treatment will be done as a day case to identify the exact size and shape of the prostate by computer imaging, and to plan the radiation dosage required.

  • The second stage consists of the actual implantation of the seeds under general anaesthetic by a series of 20 - 30 needles, each implanting between 2 and 6 seeds. X-rays are taken during the procedure. You will wake with a catheter in place, which is removed before you leave hospital. A CT scan is done following the treatment in order to check that the right dose has been delivered. Patients are sent home the next day with antibiotics and other medicines.

Is the radiation dosage dangerous?

The major portion of the radiation is released from the seeds into the prostate over the first three months. Thereafter the radiation decreases so that it is negligible after nine months. While the seeds are radio-active, you are not. No special precautions are generally considered necessary, but it is suggested that you avoid near contact with pregnant women, and young children should not sit on your lap for the first two months after the treatment. When having intercourse, you may be advised to use condoms for up to six months.

Side effects

About 5 - 10% of patients may experience temporary urinary retention. Some may experience frequency and urgency, which are again generally temporary. Bowel problems, (e.g. constipation or frequency) can occur 3 - 6 months after the treatment. Erectile problems can occur in up to 60% of men, but the risk is claimed to be lower than with surgery or conventional external beam radiotherapy.

Men on active surveillance are closely monitored with a PSA blood test every few months and possibly a repeat biopsy, typically every one or two years. Many doctors now believe that the Free to Total PSA Ratio and especially prostate MRI scans are also additional monitoring tools. Those cases that show signs of tumour progression will be advised to receive curative treatment, normally with surgery, radiotherapy or brachytherapy, dependent on age and other factors.

Advantages and disadvantages

Advantages and disadvantages of brachytherapy
Advantages Disadvantages
  • It allows a higher dose of radiation to be delivered directly to the prostate when compared with external beam radiotherapy.
  • There is only a short stay in hospital and in most cases no catheter after the treatment
  • Incontinence and impotence rates are lower than for surgery and similar to radiotherapy.
  • Only a few days off work are needed.
  • The result of the treatment will not be known for some months.
  • There will be temporary worsening of urinary symptoms for about three months after treatment.
  • Surgery is generally not possible after radiotherapy or brachytherapy treatments. Brachytherapy is normally not possible after external beam radiotherapy.

High dose rate brachytherapy

This method uses thin catheters placed into the gland with the aid of a template through which iridium seeds on rods are inserted. Computers control the length of time the radiation is given to the catheters, and so control the radiation dosage to different regions of the prostate. This method is sometimes used in combination with standard radiotherapy. The catheters are withdrawn immediately after the treatment session, with no radio-active material remaining in the prostate.

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Published: 1-May-13^ back to top