ROV Prostate LDR-Seed Brachytherapy
What is LDR brachytherapy for prostate cancer?
Brachytherapy is a minimally invasive procedure where the doctor implants tiny permanent radioactive seeds (about the size of a grain of rice) into the prostate where they irradiate the cancer from inside the gland. The implanted seeds are small enough that they will not be felt. Iodine (I -125) stranded seeds are used. Brachytherapy is also referred to seed implantation therapy.
Before the seeds are implanted, the patient receives anesthesia. Needles containing the seeds are then inserted through the skin of the perineum (the area between the scrotum and anus) using ultrasound guidance. The seeds remain in the prostate, where the radioactive material gives off localised radiation for a number of months to destroy the prostate cancer. Seed implantation is an effective treatment for men with localised (organ confined) prostate cancer. Seed implantation requires no surgical incision and offers men a short recovery time. Brachytherapy can be an outpatient procedure, and most men go home the same day as their treatment. Additionally, most men can return to their normal activities a few days after treatment.
Brachytherapy selection criteria
Brachytherapy is an option for patients with localised prostate cancer. In general, men with favourable and intermediate stage prostate cancer are candidates for seed implantation therapy. In Australia, men with low and intermediate risk prostate cancer with PSA <10 and Gleason scores of <7 are candidates for insurance funded prostate brachytherapy.
Effectiveness of Brachytherapy
Long term results from the Seattle Prostate Institute, Memorial Sloan Kettering, Mount Sinai and others have shown the effectiveness of prostate brachytherapy for Low risk and Intermediate risk prostate cancer with 80-90% PSA Relapse Free Survival. A recent study comparing the effectiveness of various radical treatment modalities for Low risk and Intermediate risk prostate cancer have demonstrated that prostate bracytherapy is as effective if not more so than radical prostatectomy.
Side Effects of Prostate Brachytherapy:
As a result of the implant procedure, some men experience mild discomfort in the groin area for two to three days, which is managed very effectively with mild analgesics. Some blood may be seen in the urine and sperm for a few days after the procedure. This is normal and stops after two to three days. The effects of the radiation from the seeds usually begin one or two weeks after seed implantation. The main symptoms are urinary difficulties such as frequency, urgency or slight pain. These can last for 2-6 months. These can usually be controlled with simple medications. Occasionally, a temporary catheter is necessary.
The chances of developing impotence or incontinence with the brachytherapy procedure are less when compared to other treatments.
The effect of the implant on potency can be immediate or delayed. Approximately 25% of men who are fully potent (able to achieve an erection) prior to seed implantation, will become impotent after. Another 25% will experience some decrease in their ability but still have intercourse. At present, there is no way of predicting who will be affected and when. Many men who are potent will notice a decrease in the durability or firmness
The risk of long-term incontinence after either seed implantation alone or in combination with external beam radiation in the typical, (non TURP) patient is extremely low, less than 1%. Short term, some patients experience significant urgency and may have difficulty reaching the restroom without some slight dribbling. This resolves as the seeds lose their energy.
Recovery time after Brachytherapy:
Brachytherapy will require an overnight admission with the procedure usually lasting around an hour. Recovery usually takes only a day or two, and most men return to work or their normal activities within a few days. Physicians recommend waiting about two weeks before returning to sexual activity.
Are you a candidate?
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References:
- Potters L, Morgenstern C, Calugaru E, et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J. Urology, 2005;173:1562-1566.
- Zelefsky M, Yamda Y, Cohen, G, et al. Five-Year Outcome of Intraoperative Conformal Permanent I-125 Interstitial Implantation for Patients With Clinically Localized Prostate Cancer. Int’l J. Oncology Biology Physics, 2007;67(1):65-70
- Merrick G, et al. Androgen deprivation therapy dose not impact cause specific overall survival after permanent prostate brachytherapy. Int’l J. Oncology Biology Physics, 2006;65(3):669-677
- Sharkey J, et al. PD-103 Brachytherapy Versus Radical Prostatectomy in Patients With Clinically Localized Prostate Cancer: A 12-Year Experience From a Single Group Practice. Brachytherapy, 2005;4:35-44
- Stone N, et al. Customized dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes. Int’l J. Oncology Biology Physics, 2007;69(5):1472-1477