Internal Radiation Therapy for Prostate
Also called sealed source radiotherapy or Brachytherapy,
Internal Radiation therapy is a form of radiotherapy consists of implanting tiny radioactive sources near or
directly into the treated area. The radioactive source comes most of the times in the form of "titanium
capsules" or “seeds” about the size of a rice grain. They contain a tiny amount of
iodine-125, and act by releasing radiation into the tumor to kill the DNA of cancer cells, thus preventing them
from reproducing. However, this radioactivity decreases over time and with distance.
seeds are implanted into the body but well located to avoid damage to surrounding health
tissue. This allows the radiologist to provide high dose of radiation in the prostate to destroy cancer cells
while minimizing damage to surrounding healthy organs such as the rectum or bladder. Internal radiotherapy is
not a negligible form of prostate cancer treatment. In recent years, Internal Radiation therapy has become the
treatment ideal for prostate cancer.
As for all major medical
procedures, the therapy requires some preparation. In fact, Brachytherapy has more prerequisites than external
Imagine Techniques - 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 prostatic wall, and set the
number of radioactive seeds needed for effective treatment. In general, the implantation of the seeds is done
under anesthesia. After which, a urine test (urinalysis) will be performed to ensure their sterility, absence of
Hospitalization – Hospitalization is also a part of the preparation for
the Internal Radiation therapy. In general, the admission lasts about two days. Patient
will stay in a single room, well controlled, while carrying radioactive material. The patient is recommended to
be fasting from midnight from the preceding night. The main role of the hospitalization is to set the
radioactive seeds under ultrasound guidance, using a needle. The number of seeds implanted 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.
after the procedure is very important. 4 to 6 weeks after the 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.
Internal Radiation Therapy Side Effects
therapy is, unfortunately, associated with side effects. Right after awakening from anesthesia, most patients
have a feeling of 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). In addition, urine may contain traces of
blood. Most of the times, however, 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. Even
in case of Urinary problems it is still advised to drink plenty of water and natural juice.
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.
Internal Radiation Therapy
There is no doubt that
among the therapeutic modalities used to combat prostate cancer, Internal Radiation therapy 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, Internal Radiation therapy 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
beam radiation therapy; and finally Internal Radiation therapy (also known as internal radiation therapy),
consisting of irradiating the tumor using radioactive implants.
therapy 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
diagnosed at an early stage and well differentiated with a Gleason score 6 or less.
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, Internal Radiation therapy 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
Disadvantages of Internal Radiation
Internal Radiation therapy 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 Internal Radiation therapy.