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Disadvantages Of Brachytherapy For Prostate Cancer

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Brachytherapy for prostate cancer is carried out under local or general anesthesia. A doctor installs the needles in the prostate to put in the radioactive sources seeds. The procedure is controlled by the visualized diagnostic units. It takes about 1.5 hours.

After the operation, a patient is hospitalized for 1 day. Then a doctor examines a patient and removes the catheter. A patient returns home.

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Is The Radiation Safe

The radiation is released into your prostate gland over the first few months. After about 12 months, the seeds are no longer active. The seeds can stay in your prostate without doing any harm.

  • It is safe for you to be around other people and pets during this time.
  • As a precaution it is best to avoid close physical contact with small children or pregnant women for the first 2 months after treatment.
  • Follow the advice from the hospital about any specific precautions you need to take.

Why Choose Memorial Sloan Kettering For Brachytherapy

Memorial Sloan Kettering has long been a leader in brachytherapy, pioneering many advances in the field. In fact, MSK doctors were the first to use brachytherapy to treat cancers in the early 20th century.

That expertise continues today, as our medical physicists work with radiation oncologists to design the safest, most precise way to administer the brachytherapy using mathematical modeling and advanced computer programs. Through this collaboration, MSK specialists have developed highly specialized brachytherapy methods for specific diseases.

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Hdr In Conjunction With External Beam

When first used for prostate cancer, HDR brachytherapy was predominantly implemented to boost the prostate as an adjunct to pelvic EBRT. This was considered particularly advantageous when first being used given the contemporary EBRT doses of 66-70 Gy that were considered standard at the time. Several single-institution experiences reported on the safety and efficacy of such treatment, and a prospective, randomized trial published by Hoskin et al6 demonstrated superior biochemical control in patients receiving HDR brachytherapy boost treatment relative to those patients treated with EBRT alone.

Biological analyses of responses to changes in HDR dosing/fractionation suggested a high sensitivity of prostate cancer cells to increasing fractional doses. That is, prostate cancer has a low alpha-beta ratio, and biologically equivalent dose , it was found, could be dramatically increased through relatively small increases in HDR fraction size. In fact, evidence of dose response in terms of enhanced biochemical control was demonstrated across a range of HDR fractionation regimens increasing progressively from as low as 550 cGy x 3 fractions up to 1150 cGy x 2 fractions.7 More recently, HDR boost regimens given in a single fraction of 1500 cGy 8,9 has gained favor and is the recommended dosing in the most recent open Radiation Therapy Oncology Group protocol to allow HDR brachytherapy as a boost.

The Declining Art Of Brachytherapy

PPT

    Modern medicine advances so quickly that it might be surprising to learn that a 100-year-old treatment for prostate cancer is still relevant. Brachytherapy, which involves bombarding the tumour with radiation from isotopes positioned around it, has a track record as a safe and effective procedure, and is less costly than other interventions such as robot-assisted surgery. Nevertheless, many oncologists are concerned that the technique could fall out of use.

    In the first demonstration of brachytherapy in 1911, French physician Octave Pasteau used a urethral catheter containing radium. The technique evolved, and by the 1980s, a version known as low-dose-rate brachytherapy, which is still in use today, had emerged. The therapy involves injecting seeds of radioactive iodine or palladium into the gland, with the help of ultrasound imaging. These seeds are permanently embedded, releasing radiation for several months.

    The process poses some problems: implanted seeds can expose patients sexual partners to radiation, and the seeds can migrate into healthy tissues over time, for example. Another iteration of the treatment, known as high-dose-rate brachytherapy, remedies this by temporarily introducing iridium isotopes into the prostate inside catheters.

    Nature574, S81

    doi: https://doi.org/10.1038/d41586-019-03275-z

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    Who To Tell About Side Effects

    It is important to tell your healthcare team know about your symptoms and how you are feeling. This could be your team at the hospital or your GP. They will be able to assess you and possible refer you for specialist support.

    If you are struggling with side effects between appointments, it is important to call the hospital or 111 and let them know.

    – Jasmine, who with us

    C How Much Radiation Is Enough

    The total amount of radiation the prostate gland will receive depends upon the amount of radiation in each seed and the total number of seeds deposited. A typical implant usually requires approximately 60 to 100 seeds, depending on the size and shape of a patients prostate gland. The extent of treatment that a patient requires is dependent upon the risk that his cancer is confined to the prostate. As a rule, low-risk patients require one treatment, such as permanent seed implant. Hormone therapy in this group of patients may be used to reduce the overall size of a large prostate gland.

    It is often recommended that men at intermediate risk for cancer that has spread undergo more aggressive treatment. At a minimum, this means a combination of hormone therapy plus a seed implant. In some cases, even more aggressive measures, such as adding five weeks of external beam radiation therapy to a seed implant, may be indicated. The purpose of the additional EBRT is to kill any cancer cells that may have escaped the prostate and are in the tissue around the prostate. High-risk patients can also benefit from brachytherapy, but this is usually done in combination with EBRT and hormone therapy.

    D. What are the Advantages of Brachytherapy?

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    What Are The Advantages And Disadvantages

    An advantage for one person might not be for someone else. If you are offered HDR brachytherapy, speak to your doctor or nurse before deciding whether to have it. They can help you think about which treatment to have. Theres a list of questions on below which you might find helpful. Give yourself time to think about whether HDR brachytherapy is right for you.

    Advantages

    • HDR brachytherapy delivers a high dose of radiation directly into the prostate. This means healthy tissue nearby only gets a small dose of radiation and is less likely to be damaged and cause side effects.
    • You will be in hospital for just one or two days for treatment.
    • Recovery is quick, which means you can usually return to your normal activities within a week.
    • If your cancer comes back, you may be able to have further treatment with hormone therapy.

    Disadvantages

    • It can cause side effects such as urinary, bowel and erection problems.
    • You will need an anaesthetic.
    • At some hospitals, you may need more than one radiation treatment. You may need to stay in the same position between treatments, with the tubes still in your prostate. Some men find this uncomfortable.
    • It may be some time before you will know whether the treatment has been successful.

    If you are having external beam radiotherapy as well as HDR brachytherapy, think about the advantages and disadvantages of both treatments. You may have more side effects if you have HDR brachytherapy and external beam radiotherapy.

    Hormone Therapy Side Effects

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    Internal Radiotherapy For Prostate Cancer

    Brachytherapy is a type of internal radiation therapy. It is when a radioactive source is put inside the prostate. It then releases radiation to destroy the prostate cancer cells. The source, also known as seeds or pellets might stay inside your prostate permanently or your radiographers or doctor will remove it after treatment.

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    Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.

    Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.

    A physician can recommend a number of treatments to address an enlarged prostate. An enlarged prostate will require surgery to relieve the symptoms. In most cases, surgical treatment for an enlargement of the penis is enough. Moreover, a doctor may recommend a course of treatment based on symptoms. A TURP procedure is not painful and requires less recovery time than open surgery. The recovery period will be shorter and less traumatic.

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    How Is Hdr Brachytherapy Given

    You may have a general anaesthetic or a spinal anaethestic . The needles are passed into your prostate and surrounding tissue through the area between your scrotum and anus. This may take about an hour.

    You may stay under anaesthetic and have the radioactive sources put into the needles, or you may be woken up and have treatment later than day under spinal anaesthetic.

    In the treatment room, the needles in your prostate will be attached to the HDR machine. This machine feeds the radioactive sources through the needle and into the prostate. The needles are left in for about 3 hours and then removed.

    Stereotactic Body Radiation Therapy

    PPT

    This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

    SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.

    The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

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    What Is Brachytherapy

    Brachytherapy is a form of internal radiation therapy where the radiation is placed directly into the tumor to target cancer cells. The radiation, which is in the form of a small pellet or seed, is placed inside the body using a needle and catheter near or within the cancer.

    Two types of brachytherapy are used to treat prostate cancer:

    Permanent, or low dose rate , brachytherapy involves placing small radioactive pellets or seeds inside the prostate. The seeds emit a specific amount of radiation over a period of months and then lose their radioactivity.

    Temporary, or high dose rate , brachytherapy involves placing a certain number of hollow needles throughout the prostate, and then a single small radioactive source attached to the end of a wire moves in and out of the needles for different amounts of time, creating a specific amount of radiation around the entire prostate. HDR prostate brachytherapy has been found to be highly effective in treating the prostate cancer with substantially fewer side effects compared to the seed implant and therefore, it is the only form of brachytherapy used at Fox Chase. Depending upon the size of the cancer, the HDR treatment is done by itself twice over two weeks or once combined with external beam radiation therapy.

    Frequent Or Loose Poo

    Your bowel movements might be looser or more frequent than before your treatment.

    You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help. Your doctor or nurse can prescribe these for you, talk to your doctor before taking these.

    You might find that you need to avoid high fibre foods. Although we normally think that a high fibre diet is the most healthy, it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .

    Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.

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    Will Radiation Therapy Make Me Tired

    Everyone have their own energy level, so radiation treatment will affect each person differently. Patients often feel fatigue after several weeks of treatment. For most patients, this fatigue is mild. However, a loss of energy may require some patients to change their daily routine.

    If your doctor thinks you should limit your activity, they will discuss it with you.

    To minimize fatigue while you are receiving radiation treatment:

    • Be sure to get enough rest.
    • Eat well-balanced, nutritious meals.
    • Pace your activities and plan frequent rest periods.

    More Information And Support

    HDR Brachytherapy for the Teal Stage of Prostate Cancer | Prostate Cancer Staging Guide

    Brachytherapy and its effects can have a huge impact on your physical and emotional wellbeing. You may be dealing with the effects of other treatments, such as chemoradiation, as well as continuing to process a cervical cancer diagnosis and all that can bring.

    Your healthcare team, both at the hospital and at your GP surgery, are there to support you with any questions or worries you have. Remember that we are here for you too, whether you are waiting for radiotherapy, in the middle of treatment, or years past it. Our trained volunteers can listen and help you understand whats going on via our free Helpline on 0808 802 8000.

    Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own whichever feels most comfortable.

    If you have general questions about the effects of brachytherapy, our panel of medical experts may be able to help. They cant give you answers about your individual situation or health its best to speak with your GP or healthcare team for that.

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    What Are The Side Effects

    Like all treatments, HDR brachytherapy can cause side effects. These will affect each man differently, and you may not get all the possible side effects. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.

    You may have more side effects if you have HDR brachytherapy and external beam radiotherapy together although this doesnt always happen. External beam radiotherapy can cause side effects months or even years after treatment.

    You might also get more side effects if you had problems before treatment. For example, if you already had urinary, erection or bowel problems, you may find these are worse after HDR brachytherapy.

    Tiredness and fatigue

    You may feel tired for the first few days after treatment as you recover from the anaesthetic. The effect of radiation on the body may make you feel tired for longer, especially if you are on hormone therapy as well. If you are getting up a lot during the night to urinate, this can also make you feel tired in the day.

    Fatigue is extreme tiredness that can affect your everyday life. It can affect your energy levels, your motivation and your emotions.Fatigue can continue after the treatment has finished and may last several months.

    If you are also having external beam radiotherapy, this can also cause tiredness.

    There are things you can do to help manage fatigue. Read more about fatigue and managing fatigue. Or contact our Specialist Nurses.

    How Prostate Cancer Staging And Risk Stratification Affect Treatment Options

    Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

    Prostate cancer staging

    Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

    Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

    The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

    Localized, meaning theres no indication that the cancer has spread beyond the prostate

    Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue

    Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate

    Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

    Prostate cancer risk assessment

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