Brachytherapy Or Internal Radiation Therapy
Internal radiation therapy , also known as brachytherapy, involves placing radioactive seeds on the prostate gland inside the body. The seeds are around the size of a grain of rice.
The implant may be temporary or permanent:
- Temporary: The doctor inserts the seeds into a small tube and leaves them there for between 5-15 minutes . A person may need 1-4 sessions, typically over the course of 2 days.
- Permanent: The doctor will place around 1000 radioactive seeds that release radiation for several weeks to months. Often, they leave the seeds in place when not active since they likely will not cause discomfort.
Before inserting the seeds, the doctor will give the patient either a general or local anesthetic. They may use imaging technology to help ensure they position the seeds accurately.
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.
Your Role On Your Radiation Therapy Team
Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:
- Getting to your appointments on time.
- Asking questions and talking about your concerns.
- Telling someone on your radiation therapy team when you have side effects.
- Telling someone on your radiation therapy team if youre in pain.
- Caring for yourself at home by:
- Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
- Caring for your skin as instructed.
- Drinking liquids as instructed.
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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
- 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
- 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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Brachytherapy For Prostate Cancer
Brachytherapy is a form of internal radiation therapy. With this type of therapy, radiation is delivered to the prostate tumor inside the body via a catheter or another implantable device.
High-dose rate brachytherapy uses radioactive Iridium-192 to deliver high doses of radiation to the prostate tumor. Treatments are short, sometimes requiring as few as five sessions. Brachytherapy radiation more tightly surrounds the tissues were targeting, which may help spare normal tissues.
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Seed Therapy Offers Faster Recovery
There are a lot of advantages to the seed therapy, he tells WebMD. Its minimally invasive no cutting, no suturing. Youre discharged two hours later, with no physical restrictions. The procedure is well tolerated.
Prostate cancer surgery, on the other hand, can cause incontinence and impotence, Potters says.
John Blasko, MD, medical director of the Seattle Prostate Institute and discussant of Potters talk at the meeting, agrees seed implants for prostate cancer offer certain advantages: ease of treatment upfront, rapid return to normal activities, and lack of incontinence or impotence.
But, he says, prostate cancer surgery shouldnt be dismissed outright.
People have a choice, says Blasko, who is clinical professor of radiation oncology at the University of Washington in Seattle. Some men might prefer surgery because it offers answers upfront you know right then and there if the cancer was confined to the prostate.
Also, PSAblood levels, which rise when a man has prostate cancer, stabilize within a few days to weeks after surgery, while they can take years to normalize after seed therapy. This makes some people anxious, Blasko says. Surgery gives them psychological reassurance.
What Happens During The Procedure
The entire procedure takes approximately 90 minutes. Most patients go home the same day.
A radiation oncologist and urologist perform the procedure. Both physicians are actively involved in all aspects of the implantation, from the planning to the post-operative care. During the procedure, the urologist provides ultrasound guidance and the radiation oncologist places the radioactive seeds.
The procedure is performed as follows:
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What Are Other Possible Early Side Effects From Radiation Therapy
Other early side effects you might have usually depend on where you get the radiation.
Radiation therapy to the head, neck, or parts of the digestive system can make you lose your appetite. But its important to keep eating a healthy diet while youâre having treatment to keep your body strong.
- Try eating five or six small meals spread out through the day instead of three large ones.
- Try new recipes or foods.
- Keep healthy snacks on hand. It will help you eat when youre hungry rather than waiting for mealtimes and maybe losing your appetite.
Before you start radiation to your head or neck, see your dentist for a thorough exam. Radiation can cause problems in your mouth that include:
- Trouble swallowing
Tell your cancer team about any of these problems so they can help you feel better. To help manage these side effects:
- Avoid spicy and acidic foods.
- Dont smoke, chew tobacco, or drink alcohol.
- Brush your teeth often with fluoride toothpaste and a soft brush.
Radiation therapy to the head can sometimes cause hearing problems. One reason might be that it hardens the wax in your ears. Let your doctor know if you have trouble hearing.
Radiation to the head, neck, and any part of the digestive tract can cause nausea and vomiting. Let your doctor know if that happens. They can give you medicine to control it. Also, you might be able to learn relaxation techniques and biofeedback to help control and reduce feelings of nausea.
What Type Of Technology Does This Treatment Use
We use real time, 3-dimensional imaging to carefully place each seed at a predetermined location and depth. In this way, we cover the entire gland and the cancer site. The number of seeds implanted into your prostate will depend on your unique anatomy.
We place an ultrasound probe in your rectum to image the prostate. We also use continuous X-ray imaging. Together, these provide a magnified, 3D view of your prostate during the procedure. After the implantationand while you are still anesthetizedwe will check your urethra and bladder and retrieve any seeds found in your bladder.
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Seed Migration To The Kidneys And Batsons 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 Batsonâs 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 Batsonâs 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 Batsonâs vertebral venous plexus were found in the present study. We speculate that some seed migration to the kidneys and Batsonâs vertebral venous plexus might have gone undetected in other institutions.
External Beam Radiation For Prostate Cancer
When most patients think of radiation therapy, they think of external beam radiation therapy , in which a beam of radiation is directed at cancerous tissue from outside the body. Technological advances, such as intensity-modulated radiation therapy and image-guided radiation therapy , allow radiation oncologists to use computer-controlled devices and image-guidance technology to see and target a three-dimensional image of the tumor, making the treatment more precise than ever before.
EBRT used to require 40-45 daily treatments. Now, 25-28 treatments are the norm. This type of protracted, fractionated radiation therapy, however, is now generally considered to be less appropriate for low-risk and favorable intermediate-risk patients. Instead, hypofractionated techniques and brachytherapy techniques are generally more advisable for many patients.
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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.
Thereâs 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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About Prostate Seed Implants
Prostate seed implants are a type of brachytherapy, which translated from latin literally means short therapy. This describes that the radiation seeds deposit their radiation dose over a very short distance. In this technique the seeds are placed directly within the prostate gland. This allows a very high dose to be delivered to the prostate with a fast drop-off of dose outside the prostate, minimizing damage to surrounding structures. Radioactive seeds are about the size of a grain of rice. After delivering their radiation over weeks to months, the seeds are inert and remain in the body.
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The Process For Implanting Prostate Seeds
- 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.
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 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.
Conditions Treated With Proton Therapy
Proton therapy is considered the most technologically advanced radiation delivery method for cancerous tumors. With this powerful, precise technology, tumors are more accurately targeted so healthy tissues and organs get less unnecessary radiation.
Proton therapy is commonly used to treat tumors in sensitive areas where traditional X-ray or photon radiation may not be the best option. Depending on your particular diagnosis, proton therapy may be a treatment option for cancers of the brain and central nervous system, breast, esophagus, head and neck, liver, lung, lymphatic system, eyes, pancreas, prostate, bone and others. It is particularly beneficial for many pediatric cancers.
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Active Surveillance Also An Option
The researchers did not consider a fourth option: active surveillance. It involves close monitoring of the prostate tumor via tests, digital rectal exams, and intermittent biopsies with the intent of averting treatment unless the cancer progresses.
Active surveillance is a good option for men with smaller or slow-growing tumors or who have other medical conditions that might shorten their life span, Ciezki says. But many men who are good candidates don’t choose it because of anxiety — they feel they have to do something to treat a potentially growing cancer, he says.
Similarly, some men opt for surgery over other treatments because “they want the cancer out of their body,” he says.
There are other considerations as well. Not every man is a good candidate for brachytherapy, for example: The cancer has to be confined to the prostate region and the man has to be able to undergo anesthesia, Ciezki says.
Exams For Women Whove Had Cervical Cancer
If youve had cervical cancer, you need a different plan to check for cancer recurrence.
Print and share MD Andersons cervical cancer survivorship chart with your doctor. Your doctor can use this chart to develop a more tailored plan for you.
The screening plans on this page apply to women expected to live for at least 10 years. Theyre not for women who have a health condition that may make it hard to diagnose or treat cervical cancer.
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What Are The Advantages And Disadvantages
What may be important to one man might be less important to someone else. Your doctor, nurse or radiographer can help you choose the right treatment for you. Theres usually no rush to make a decision, so give yourself time to think about things.
- Recovery is quick, so most men can return to their normal activities one or two days after treatment.
- It delivers radiation directly into the prostate, so there may be less damage to surrounding healthy tissue, and a lower risk of some side effects.
- You will only be in hospital for one or two days.
- If your cancer comes back, you may be able to have further treatment.
- It can cause side effects such as urinary and erection problems.
- You will usually need a general or spinal anaesthetic, which can have side effects.
- It may be some time before you know whether the treatment has been successful.
- You will need to avoid sitting close to pregnant women or children during the first two months after treatment.
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