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Brachytherapy For Prostate Cancer

Brachytherapy is a form of radiation therapy involves implanting tiny radioactive sources directly into the prostate tissue. The therapy is also called also known as internal radiotherapy, sealed source radiotherapy or endocurietherapy. The permanent implants used most often come in the form of "titanium capsules" or “seeds” about the size of a rice grain of 0.8 mm in diameter and 4.5 mm long. They contain a tiny amount of iodine-125, and act by releasing radiation covering a distance of a few millimeters. However, this radioactivity decreases over time and with distance.  


The radiation implants around the radioactive source is well located to avoid damage to surrounding health tissue. This allows to provide a high dose of radiation in the immediate area of the grains to destroy cancer cells while minimizing damage to surrounding healthy organs such as the rectum or bladder. In recent years, Brachytherapy becomes the treatment of choice for prostate cancer. As for all major medical procedures, the therapy requires some preparation.


Imagine Technique - A transrectal (inside the rectum) ultrasound is essential for accurate analysis of the tumor and to determine the volume and structure of the prostate gland. The screening also allows the physician to assess the extent of the tumor in the wall of the prostate, and set the number of radioactive seeds needed for effective treatment. In general, the introduction of the seeds is done under anesthesia. After which, a urine test (urinalysis) will be performed to ensure their sterility, absence of infection. 


Hospitalization – Hospitalization is not out of the picture when it comes to brachytherapy. In general, the admission lasts two days. Patient will stay in a single room, in an area known as "controlled room", while carrying radioactive material.  


It is also important to be fasting from midnight from the preceding night. The patient should not eat or drink. The main role of the hospitalization is the setting up of radioactive seeds (Iodine 125) under ultrasound guidance, using a needle. The number of seeds varies between 60 and 100. Their repartition in the prostate is calculated by appropriate software. A urinary catheter is in place during the surgery and will be removed the next morning. 


Follow-up Testing- Approximately 1 month after surgery, a scanner will be performed to control the position of the radioactive seeds in the prostate gland and evaluate the progress of the therapy, the dose of radiation the prostate is receiving. The PSA will be measured regularly; its normalization is relatively slow and tends to occur over several years. 


Brachytherapy Side Effets  


Brachytherapy is not without side effects, unfortunately. Immediately after awakening from anesthesia, the patient feels a gene in the perineum, the area between the anus and the scrotum in the male and between the anus and the external genital organs (vulva). This requires an analgesic treatment in almost all cases. In addition, urine may contain traces of blood. This bleeding is not disturbing and is temporary. However, persistent Blood in urine (hematuria) should not be overlooked, and requires immediate medical observation to ensure that this is not a complication. Even in the absence of complications, there are urinary problems: frequent urination, difficulty emptying the bladder, and others. Urinary problems are common and can last for weeks or months. It is still recommended to drink plenty of fluids. 


The implantation of the radioactive seeds is permanent, but some can be eliminated. Therefore, it is advised to filter the urine for 2 to 3 weeks after surgery and to use condom during intercourse. In addition, it is important to take all necessary precautions that have been given by the Urologist.  


Advantages of Brachytherapy 


There is no doubt that among the therapeutic modalities used to combat prostate cancer, brachytherapy is surely one of the most powerful weapons. In fact, this approach of fighting malignant prostate tumors has considerably increased in recent years in the U.S.  However, brachytherapy may not be used in all forms of prostate cancer. When prostate cancer is localized, three major treatment options can be considered: prostatectomy, which involves surgically removing the prostate and seminal vesicles; external radiation therapy; and finally brachytherapy (also known as internal radiation therapy), consisting of irradiating the tumor using radioactive implants.  


Brachytherapy cannot be performed on all patients having prostate cancer. To be eligible, patients must have: 

  • A PSA less than 10 ng/ml, which indicates the tumor is confined to the prostate 
  • A tumor diagnosed at an early stage and well differentiated with a Gleason score 6 or less. 
  • A small prostate having a volume less than 50 cc. The larger prostates (50-70 cc) can be reduced using a short-term hormone therapy. 

Unlike other therapies such as surgical therapy, brachytherapy reduces the side effects encountered in other treatments such as erectile dysfunction and incontinence. The planning of the treatment area shall be assisted by ultrasound-guided [Transperineal Ultrasound Guided Radiation Implantation of the Prostate Gland (TPI)] to simplify and make more accurate three-dimensional distribution of the radiation doses. 

Disadvantages of Brachytherapy 

Brachytherapy has certain disadvantages worth to be mentioned. Certain patients may experience infection and bleeding. Those are often resulted from the surgical procedure. As in any surgery involving general anesthesia, death is also a risk. But this is extremely rare with brachytherapy.