Brachytherapy As Effective As Surgery For Prostate Cancer
New York Jun 23 A world renowned expert in the field of prostate cancer treatment, Dr. Haakon Ragde, presented results of a 12-year study that demonstrates brachytherapy, or implanting of radioactive seeds into the diseased prostate, is as effective as removing the prostate surgically. He also noted that adverse effects from the procedure, such as incontinence and impotence, are minimal. There is no open surgery and the recovery period is short, usually hours to a couple of days.
Final results of the study, which were announced at a meeting with journalists at the Commonwealth Club, will be published in the July 1 issue of Cancer. Dr. Ragde disclosed preliminary results at a medical conference of radiation oncologists in Washington, DC, in May.
“Increasingly, patients are seeking, if not demanding, accurate estimates of their prognosis,” explained Dr. Ragde, who has performed more than 4000 brachytherapy procedures since 1985. “Physicians also require such estimates, based on the most precise and up-to-date information, when planning therapy. For the clinician and patient alike, a vital question has long waited for an answer: Is brachytherapy effective in the long-term?”
Dr. Ragde noted that there are several treatments with intent to cure the disease of prostate cancer. They include radical prostatectomy, cryosurgery, external beam radiation, and brachytherapy.
What Side Effects May Occur As A Result Of Brachytherapy
Side effects of brachytherapy can include swelling, bruising, bleeding, or pain and discomfort at the spot where the radiation was delivered. Brachytherapy used for gynecologic cancers or prostate cancer can lead to short-term urinary symptoms, including incontinence or pain on urination. Brachytherapy for these cancers can also lead to diarrhea, constipation and some rectal bleeding. Prostate brachytherapy can occasionally cause erectile dysfunction.
What Does Treatment Involve
If you decide to have HDR brachytherapy, you will be referred to a specialist who treats cancer with radiotherapy, called a clinical oncologist. The treatment itself may be planned and carried out by specialists including therapy radiographers, radiologists, urologists, physicists and sometimes a specialist nurse.
If you have a large prostate, you may have hormone therapy before brachytherapy starts, to shrink your prostate. If you have a higher risk cancer, you may have hormone therapy before and after treatment. You may also have a short course of external beam radiotherapy. You may have this before or after your HDR brachytherapy.
Before treatment
On the morning of your treatment, you will have an enema to help you empty your bowels. An enema is a liquid medication which is inserted directly into your back passage . Its important that your bowel is empty so that clear images of your prostate can be taken. The nurse may then give you a tablet to stop you needing to open your bowels when the radiation is being delivered.
You will probably have a general anaesthetic so that you are asleep during the procedure. But you may have a spinal anaesthetic , so that you are awake but cant feel anything. Talk to your doctor about which type of anaesthetic you will have it may depend on what your hospital offers.
Treatment
One treatment
Two or three treatments in total
After treatment
Don’t Miss: Pomegranate Prostate Cancer Latest News
Benefits And Disadvantages Of Brachytherapy For Early Prostate Cancer
If you have a low-risk cancer, you may be asked to decide between external beam radiotherapy and brachytherapy. This is because your doctor thinks they are both effective treatments for you. It is important to talk about the possible advantages and disadvantages of each treatment with your doctor or nurse. You can then decide with them which treatment is right for you.
Read Also: Immunotherapy For Prostate Cancer Treatment
Inception Cohort Study Offers Unique Perspective
Researchers report that approximately 80 percent of patients with new diagnoses present with clinically localized disease, but no clear consensus exists on the best method of treating localized prostate cancer that maximizes the chance for cure while minimizing toxicity. This is in large part because randomized controlled trials are difficult to conduct in this disease, mainly due to its long natural history, well-established referral patterns and strong patient preferences regarding treatment options.
Brachytherapys efficacy in controlling disease in the Cleveland Clinic study was consistent with other large published series, many of which, unlike the Cleveland Clinic study, included supplemental EBRT for a substantial proportion of patients and mandated androgen deprivation therapy for intermediate-risk and high-risk patients, or both.
The median age of patients in the Clinic study was 67 years, and the median overall and prostate-specific antigen follow-up times were 6.8 years and 5.8 years, respectively. The overall 5-year rates for biochemical relapse-free survival, distant metastasis-free survival, overall survival and prostate cancer-specific mortality were 91.9%, 97.8%, 93.7% and 0.71%, respectively. The 10-year rates were 81.5%, 91.5%, 76.1% and 2.5%, respectively.
Androgen deprivation therapy did not appear to provide additional benefit compared with PI alone. A relatively low percentage of patients received ADT, despite being treated without EBRT.
Read Also: What Kind Of Pain Does Prostate Cancer Cause
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
Read Also: How Successful Is Prostate Cancer Treatment
Low Dose Rate Or Seed Brachytherapy
How it works
In this type of brachytherapy, small seeds of radioactive Iodine are placed into the prostate. Each seed is 5mm long and 1mm wide and 80 to 120 seeds would typically be used. These seeds deliver a high dose of radiation but do so over a long time . As they are placed within the prostate, this allows a high dose to be delivered directly to the tumour with minimal dose to the surrounding healthy organs, such as the rectum and bladder. Using this technique provides a very high chance of cure for suitable patients with reduced side effects.
Who is suitable?
This treatment is suitable for lower risk, localised prostate cancers. There are some requirements that the radiation oncologist will discuss.
What are the benefits and side effects?
The main advantage of brachytherapy is the reduced long-term toxicities. However, there is still a small risk of urethral scarring and long-term change in bladder habit. Like all other prostate cancer treatments, there is a chance that men can develop erectile dysfunction. However, it seems that this risk is lowest with seed brachytherapy. Approximately 30-40% of men will have some erectile problems after LDR brachytherapy.
One of the other big advantages of this treatment is convenience. It typically requires 2 3 visits to the hospital with up to 1 night in hospital.
What is the procedure for treatment?
Results of LDR brachytherapy
For more information about this technique watch the video.
Also Check: How Curable Is Prostate Cancer
What Are The Different Types Of Radiation Treatment For Prostate Cancer
Three types of radiation therapy are used to treat prostate cancer.
Brachytherapy involves inserting radioactive pellets into your prostate. External beam radiation involves aiming radiation at your prostate from an external device. Radiopharmaceuticals involve taking radioactive medication through an intravenous line that travels through your bloodstream.
Technical Aspects Of Hdr
During the HDR-BT procedure, a RALS automatically deploys and retracts a single small radioactive source of 192Ir along the implant needle at specific positions delivering 12 Gy/h, compared with 0.42.0 Gy/h with LDR-BT. The RALS enables a physician to control the position where the HDR source stops for a predetermined time period . The 192Ir used in HDR-BT is contained within the needles placed in the prostate during this temporary implant thus, the target does not move during radiation, and seed migration, is not possible, as it is with LDR-BT.130, 131 Moreover, the treating clinicians are not exposed to radiation, and source preparation is not required, unlike the case with LDR-BT.132 Furthermore, ultrasonography-based planning minimizes catheter displacement.55, 56, 63
HDR-BT has a number of benefits compared with EBRT and LDR-BT, some of which are theoretical and not yet validated in the clinic. Firstly, HDR-BT has the potential to increase prostate-cancer-cell death and minimize radiation-related toxicity by widening the therapeutic ratio, depending on the fractionation, / ratio, and relative biologically equivalent dose .35, 63, 75, 133
Secondly, dosimetry is improved, as a range of dwell times can be employed at each dwell position, with better dose distribution than EBRT .134, 135 Thirdly, the treatment is completed in a few fractions over 14 days, which is more convenient for the patient than a protracted course of conventional EBRT.11, 35, 55, 63, 136–140
Read Also: Where Is Prostate Cancer Located
Possible Risks And Side Effects Of Brachytherapy
Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.
These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.
Dose And Fractionation For Hdr Boost
The American Brachytherapy Society consensus guidelines for HDR prostate brachytherapy was unable to recommend a particular dose fractionation schedule for HDR boost, reporting high biochemical control rates despite a wide variation in dose and fractionation . Recommendations from the European brachytherapy group, GEC/ESTRO reference the following published EBRT dose fractionation schedules :
- 45 Gy in 25 fractions over 5 weeks
- 46 Gy in 23 fractions over 4.5 weeks
- 35.7 Gy in 13 fractions over 3 weeks
- 37.5 Gy in 15 fractions over 3 weeks.
Combined with the following HDR brachytherapy schedules:
- 15 Gy in 3 fractions
- 1122 Gy in 2 fractions
- 1215 Gy in 1 fraction.
Focal boosting with increased dose to areas of gross disease is readily achieved with HDR. Most reports use multimodality fusion, where the planning image sets are co-registered with a diagnostic multiparametric MRI. This can involve either a rigid or elastic co-registration. The purpose of this strategy can either be to improve local control by dose escalation to the gross disease, and/or to reduce toxicity by selective dose de-escalation to the remainder or the gland. Such approaches are well tolerated, but it is not yet known how they compare with more conventional whole gland treatments .
Recommended Reading: Homeopathic Remedies For Enlarged Prostate
Treatment For A Rising Psa After Brachytherapy
A PSA test measures prostate-specific antigen levels in the blood. Benign enlargement of the prostate, inflammation of the prostate, and prostate cancer can all cause a high PSA.
PSA levels sometimes rise after brachytherapy. However, your doctor wont recommend further cancer treatment based on this test alone. Theyll look for a rising trend in PSA over time and consider other factors, such as imaging tests, before recommending further treatment.
Even if your doctor cant see cancer cells with imaging, they may recommend you undergo treatment again based on a risk-benefit analysis. The benefit of catching all the cancer may outweigh the risk of additional treatment.
Other Treatment For Prostate Cancer
In addition to brachytherapy, physicians may recommend additional treatment options, including:
- Prostatectomy to remove the prostate, or a resection to remove a portion of the prostate.
- External radiation therapy using a machine outside the body to target the cancerous cells.
- Hormone therapy to block the hormones that cancer cells need to continue growing.
- Other innovative treatments including cryosurgery to freeze the cancer cells, biologic therapy that uses the patient’s own immune system to fight cancer, high-intensity focused ultrasound to destroy cancer cells, and proton beam radiation therapy that targets tumors with streams of protons.
Learn more about prostate brachytherapy, as well as other forms of prostate cancer treatment at Brigham and Women’s Hospital.
Also Check: Survival Rate Prostate Cancer Stage 4
Having The Tubes Put In
Your doctor passes an ultrasound probe into the back passage to take pictures of the prostate. This helps them to plan the number of tubes needed and where they should be placed. They sometimes also use a CT scan to help position the tubes.
Your doctor passes the tubes that deliver the brachytherapy into your prostate. This is done through the skin between the scrotum and back passage. They may also put a tube into the bladder to drain urine . This prevents any swelling of the prostate stopping you passing urine. They remove the catheter before you go home.
When the tubes are in, you have a CT or MRI scan. This helps your doctor plan exactly how much radiation to give the prostate.
Indications And Contraindications To Brachytherapy For Prostate Cancer
All patients require a biopsy to determine tumour Gleason score, pretherapy serum PSA measurement ,and clinical tumour classification with digital rectal examination and possible imaging with a CT of the pelvis before initiation of any form of treatment, as these prognostic factors determine risk classification.3, 77 Over 80% of prostate cancer patients do not die of their disease 78 thus, maintaining quality of life is key in all patients. All patients should have their urinary and erectile function assessed with validated questionnaires, including the American Urologic Association , International Index of Erectile Function , and/or Expanded Prostate Cancer Index Composite , before treatment begins.3, 79
Recommended Reading: Where’s My Prostate Located
Problems With Your Bowels And Back Passage
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.
You might find that you need to avoid high fibre foods as it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Inflammation of the back passage is another possible long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Talk to your doctor or specialist nurse if you have any of these side effects. They will be able to refer you to a specialist team that can help you to find ways of controlling the effects.
Also Check: Oral Medication For Prostate Cancer
What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
You May Like: Castration Resistant Prostate Cancer Definition
What Are The Pros And Cons Of Brachytherapy
Brachytherapy is highly effective at treating prostate cancer. But its main benefit is that it limits radiation exposure to the surrounding areas. The normal structures around the prostate get close to no radiation, which is really dramatic, and that’s why people tolerate these treatments so well, Horwitz said.
Stereotactic Body Radiation Therapy
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.
Also Check: Prostate Cancer Active Surveillance Diet