Do you know your options when it comes to Prostate Cancer treatment?

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The American Brachytherapy Society recently found that many men diagnosed with prostate cancer aren’t presented with a highly effective minimally invasive treatment option: prostate brachytherapy seed implants.

Prostate brachytherapy is a treatment option for men diagnosed with prostate cancer with disease confined to the prostate. Depending on the aggressiveness of the disease, patients can be treated with brachytherapy alone or with a combination of brachytherapy, external beam (x-ray) radiation therapy, and hormone therapy.

What is brachytherapy?

Brachytherapy consists of permanent radioactive “seeds” or temporary radioactive catheters implanted into the prostate. An advantage of brachytherapy over traditional external beam radiation therapy is that higher doses of radiation can be safely delivered to the prostate with less radiation to the surrounding normal tissues such as the rectum or bladder.

What is involved in the procedure and how does it work?

The brachytherapy procedure consists of an outpatient surgery in which the patient is placed under anesthesia. While the patient is under anesthesia, an ultrasound probe is placed in the rectum to visualize the prostate. Using ultrasound guidance, the radioactive “seeds” or catheters are inserted into the prostate through the perineum (the area between the scrotum and anus).

The “seeds” stay in the prostate permanently and deposit all the radiation over the course of several months – this is called low dose rate brachytherapy. If catheters are used for prostate brachytherapy, once the catheters are implanted in the prostate, a radioactive wire is temporarily placed in each catheter to deliver a high dose of radiation – this is called high dose rate brachytherapy.

After the radioactive wire is placed in each catheter, it is returned to a lead capsule, and the catheters are removed from the prostate. For both types of prostate brachytherapy, patients are discharged home after the procedure.

What are the side effects of brachytherapy?

The side effects of brachytherapy include possible decreased ability to achieve and maintain erections, weak urinary stream, burning with urination, diarrhea, and bleeding in the urine or stool.  The risk of having severe urinary side effects is approximately 5 percent and risk of having severe rectal side effects is less than 1 percent.  Generally, men who do not have urinary symptoms prior to brachytherapy are less likely to have urinary side effects from brachytherapy.

Is brachytherapy effective?

A study by Sanda et al in March 2008 published in the New England Journal of Medicine showed patient-reported outcomes of prostate cancer patients treated with prostatectomy, external beam radiotherapy, or brachytherapy. With regards to curing prostate cancer, studies have demonstrated that approximately 70-90 percent of men will be free of prostate cancer 10 years after brachytherapy.

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Article by: Scott Silva, M.D., Ph.D.

Scott R. Silva, M.D., Ph.D. is a radiation oncologist at UofL Health – Brown Cancer Center. He graduated from medical school at the University of Kentucky and completed his residency training in radiation oncology at Loyola University in Chicago. He specializes in genitourinary cancers and has an interest in using brachytherapy in the management of cancer.

All posts by Scott Silva, M.D., Ph.D.
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