Brachytherapy for Prostate Cancer

There are two forms or radiation therapy used to treat prostate cancer: external beam radiation therapy (EBRT) and brachytherapy. Both these therapies are generally used in the early to mid stages of the disease. While the EBRT bombards the area of the cancer with x-rays from a machine outside the body, brachytherapy inserts the radioactive material into the body in very close proximity to the cancer site. The advantage of brachytherapy is that the tumor can be treated with very high doses of localized radiation, while reducing the probability of unnecessary damage to surrounding healthy tissues.

There are two different types of brachytherapy: temporary brachytherapy (catheter placement), and permanent brachytherapy (seed implantation).

Temporary brachytherapy, sometimes called High Dose Rate Brachytherapy (HDR), is a technique that was developed to supplement the dose of radiation given by external beam therapy for patients with high risk prostate cancer. This is considered an effective way to treat such cancers. After patients have received several weeks of standard external beam radiation therapy, he will be given one to three HDR sessions. These sessions require anesthesia and the placement of several catheter needles into the prostate. The patient is then hooked up to an HDR afterloader (a radiation machine), which contains single highly radioactive iridium pellets at the end of wires inside the catheters. One pellet is pushed into each of the catheters which are under computer control. The computer controls how long each pellet stays in its catheter (dwell time), and where along the catheter it should pause and release its radiation (dwell positions). By placing the catheters exactly in the area of the cancer tumor, HDR brachytherapy can provide a very precise treatment that takes only a few minutes.. This type of brachytherapy leaves no permanent source of radiation in the patient. HDR brachytherapy is a boost in extra radiation treatment for prostate cancer patients, and means that the EBRT course can be shorter than when EBRT is used alone.

Permanent brachytherapy is an operation where tiny radioactive pellets (the size of a rice grain) are placed into the prostate next to the tumor. With the seed implantation treatment, radiation hits the prostate tumor first, and only then strikes healthy surrounding tissues. This implantation technique has been in use for decades, however, recent advances in imaging technology have made it more effective. By using ultrasound to see the prostate gland and the tumor, the seeds can be placed in the proper area, and better control the effect on surrounding tissues. Permanent brachytherapy may be the only type of radiation therapy needed by a man with low-risk prostate cancer. Or it can be used after external beam radiation therapy in men with intermediate- and high- risk prostate cancer to provide a boost in radiation to the tumor. The goal is to destroy cancer cells while preserving healthy, surrounding tissue and organs like the bladder, the urethra (the tube that drains urine from the bladder), and the rectum.

There are significant advantages to permanent prostate seed implants because the procedure requires only minor surgery; it is generally a simple outpatient procedure. In addition, this radiation treatment limits the radiation effects on surrounding tissues. Recent reports suggest that when the procedure is performed on properly selected men, it is as effective as surgery on the prostate cancer.

The most important thing about brachytherapy is that the side effects are minimal, especially when compared with EBRT because the duration of the radiation is shorter. Side effects of brachytherapy include frequency of urination, weak urine stream, impotence, and loss of penis volume. Most of the side effect disappear over time.

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