Side Effects Of Hdr Brachytherapy For Prostate Cancer

Less Common Side Effects Of Brachytherapy

There are some other side effects that may happen after treatment, but they arent as common.

Fistula

There is not much research about fistulas caused by brachytherapy, but we know they can happen. Any symptoms will depend on where the fistula is, but could include:

• vaginal discharge that smells badly

Its important to tell your healthcare team about any symptoms, as they can check for a fistula and offer you treatment.

Second cancer

There is limited research to suggest that having brachytherapy increases the risk of developing another cancer. This is sometimes called second cancer.

We know that this will be worrying, so it is best to speak with your healthcare team to understand more about this risk and find out any symptoms to look out for. Remember that you will be in the care of your healthcare team for follow up, so they will make sure you are well and can check out any problems.

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

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Who Is Eligible For Brachytherapy

Brachytherapy is widely used to treat men with all different stages of prostate cancer. Brachytherapy alone is used for men with early-stage and some intermediate risk prostate cancers and in combination with intensity modulated radiation therapy for men with larger prostate cancers. All men should be evaluated to see if it is a good treatment option for them. However, it may not be ideal for men who already have significant urinary issues such as frequency, urgency, or incomplete emptying, since those may be exacerbated by brachytherapy treatments. For patients with larger prostate glands, it can also be harder to accurately place the radiation.

According to Horwitz, there are some instances where traditional, noninvasive radiation therapies may be preferable.

The brachytherapy implant is a small surgical procedure, but it does involve anesthesia, he said. So for people who have a cardiac history, it may not be as safe for them. In addition, people using blood thinners may want to opt for a less invasive treatment.

But if a person is relatively healthy and it’s safe for them to have anesthesia, then they can do either.

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How Is Hdr Brachytherapy Given

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.

Long Term Side Effects Of Prostate Cancer Radiotherapy

Most side effects of radiotherapy gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that some side effects begin months or years later.

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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Hdr Treatment Protects Healthy Tissues Patients Quality Of Life Remains Better Than In Surgery

Fears associated with prostate cancer treatments often concern the maintenance of quality of life such as erectile dysfunction and urinary incontinence, and in particular the ability to hold urine.In HDR brachytherapy, the high dose of radiation can only be limited to the prostate area.Precision radiotherapy thus protects healthy tissues, resulting in a better quality of life in terms of sexual function and urinary retention than surgery or external radiotherapy. The effect of the male hormone on prostate cancer cells is reduced during radiotherapy with hormone therapy because it is known to improve the effectiveness of radiotherapy, especially in the most aggressive stages of prostate cancer.However, hormone therapy is short-lived and is stopped six months to two years after the end of radiotherapy.In most cases, erection problems are relieved afterwards, and sex life is restored with erection medication.

Drink The Nylytely Bowel Preparation

At 3 p.m. on the day before your procedure, start drinking the NuLYTELY. Drink 1 cup of the mixture every 15 minutes. Drink only half of the NuLYTELY solution . Throw out the other half. Then, keep drinking clear liquids.

• Take the medications your healthcare provider told you to take the night before your procedure. Take them with a small sip of water.
• Shower using soap and water the night before or the morning of your procedure.

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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.

The Advantages Of Brachytherapy Over External Beam Radiotherapy

Prostate brachytherapy is a form of radiotherapy in which radiation delivery is targeted directly at the prostate gland via a radiation source that is implanted or temporarily placed within the gland. Brachytherapy has a long heritage in cancer treatment, first being used over 100 years ago . Traditionally, brachytherapy was delivered by using radioactive seeds that were permanently implanted into the prostate using an open retropubic approach, delivering radiation at a continuous LDR . This has now been succeeded by a transperineal approach using transrectal ultrasound. There are now good robust durable data for the efficacy of LDR brachytherapy with results similar to both surgery and EBRT . As such, it is now well established as a treatment modality for localised prostate cancer.

More recently, HDR brachytherapy has emerged into the clinical arena. This procedure involves using a radiation source that is delivered from a chamber through a series of catheters that are temporarily placed within the prostate transperineally using ultrasound guidance.

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Evidence For The Efficacy Of High Dose Rate Brachytherapy Boost

The use of HDR brachytherapy as a boost to EBRT is now well established, with studies reporting durable 10-year freedom from biochemical failure in excess of 60% for high-risk groups and more favourable results for low- and intermediate-risk prostate cancer . This is especially encouraging if these results are compared with historical data of using whole pelvic EBRT and hormonal treatment, as carried out in the Radiation Therapy Oncology Group trial RTOG 9413, for essentially intermediate- to high-risk prostate cancer in which progression-free survival does not reach beyond 50% at 10 years .

Treatment Vs Side Effects

Prostate cancer treatment side effects can vary greatly from little to none, or create lifetime issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.

Treatment or the combination of treatments in advanced cases can lead to a wide range of side effects. Prostate cancer treatment side effects include erectile dysfunction, incontinence, urinary issues, diarrhea, hot flashes, weight gain, loss of muscle, vomiting and hair loss. There are short term prostate cancer treatment side effects that subside over time, as well as long term side effects that can last for years. Question your Doctor about the side effects of the treatment you have selected. Make an informed decision.

Prostate cancer treatment side effects can vary greatly from little to none, or create lifetime issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.

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Questions To Ask Your Doctor Or Nurse

• Will I have external beam radiotherapy before or after temporary brachytherapy?
• Do I need hormone treatment before and/or after temporary brachytherapy?
• What are the chances of side effects such as urinary problems, erection problems and bowel problems with this treatment?
• How many treatments will I have?
• Will I be asleep or awake during treatment?
• How long will I need to stay in hospital for the treatment?
• How will we know if the treatment has worked?
• What should my PSA level be after treatment and how often will you measure it?
• If my PSA continues to rise, what other treatments are available?

Complete A Health Care Proxy Form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• For information about health care proxies and other advance directives, read Advance Care Planning.
• For information about being a health care agent, read How to Be a Health Care Agent.
• If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

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What Is Brachytherapy For Prostate Cancer

Brachytherapy is a form of radiation treatment. During brachytherapy, doctors take small particles or seeds that contain a source of radiation and place them inside the body in or near a tumor.

The radioactive material only affects the tissue very close to it, so it tackles the tumor but doesnt harm the rest of the body.

According to the American College of Surgeons , healthcare professionals may recommend brachytherapy as a stand-alone treatment if you have very low- or low-risk prostate cancer or favorable intermediate-risk prostate cancer.

If you have a higher-risk case, healthcare professionals might use brachytherapy in addition to external beam radiation therapy .

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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.

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Who Can Have Brachytherapy

Your doctor will let you know if you are suitable for brachytherapy.

You may not be suitable if you have trouble passing urine, have a very large prostate gland or have recently had surgery to your prostate gland.

• If you have a larger prostate glandâ you may be given hormone therapy to shrink it before brachytherapy.
• If you have higher-risk prostate cancerâ you may receive brachytherapy along with another treatment. For example, you may need some doses of external beam radiotherapy or hormone therapy as well.

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What Are The Possible Side Effects Of Brachytherapy

A common concern among patients is whether they are radioactive after the procedure. The answer is yes temporarily.

That means that you should not have pregnant women or children in your lap for more than 20 minutes per hour for the first two months, Dr. Ciezki says. You can be around people for as long as you want. The only area of risk is the lap, he says. Its a minor risk but we tell people about it.

Some patients also may have trouble urinating or they may have the frequent urge to go. They may also experience a burning sensation when they urinate. In certain cases, patients may need to use a catheter because of temporary prostate swelling.

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Surgery For Prostate Cancer

A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.

The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.

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Patient Selection And Technical Description

Successful implementation of HDR brachytherapy for prostate cancer begins with appropriate patient selection. Anatomic factors lending to successful HDR treatment are as follows: prostate volume of approximately 20-60 cc a central/straight urethral position that can be adequately avoided during transperineal needle implant absence of significant benign prostatic hypertrophy/median lobe or transurethral resection of the prostate defect at the prostate base adequate spacing between the prostate and rectum and adequate pubic arch width to avoid interference with needle placement. Clinical factors include general risks of both anesthesia and elective surgical procedures . Careful attention must be paid to baseline urinary function. Brachytherapy is not a good treatment option for patients with significant baseline obstructive uropathy. Risks for significant obstructive complications of brachytherapy increase substantially in such patients, and our practice typically will exclude patients with a baseline American Urologic Association symptom score > 15 if already on medication, or > 20 if previously untreated for obstructive symptoms.3 Any of these factors are relative contraindications to performing HDR brachytherapy and the treating physician should consider them on a patient-by-patient basis, weighing risks and benefits.

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Who Can Have Hdr Brachytherapy

HDR brachytherapy is most suitable for men whose cancer has not spread outside the prostate gland and has been classed as CPG2 /CPG3 or CPG4 / CPG 5 of spreading outside the prostate or coming back after treatment.

Read more about low, medium and high risk prostate cancer.

If you have medium or high risk cancer, you will also have external beam radiotherapy as well as HDR brachytherapy. You may also have hormone therapy to shrink the prostate and make the cancer easier to treat. Having HDR brachytherapy together with other treatments can help make the treatment more effective, but it can also increase the risk of side effects.

HDR brachytherapy may also be suitable for some men whose cancer is beginning to spread to the area just outside the prostate, such as the seminal vesicles . You will usually have hormone therapy or external beam radiotherapy as well.

HDR brachytherapy isnt suitable for you if your cancer has spread outside the prostate to other parts of the body .

HDR brachytherapy is newer than some of the other treatments for prostate cancer and isnt available at all hospitals. If your hospital doesnt do HDR brachytherapy, your doctor may be able to refer you to one that does.

Other things that might affect whether you can have HDR brachytherapy

What other treatments might be available?

You might be able to have other treatments, depending on whether your cancer is localised, locally advanced or advanced. Read more about other treatment options.