Advantages And Disadvantages Of Brachytherapy
- 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.
- 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.
How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
Radiation For Prostate Cancer: Treatment And Side Effects
Radiation therapy is one of the procedures your doctor may recommend for prostate cancer. This treatment can affect other parts of your body like your mouth, teeth, and gums. It would be best if you have dental insurance, or comprehensive medical insurance, to address the radiations side effects not only on your oral health but your overall well-being too. In any case, keep reading to learn how radiation for prostate cancer works, including the side effects and when its generally used.
Don’t Miss: Side Effects Of Radiation On Brain
What Is Internal Radiation Therapy
Internal radiation therapy is also called brachytherapy. This type of radiation therapy is when radioactive material is placed into the cancer or surrounding tissue. Implants may be permanent or temporary. This treatment may require a hospital stay.
The different types of internal radiation therapy include:
Permanent implants. These are tiny steel seeds that contain radioactive material. The capsules are about the size of a grain of rice. They deliver most of the radiation therapy around the implant area. However, some radiation may exit the patient’s body. This requires safety measures to protect others from radiation exposure. Over time, the implants lose radioactivity. The inactive seeds remain the body.
Temporary internal radiation therapy. This type of radiation therapy can be given by needle, through a tube called a catheter, and through special applicators. The radiation stays in the body for anywhere from a few minutes to a few days. Most people receive internal radiation therapy for just a few minutes. Sometimes, internal radiation therapy can be given for more time. If so, they stay in a private room to limit other people’s exposure to radiation.
What Is Temporary Or High
In temporary brachytherapy, the radioactive material is placed inside or near a tumour for a specific amount of time and then withdrawn. It uses a delivery device, such as a catheter, needle, or applicator, that is placed into the tumour using X-ray, ultrasound, magnetic resonance imaging , or computed tomography to help position the radiation sources.
For the purpose of high dose radiation administration, radioactive Iridium-192 and Cesium-137(12Trusted SourceBrachytherapy in the treatment of cervical cancer: a review
The radioactive material is kept inside the catheter for five to fifteen minutes and then removed. The procedure is repeated 2-3 times over two days of hospitalisation. The catheter is removed only after the last radiation treatment.
Don’t Miss: Will Cancer Show Up In Blood Work
Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy causes similar side effects to external beam radiotherapy. If you have brachytherapy on its own, some side effects may be less severe. If you have it with external beam radiotherapy, they may be more severe.
Brachytherapy causes similar side effects to external beam radiotherapy. Having brachytherapy with external beam radiotherapy may make some side effects more severe. Some side effects may take several weeks to develop and may last for longer.
What Drugs Are Given During The Treatment With Brachytherapy
Since brachytherapy involves a minor surgical procedure, drugs are given to reduce the chances of complications like infection and to reduce pain.
- Antibiotics are given intravenously before the treatment.The two most commonlyused antibiotics are Ciprofloxacin and Cefazolin.
- Pain medications like paracetamol are given to relieve pain after the procedure.
How Successful is Brachytherapy for Prostate Cancer?
Brachytherapy is safe with excellent results for all risk groups. It shows a success rate of more than 90% among patients. It is also noted that the addition of brachytherapy to EBRT improves outcomes compared with EBRT alone. Brachytherapy increases the 9-year success rate from 62 percent to 83 percent for those with intermediate- to high-risk cancer.
What to Expect After Brachytherapy?
After prostate brachytherapy procedure, you can expect some pain and swelling in the area where surgery was performed. You may find relief by taking pain medication prescribed by the doctor. You can resume normal activities when you feel up to it.
At an average of 7.5 months after the treatment of brachytherapy for prostate cancer, the normal quality of life is restored(17Trusted SourceQuality of life outcomes after brachytherapy for early stage prostate cancer
Recommended Reading: Las Vegas Skin And Cancer Clinics
Planning For The Implant
You will need to have a special ultrasound before your implant. This is called a transrectal ultrasound . It is done by placing a probe in your rectum to view the prostate gland. This will allow the doctor to take measurements and plan for the PSI. Your radiation oncology nurse will schedule this for you.
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.
Recommended Reading: Low Back Pain That Radiates To Abdomen
Robotic Prostatectomy Or Radiotherapy For Localised Prostate Cancer
Overview by Professor Christopher Eden Consultant Urological SurgeonThe Royal Surrey County Hospital
Prostatectomy or radiotherapy for prostate cancer
Prostate cancer is a unique disease in that the choice of treatment is usually devolved to the patient, although the care-giver discussing treatment options may steer patients in a certain direction depending on age, obesity and co-existing medical conditions.
Active surveillance is a valid option for patients with a low volume of Gleason 6 or 7 prostate cancer but the burden of follow-up together with the uncertainty regarding outcome persuades approximately 1/3 of patients on AS to opt for active treatment within 3 years, joining another 1/3 of patients who show evidence of tumour progression or spread in having treatment.
Surgery or radiotherapy?
Although experimental options exist in the form of focal high-intensity focused ultrasound therapy and whole-gland phototherapy follow-up is short and what follow-up we do have in published series shows that patients treated in this way trade off fewer side-effects against cancer control.
Long term survival
For more details see the link below.
Combination Of High Dose Brachytherapy And Ebrt For Prostate Cancer
Mostly, for the treatment of prostate cancer, High dose brachytherapy is given in combination with low doses of external beam radiation therapy. Combining external beam radiotherapy with a brachytherapy boost has been effective in tumour control, allowing for significant dose escalation without any change in acute and late toxicities in comparison to external beam radiotherapy alone Patients and Its Effects on Toxicity and Quality of Life: Protocol of a Randomized Feasibility TrialGo to source).
Brachytherapy is considered to boost the effectiveness of external radiotherapy. This combination treatment is a lengthy procedure and is completed in 4-5 weeks.
Research suggests that patients treated with a combination of high dose brachytherapy and EBRT experienced a disease-free survival period of 5.3 years, compared to 4.3 years for patients treated only with EBRT. However, this data is only applicable to patients with localised prostate cancer. No conclusive research is available that observes the effectiveness of high dose brachytherapy and EBRT combinations in intermediate and high risk patients.
Conventionally, only the combination plan has been used by the Radiation oncologists. However, recent findings are advocating the use of only high dose brachytherapy for treating low or intermediate risk patients, as it provides a 5 year of disease-free survival rate in 96% patients(15Trusted SourceHigh dose rate brachytherapy as monotherapy for localised prostate cancer
Read Also: Best Gloves For Chemo Patients
Oral Or Systemic Radiation Treatment
Oral or systemic radiation uses an unsealed radioactive substance that goes through your whole body. Because of this, some radiation will be in your body for a few days until your body has had a chance to get rid of it. You may need to stay in the hospital for 1 or 2 days, and may need to take special precautions at home.
To protect others from radiation, the drugs are kept in special containers that hold the radiation inside, and youll be treated in a shielded room that also keeps the radiation inside. The health providers handling the drugs might wear safety gear that protects them from exposure while giving you the radioactive drug.
Patient and family safety for oral or systemic radiation treatment
If you’re getting systemic radiation treatment, sometimes safety measures are needed to protect the people around you. This is because the radioactive materials can leave your body through saliva, sweat, blood, and urine and that makes these fluids radioactive. It’s very important to keep radiation exposure to the people around you as limited as possible.
In most cases for systemic radiation treatment, the safety precautions must be followed only the first few days after treatment.
Here are examples of things you might be told to do if you’re getting systemic radiation treatment:
Comparison Of The Leading Techniques Of Rp And Ebrt: Rarp Versus Vmat
A retrospective study has recently been published in Radiotherapy & Oncology, which reports comparative outcomes of RARP and VMAT, as the leading respective techniques of RP and EBRT . RARP is a novel, gold standard, surgical procedure for localized PC using the da Vinci Surgical System and has been reported to reduce blood loss complications and positive surgical margin rates, resulting in improved safety and feasibility . VMAT represents a sophisticated EBRT technique based on rotational IMRT, which delivers a highly conformal beam from a rotating radiation source to the target while avoiding risky organs such as the rectum in a short time, by computerized optimization. VMAT has been reported to reduce complications and improve oncological outcomes .
Recommended Reading: Sleep Caps For Chemo Patients
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.
Donât Miss: Radiation Seeds For Prostate Cancer
What Other Details About The Radioactive Seed Implant Procedure Are Important
Close, prolonged contact with young children should be limited to 20 minutes per hour for the first two months after the procedure. Its safe to sleep in the same bed if your partner/spouse is NOT pregnant. If your partner/spouse is pregnant, separate sleeping arrangements will be necessary for two months. If you have other questions, please call your radiation oncologist or urologist.
Also Check: Foods To Eat During Chemo Treatment
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.
For Prostate Seed Implantation Trust Experience And Skill
The outcome of implantation is highly operator-dependent. As such, it is important for the radiation oncologist to be experienced and proficient with this procedure. The physicians of Princeton Radiation Oncology are among the most experienced and have been instrumental in pioneering this treatment option.
Read Also: What Does Chemo Therapy Do
Are You A Candidate
Whether your doctor recommends radiation depends on various factors, including your age, health, and personal preferences. The type of radiation is often dictated by your risk group and whether the cancer is localized or has spread.
Sometimes hormone therapy is given before radiation or along with it. ADT reduces levels of male hormones, called androgens, which can slow or even stop the cancers growth. Studies have found this one-two punch leads to higher survival rates than radiation alone among men with localized prostate cancer and a Gleason score of 7 or higher.
If you opt for surgery, your doctor may suggest radiation afterward, called adjuvant radiation therapy. “You have surgery to remove cancer, and then radiation to eliminate any remaining tumor deposits to keep cancer from returning,” says Dr. Anthony DAmico, a radiation oncologist with Harvards Dana-Farber Cancer Institute. Cancer that has grown beyond the prostate also may require post-surgery radiation.
After youve had radiation, youll have a prostate-specific antigen test every three to six months for five years and then annually after that to check for recurrence of the cancer. “If your PSA ever rises above 2, then imaging tests are done, and if needed, additional radiation or other appropriate treatment is given,” says Dr. DAmico.
What Is Proton Beam Radiation Therapy
This type of therapy treats tumors with protons instead of X-ray radiation. It may be able to deliver more radiation specifically to a prostate cancer tumor with less damage to normal tissue.
Proton beam therapy might be a safe treatment option when a doctor decides that using X-rays could be risky for a patient. But so far, research hasnÃ¢t shown that it works better than traditional radiation therapy against solid cancers in adults.
The side effects of proton beam therapy are similar to the ones that other types of radiation treatment bring on. But since proton therapy may be less damaging to normal tissue, the side effects might be milder.
After treatment, you may gradually have ones like:
- Fatigue or low energy
- Sore, reddened skin around the area where you got treated
- Hair loss around the treatment spot
One of the disadvantages of proton therapy is that it might not be covered by all insurance companies. YouÃ¢d need to check with your health plan to find out.
Proton therapy also isnÃ¢t widely available. You can get it only at certain centers in the U.S.
Read Also: Skin Cancer In Dogs Pictures
How Does It Work
There are multiple types of radiation treatments that can be used for prostate cancer.
External beam radiation: This treatment is administered through a specialized machine that directs beams of radiation to targeted areas in the prostate. It is usually given in daily doses five days a week for about six weeks.
Stereotactic radiation: This type of radiation uses advanced images of the prostate with a different type of radiation machine. This may also be referred to as Gamma Knife or CyberKnife.
This type of radiation often uses much higher doses than standard external beam radiation. However, it is given in such a way that healthy tissue around the prostate is spared from high doses of radiation. Because of the high doses of radiation, this type of treatment may only need five or fewer treatments.
Brachytherapy:During this type of radiation, radioactive seeds are placed into the prostate. These radiation seeds emit radiation for a period of time and remain in the prostate even after the radiation has left.
What Is The Procedure For The Placement Of The Implants
In the operating theater, spinal or general anesthesia is given, and the legs are gently lifted and cushioned.
The prostate is scanned using an ultrasonic probe placed into the rectum. Throughout the whole process, this probe is stationary.
A personalized treatment plan is created using these ultrasound images.
The specified number of radioactive seeds are then inserted into the needles.
The seeds in that needle are released once precise needle insertion has been verified. The radioactive seeds are implanted one at a time until all have been placed.
At times, needle insertion might be hindered by the pubic arch due to the pelvic anatomy, patient posture at the time of surgery, and the size of the prostate gland.
There is no need for cutting or incision during this surgery.
If blood is detected in the urine, a catheter may be temporarily inserted into the bladder. All patients are instructed on how to catheterize themselves at home should the need arise to empty the bladder.
Read Also: New Prostate Cancer Treatment In Germany
Read Also: Lower Back Pain Radiating To Buttocks