Lesson 3: Prostate Cancer Treatment Options

Brachytherapy

Brachytherapy is radiation charged seeds that are delivered to the prostate via very small tubes that are inserted into the prostate. These tubes are inserted into the prostate through the area between the scrotum and rectum (the perineum). Sometimes, the radiation will stay in your prostate forever (permanent or seed Brachytherapy). With another technique, needles are placed temporarily in the prostate and a radioactive source is introduced for a short period of time (high-dose rate Brachytherapy). Both techniques place the seeds or needles using the assistance of ultrasound and/or CT imaging. The seeds will release radiation into the surrounding area and kill the cells that they are closest to. The most common type of "seeds" (Iodine-125) will release half of their radiation in the first two months after placement. After 1 year the beads will have only 1% of their radiation left. Palladium seeds are used in some US centers and deliver the dose of radiation to the prostate faster than Iodine-125 seeds. Palladium seeds are more expensive than Iodine-125, but haven’t been shown to be more effective than Iodine-125.

The side effects of Brachytherapy are contingent upon the location of the cancer and the placement of the seeds. While external radiation disrupts both the bladder and bowels, almost all of the side effects from seed Brachytherapy are urinary-related. The urinary effects of Brachytherapy are more severe than external radiation, and are more prolonged. The average man with an Iodine-125 implant will have disrupted urinary habits for 6 months after the implant and will likely need to take medication to help his urine flow during this time. Mild fatigue is also seen with Brachytherapy, but men are often able to work full-time a couple of days after the implant. There are potential long-term problems but they are approximately the same risks as for external radiation. Patients with an implant may also have a narrowing of the urethra, which may require expansion by your Urologist. There is a risk of impotence: approximately 40-50% for men who are fully potent before the therapy. In addition, urinary incontinence (or inability to control the urine) can occur, but this is almost always seen in men who have had a TURP (trans-urethral resection of the prostate) before Brachytherapy.

Brachytherapy is performed on an outpatient basis but several visits be may needed. Brachytherapy is a specialized form of treatment and may not be available in all areas. However, as with the previous forms of treatment, the list of clinics and hospitals offering Brachytherapy is growing. Brachytherapy is a relatively new treatment (less than 20 years old), so this treatment cannot boast the same 90% survival rate over 20 years that Beam Radiation and Surgery can. At the time of this writing there are reports of 90% survival at 16 years follow-up.

Some treatment centers are recommending Brachytherapy and External Beam Radiation as a "belt and suspenders" treatment. There is no scientific evidence that these two treatments, when administered together, are any more successful than either External Beam Radiation or Brachytherapy on its own. However, there is strong evidence that the higher the dose of radiation delivered to the prostate, the better the cancer control, especially for men with intermediate risk disease. The combination of External Beam Radiation and a Brachytherapy implant provides almost twice as much radiation as Conformal Radiation alone.

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