Brigham And Women’s Hospital Delivers The Most Advanced Prostate Brachytherapy
Physicians and caregivers provide compassionate care and world-class treatment for a variety of cancers, including prostate, kidney and testicular cancer. With a treatment team made up of medical, urologic and radiation oncologists, the center provides each patient with a treatment plan tailored to meet their unique needs. Patients also have access to a wide range of support services to help them cope with the emotional and physical challenges of a cancer diagnosis and treatment.
Get The Nulytely Mixture Ready
On the morning of the day before your procedure:
Dont mix the NuLYTELY earlier than the morning of the day before your procedure.
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
- whether the cancer has spread to other parts of your body
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Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.
Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
How Can I Reduce Skin Reactions
- Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Do not rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
- Try not to scratch or rub the treated area.
- Do not apply any ointment, cream, lotion, or powder to the treated area unless your radiation oncologist or nurse has prescribed it.
- Do not wear tight-fitting clothing or clothes made from harsh fabrics such as wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers such as cotton.
- Do not apply medical tape or bandages to the treated area.
- Do not expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
- Do not expose the treated area to direct sunlight, as sun exposure may intensify your skin reaction and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.
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Prostate Cancer Treatment: Radiation Therapy
Radiation, focused as a beam, can be used to kill cancer cells, especially those cells that have migrated from the prostate gland. Beams of radiation can be used to reduce bone pain caused by invasive cancer cells.
Low Dose Rate Brachytherapy
In another type of radiation therapy termed low dose rate brachytherapy, radioactive pellets about the size of a grain of rice are inserted into the prostate.
High Dose Rate Brachytherapy
High dose rate brachytherapy applies more radioactive sources temporarily into the cancerous prostate gland.
Both methods have side effects that can include erectile dysfunction, urinary tract problems, diarrhea, and other side effects.
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The Declining Art Of Brachytherapy
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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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
After Radioactive Seed Brachytherapy
You can usually go home on the same day, but someone will need to take you. You will not be able to drive, because of the anaesthetic. Your doctor or nurse will explain what to expect after treatment and the precautions you need to take.
Before you go home, they give you antibiotics and tablets to help you to pass urine more easily. Take them exactly as explained.
They also give you a card to carry with you at all times. It explains the treatment you have had and gives your hospital contact details.
- Precautions
The radioactivity from the seeds is absorbed from inside the prostate, so it is safe for you to be around other people. As a precaution, you should avoid periods of close contact with children and anyone pregnant for the first few months. It is safe for them to be in the same room as you. But you will be asked to keep a certain distance from them. Avoid holding or hugging anyone who is pregnant or children for more than a few minutes each day.
Your doctor or nurse will give you specific advice about the safety precautions you need to follow.
- Physical activity
You need to avoid heavy lifting or energetic physical activity for 2 to 3 days. The area between your legs can feel bruised and inflamed for a few days. Your doctor can prescribe painkillers to take.
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How Long Does The Radiation Last
How long the radiation lasts will depend on the type of treatment given. Your health care provider will determine the brachytherapy type based on:
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The type of cancer you have
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The location of the cancer
If the brachytherapy implant is a low dose implant, it may be left in for several days. High dose implants may be removed after only a few minutes.
Some implants are permanent. If you have one, you may need to stay in the hospital for a few days. The radiation gets weaker each day. This means you will most likely be discharged after a few days. There may be certain safety measures to be taken at home. Your health care provider will give you specific instructions, if needed.
Your doctor may remove temporary implants after you have the complete dose of radiation.
What Types Of Brachytherapy Can Be Used For Treatment Of This Cancer Type
There are two types of brachytherapy which can be used to treat prostate cancer:
- Low Dose Rate brachytherapy â also referred to as ‘seed therapy’ or âpermanent seed implantation’. Tiny radioactive seeds, about the size of a grain of rice, are permanently placed inside the tumor. The seeds give out low levels of radiation for a few months, killing the cancer cells.
- High Dose Rate brachytherapy involves the temporary placement of a radioactive source to treat the tumor. In contrast to LDR, no radioactive material is left in the prostate after treatment.
HDR brachytherapy has been shown to be an effective treatment for low, intermediate and high risk prostate cancer.
It is often given in combination with external beam radiotherapy , as it can provide an additional dose of radiotherapy to help prevent the cancer from returning.Some centers offer HDR brachytherapy as the sole method of treatment as it is a very effective and quick treatment, making it very convenient for many patients. Your doctor will be able to advise you if HDR brachytherapy is a possible treatment option for you.
LDR brachytherapy has a longer history of clinical usage than HDR brachytherapy. LDR and HDR brachytherapy show similar results for treatment of prostate cancer. However, since LDR radioactive seeds remain in the body, the radiation protection for patients and families could be an issue. Moreover, active seeds can migrate outside the prostate.
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Possible Side Effects Of Ebrt
Some of the side effects from EBRT are the same as those from surgery, while others are different.
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
Side Effects Are Part Of All Types Of Prostate Radiotherapy
A common misconception among prospective patients is that prostate implantation has fewer side effects than external beam radiation therapy. Nearly all patients suffer from some urethritis . Urinary retention requiring a temporary catheter occurs in 5% of patients.
To learn more about prostate seed implantation to treat prostate cancer, or to schedule a consultation, call . You can also reach us using our easy online form.
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How Long Does The Implant Stay In The Body
The implants may be temporary or permanent. If the implants will be removed but then put in again later, the catheter is often left in until the treatment is finished. The catheter is then removed when the implants are taken out for the last time. The way you will receive brachytherapy depends on a number of factors, including where the tumor is, the stage of the cancer, and your overall health.
Brachytherapy Will Make You Give Off Radiation
With brachytherapy, the radiation source in your body will give off radiation for a while. If the radiation you receive is a very high dose, you may need to follow some safety measures.
- Staying in a private hospital room to protect others from radiation coming from your body.
- Being treated quickly by nurses and other hospital staff. They will provide all the care you need but may stand at a distance, talk with you from the doorway of your room, and wear protective clothing.
Your visitors will also need to follow safety measures, which may include
- not being allowed to visit when the radiation is first put in
- needing to check with the hospital staff before they go to your room
- standing by the doorway rather than going into your hospital room
- keeping visits short, about 30 minutes or less each day
- not having visits from pregnant women and children younger than a year old
You may also need to follow safety measures once you leave the hospital, such as not spending much time with other people. Your doctor or nurse will talk with you about any safety measures you should follow when you go home.
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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.
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.
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When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.