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Radioactive Seeds For Prostate Cancer

The Process For Implanting Prostate Seeds

Treating Prostate Cancer with Radioactive Seed Implants
  • Step 1: The first step in the process is an outpatient consultation with a Princeton Radiation Oncology radiation oncologist. Your radiation oncologist will advise on the implant option based on your PSA, Gleason score, tumor stage, and other factors.
  • Step 2: The second step is a planning transrectal ultrasound . We place a transducer in the rectum and obtain images of the prostate gland in 5mm segments. Once the prostate is visualized, your Princeton Radiation Oncology radiation oncologist works with the radiation physicists to determine precisely where the seeds should be placed. Using a treatment-planning computer, we generate a series of dose maps called isodose curves. Our goal is to deliver a radiation dose of 150-160 Gy to the prostate with Iodine and approximately 120 Gy with palladium seeds . We peripherally load the seeds to minimize the radiation dose to the centrally located urethra. This will minimize the risk of urinary side effects.
  • Step 3: The third step is the implant procedure, which our doctors perform in the operating room while youre under either general or spinal anesthesia. Under transrectal ultrasound guidance, the prostate is implanted through the perineum with needles loaded with radioactive seeds. Fluoroscopy confirms the seed placement into the prostate. After the procedure, well monitor you for several hours. Typically, we discharge patients to home on the same day.

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.

Side Effects And Complications

Common side effects of prostate brachytherapy include:

  • Blood in the urine: This is normal and should resolve within a few days
  • Bruising and tenderness of the perineum
  • A burning sensation when urinating: Drinking plenty of fluids will help to minimise this and will help prevent urinary infection
  • Difficulty passing urine, or an urge to pass urine quickly or more often
  • A temporary increase in the frequency of bowel motions
  • Pain or burning with ejaculation
  • Discolouration of the semen
  • Fatigue: this is common to all types of radiation treatment.

These side effects are at their most troublesome four to six weeks after the procedure. However, for most patients they will subside completely over a period of a few months. More serious side effects can occur, including:

  • Urinary incontinence
  • Rectal bleeding
  • Ulceration of the rectum
  • Erectile dysfunction
  • Prostate brachytherapy may result in infertility.

The risks and side effects of brachytherapy should be discussed with the specialist prior to treatment and should be considered when deciding whether or not to opt for this treatment. More detailed information about the treatment and radiation safety guidelines will be given by the specialist performing the procedure.

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Coping With The Side Effects

The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someones life.

The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:

  • Urinating every few hours
  • Limiting caffeine intake
  • Talking to your healthcare team about any medications or other interventions that may be helpful

Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:

  • Having open communication with your partner
  • Prioritizing activities for the day and taking breaks as needed

Overview Of Radiation For Prostate Cancer

Radioactive Seeds in a Patient with Prostate Cancer

Radiation therapy has the same cure rate as surgery for prostate cancer that’s localized and locally advanced . This treatment uses high-intensity ionizing radiation, such as X-rays and gamma rays, to strategically pinpoint and destroy cancer cells.

Ionizing radiation is a kind of energy that can pass through living tissue. Low levels of ionizing radiation are used in medical tests such as X-rays and computed tomography scans. Radiation therapy for cancer differs from these common tests in intensity and frequency of use.

Radiation can be used to target cancer cells from outside the body. This technique is called external beam radiation.

Radiation can also be deposited internally in the form of seeds that are placed strategically in the prostate gland. This technique is called brachytherapy . You may be given one or both types of radiation during treatment.

Radiation therapy of either type may be used alone or in conjunction with other treatments. These treatments include surgery and hormone therapy called androgen deprivation therapy, in which levels of hormones that can stimulate the tumor are reduced.

In some instances, the Gleason score may be used as a tool to determine which treatments will be most effective for you. The Gleason score is a diagnostic tool that can help predict the aggressiveness of prostate cancer.

Your doctor may recommend radiation therapy at various stages of treatment, such as:

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Advantages And Disadvantages Of Brachytherapy

Advantages

  • Treatment time is short: 1-2 days.
  • You can return to your normal routine quite quickly.
  • Compared to external radiotherapy, brachytherapy may have fewer immediate side-effects and cause less damage to surrounding tissues like the back passage, urethra and bladder.

Disadvantages

  • It can cause urinary, erection and bowel problems.
  • You may have some temporary discomfort after the procedure.
  • You will need to have a general anaesthetic.
  • You may not be able to have prostate surgery in the future, due to the effects of the radiotherapy.

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.

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What Is Prostate Seed Implantation

Prostate seed implantation is a type of radiation therapy that involves placing radioactive seeds into the prostate. PSI delivers a high dose of radiation to the prostate gland and sometimes the seminal vesicles, which lie on either side of the prostate gland.

Your doctors have decided that you are a candidate for PSI. Depending on the stage of your cancer, you may be treated with:

  • Seed implant alone
  • Seed implant with hormone ablation
  • Seed implant and external beam radiation therapy with or without hormone ablation

The type of radioactive sources used in PSI come in the form of metallic seeds, about the size of a grain of rice. The number of seeds needed to treat your cancer is determined by the size of your prostate gland and the dose of radiation being used. Typically, between 70 and 150 seeds are placed at one time. The seeds give off their radiation slowly over several months. Within one year, the radioactivity can be considered gone however, the metallic seeds will remain in your prostate gland.

What Is The Radioactive Seed Implant Procedure

The Difference Between Temporary & Permanent Seeds Brachytherapy | Ask a Prostate Expert, MD

Permanent radioactive seed implants are a form of radiation therapy for prostate cancer. The terms “brachytherapy” or “internal radiation therapy” might also be used to describe this procedure.

During the procedure, radioactive seeds are implanted into the prostate gland using ultrasound guidance. The number of seeds and where theyre placed is determined by a computer-generated treatment plan tailored for each patient. About 100 seeds are commonly implanted.

The implants remain in place permanently, and become biologically inert after about 10 months. This technique allows a high dose of radiation to be delivered to the prostate with limited damage to surrounding tissues.

Radioactive seed implants are an outpatient procedure. Compared to external radiation which requires up to seven to seven-and-a-half weeks of daily treatments convenience is a major advantage of this treatment option.

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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.

Side Effects Of Brachytherapy

Brachytherapy causes the same types of side effects that external beam radiation therapy does, such as erectile dysfunction.

In some instances, side effects to the bowels may be less severe than those caused by EBRT. Side effects that impact the bladder, however, may be more severe.

High-dose brachytherapy may cause temporary pain and swelling. It may also cause your urine to look red or brown for a short period of time.

Brachytherapy presents with some risks that external beam radiation therapy does not. If you have permanent brachytherapy, you may emit radiation to others for several weeks or months. Your doctor may advise you to stay away from pregnant people and small children during this time.

Occasionally, the seeds may migrate away from their original placement. For this reason, you may also be instructed to wear condoms during sexual activity, to protect your partner.

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Seed Migration To The Kidneys And Batson’s Vertebral Plexus Is Not Very Rare

The results of the present study show a total of four and five cases of seed migration to the kidneys and Batson’s vertebral venous plexus, respectively, at only one institution, which suggests that such cases are not very rare. Meanwhile, in previous studies, a total of only four and four cases of seed migration to the kidneys and Batson’s vertebral venous plexus, respectively, have been reported as rare cases, which is in disagreement with our conclusion . The same number or more cases of seed migration to these areas were found in our single study compared with all previous studies. A possible explanation is that, in the present study, orthogonal chest radiographs, an abdominal radiograph, and a pelvic radiograph were undertaken routinely to detect seed migration to the chest, abdomen, and pelvis at several time points after seed implantation. Moreover, in all patients who had seed migration to the abdomen and pelvis, a CT scan was undertaken to identify the exact location of the migrated seeds. Consequently, more cases of seed migration to the kidneys and Batson’s vertebral venous plexus were found in the present study. We speculate that some seed migration to the kidneys and Batson’s vertebral venous plexus might have gone undetected in other institutions.

Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy

Radioactive Seeds in a Patient with Prostate Cancer

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.

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How Is The Radioactive Seed Inserted

Using a mammogram as guidance, a radiologist places one seed, so tiny it can be safely injected with a needle, inside the tumour. It emits a very small amount of radiation that is picked up in the operating room with a small, handheld Geiger counter. After the piece of breast tissue with the radioactive seed is removed, the seed is separated from the tissue and appropriately disposed of, with every seed being accounted for.

Long Term Side Effects Of Brachytherapy For Prostate Cancer

Brachytherapy for prostate cancer can cause some long term side effects such as passing urine more often and difficulty getting an erection.

Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Tell your doctor or nurse if you have any of these problems. They can help you to find ways of controlling the effects.

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How Long Does It Take To Recover From Radiation Treatment

Theres no doubt radiation therapy can make the difference between life and death for cancer patients, but unfortunately it often comes at a cost.

Radiation therapy is associated with harsh side effects, many of which dont emerge until months or years after treatment. Acute side effects occur and disappear within 14 days of treatment, but long-term effects like bone degeneration, skin ulcers, and bladder irritation take much longer to manifest.

The complications of radiation therapy are frustrating, painful, and often embarrassing, but using ongoing therapy, such as hyperbaric oxygen therapy , can accelerate your radiation therapy recovery in a natural way and stop your symptoms from defining your quality of life.

Coping With Side Effects Of Radiation For Prostate Cancer

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The side effects you experience from radiation and other prostate cancer treatments can be upsetting and challenging to live with.

Erectile dysfunction and urinary problems may be worse in people who have these issues prior to treatment. Your age and underlying conditions such as high blood pressure and diabetes may also be factors.

Urinary dysfunction often lessens or resolves on its own, over time. It can also be treated successfully with oral medication. In some instances, surgical solutions may produce long-term, satisfactory results.

Radiation therapy can damage nerves located near the prostate gland that help you have an erection. Challenges with getting and keeping an erection hard enough for penetration is common after radiation therapy.

The amount of ejaculate you produce will also diminish significantly, altering fertility potential and your ability to genetically parent a child.

If no nerve damage occurred, your doctor may prescribe medications, such as Cialis , that can help you have and keep an erection. Other treatments, such as penile injections, vacuum pumps, and penile implants can also help.

Keep in mind that you dont need to have an erection to have an orgasm. As long as you maintain normal skin sensation, orgasm is possible.

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Who Is A Candidate For Prostate Seed Implantation At Princeton Radiation Oncology

Prostate seed implantation is not for everyone. Treatment decisions are based on important prognostic factors:

  • Stage
  • Gleason grade
  • PSA level
  • An ideal candidate should have a PSA level less than 10 and a Gleason grade 6 or less, with non-palpable disease. The size of the prostate is also an important factor. As a general rule, patients with prostate glands greater than 60cc are at increased risk for pelvic arch obstruction and poor dose distribution. Several months of androgen deprivation can be used to shrink large prostates to allow an optimal seed implant.

    Patients whove previously had a vigorous transrectal resection of the prostate for benign prostatic hypertrophy may not be ideal candidates for this implant procedure. Higher rates of urinary complications have been reported for this subset of patients.

    How Long Has This Procedure Been Around

    Using internal radioactive sources to treat cancer is not a new concept it emerged over 100 years ago. However, radioactive seed localization specifically is a relatively new technique the first procedure in the Ottawa Hospital Radioactive Seed Localization Program was on April 21, 2015. Our hospital was the third centre in Canada to have this program, and we are a leader in the procedure, with other healthcare centres looking to us for guidance.

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