Prostate Brachytheraphy

Prostate Brachytherapy

Prostrate brachytherapy is a form of radiation therapy used to treat prostate cancer. It involves placing radioactive sources in the prostate gland, where the radiation can kill the cancer cells while causing minimum damage to nearby healthy tissue.

Types of prostate brachytherapy

There are two (2) types of prostate brachytherapy

• High dose rate (HDR). HDR brachytherapy is a temporary type of prostate cancer treatment. It involves placing radioactive sources in the prostate gland and delivering a high dose of radiation for a few minutes before the sources are removed. Treatment may involve several sessions
• Low dose rate (LDR). LDR brachytherapy is a permanent type of prostate cancer treatment. It involves placing radioactive seeds in the prostate gland permanently, where they slowly release radiation over several months.

What you experience during the procedure depends on whether you have HDR or LDR treatment.

Why is it done?

Prostate brachytherapy is used to treat prostate cancer. The procedure places radioactive sources within the prostate, so cancer receives most of the radiation, therefore close healthy tissue receives a minimum dose of radiation.

If you have early-stage prostate cancer that is less likely to spread beyond the prostate, brachytherapy may be the only treatment required.

For larger prostate cancers or those that have a greater chance of spreading beyond the prostate, brachytherapy may be used along with other treatments, like external beam radiation therapy (EBRT) or hormone therapy.

Prostate brachytherapy generally is not used for advanced prostate cancer that has spread to the lymph nodes or to other areas of the body.

Risks

All surgical procedures involve risk and prostate brachytherapy may cause some side effects including:

• Difficulty urinating
• Frequent sensation for an urgent need to urinate
• Pain or discomfort while urinating
• Needing to urinate at night
• Blood in the urine
• You can’t empty your bladder completely
• Erectile dysfunction
• Bleeding from the rectum
• Blood in the stool
• Urgent bowel movements
• More frequent bowel movements

Doctors may prescribe medicines to reduce side effects of treatment. Most side effects decrease over time.

Complications

Some serious complications may happen after the procedure, but they are rare. You may suffer

• Narrowing of the urethra (the tube that carries urine from the bladder to the penis)
• Abnormal opening in the wall of the rectum (fistula)
• Cancer in the rectum or bladder caused by radiation.

Procedure

• Low dose rate brachytherapy:
  LDR involves placing radioactive sources in the prostrate permanently. During this procedure, you will be placed under anesthesia so you don’t feel pain, or unaware. A wandlike instrument is inserted into the rectum. The instrument produces ultrasound pictures of your prostate. They help to guide a long needle that is used to place many seedlike radioactive implants into your prostate.
  The seeds, about the size of grains of rice, will give off radiation for a few months and will remain in your body permanently. Once the seeds are placed in the prostate, you will spend a short time in recovery, you can then be discharged.
  The low levels of radiation in the seeds normally are not harmful to others, but as a precaution, you may be advised to avoid contact with children or pregnant women for a short time. You are advised to wear a condom during sex.
  
  
• High dose rate brachytherapy:
  HDR involves placing radioactive sources in your prostrate for several minutes at a time. This is a temporary procedure. Before receiving HDR treatments, thin tubes are inserted through a perineum into your prostate at precise locations. You’ll be under anesthesia for this part so you won’t be aware or feel any pain. The tubes are kept in place until you have completed your treatments.
  The tubes are connected to a machine that feeds wires that contain radioactive sources into the prostrate. The wires are left in place for a few minutes. You may hear a clicking noise as the machine adjusts the wires, after which the radioactive wires are removed. This procedure may be repeated a few times, pending your specific treatment plan.
  
  The radioactive source is then removed from your prostate after HDR treatment, so you won’t require any special precautions, so close contact with people is OK.
  
  
• After the procedure, you can expect some pain and swelling in the perineum (anus area). An ice pack placed over the area will give some pain relief as well as some pain medication prescribed by your doctor. Avoid vigorous exercise or heavy lifting for a period of time. You will have blood tests as a follow-up with your doctor to indicate the level of prostate-specific antigen (PSA) in your blood. This will indicate whether the treatment has been successful. Rising PSA levels may indicate that cancer has returned, so imaging tests or a biopsy may be recommended.

Article by
Dr Paibul Boonyapanichskul

A doctor specialist in Urology
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Dr Viroon Donavanik,MD,FACR

A doctor specialist in prostate brachytherapy
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