Brachytherapy for Prostate Cancer

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« More on Radiation Therapy for Prostate Cancer Treatment

Real-time Intraoperative Planning Improves Treatment

At Fox Chase, our radiation oncologists offer patients two types of brachytherapy--low-dose rate permanent seed implants and high-dose rate temporary implants. New advances, such as real-time intraoperative planning, allow doctors to map out and plan both permanent and temporary implants in the operating room so that they can target the radiation in real time. This technique has created better results and reduced side effects. (Brachytherapy is a surgical procedure performed in the OR by a radiation oncologist).

Low-dose rate (LDR) brachytherapy

LDR involves the use of tiny radioactive seeds implanted directly in the prostate, delivering a continuous dose of radiation. A permanent "seed" implant is the placement of non-removable seeds (Iodine-125 or Palladium-103) directly into the prostate. Treatment with an implant alone is recommended for men who have low-risk, early-stage prostate cancer whose cancer is confined to the prostate gland.

Men who are candidates for an LDR Permanent Seed Implant

  • Pre-treatment PSA less than or equal to 10 ng/ml
  • Clinical stage T1 or T2a (tumor can't be felt or involves less than half of the prostate)
  • Gleason score of 6 or less

These patients do not require additional external beam radiation.

High-dose rate (HDR) brachytherapy

HDR involves the placement of needles into the prostate through which a temporary radioactive source (Iridium-192) delivers the radiation dose. The source and the needles are removed after the treatment is done. The radiation is delivered during 2 sessions, 2 weeks apart (week 1 and week 3). The procedure takes 2 hours and general anesthesia is given. It is combined with IMRT. This treatment is generally recommended for men who have intermediate or high-risk prostate cancer, especially if there is a chance the cancer is outside of the prostate gland.

Men who are candidates for a HDR Temporary Implant

  • Clinical T stage T2b and T3 (tumor involves more than half of the prostate or extends outside of the prostate)
  • Pre-treatment PSA greater than 10 ng/ml
  • Gleason score greater than or equal to 7

These patients also receive IMRT.

Common side effects of prostate implants:

Short-term

  • Slight bleeding beneath the scrotum
  • Blood in the urine
  • Bruising and tenderness between the legs

Long-term

  • Frequent urination
  • Burning with urination
  • Sense of urgency
  • Weaker urinary stream
  • Tiredness
  • Rectal urgency
  • Frequent bowel movements

These symptoms begin about 2 weeks after the implant is done and most resolve about 6-8 weeks later.

For more information regarding either permanent or temporary implants call 215-728-2995 or 215-728-3022.

Real-time intraoperative planning

Fox Chase radiation oncologists use real-time intraoperative planning for all brachytherapy procedures--permanent LDR and temporary HDR. Real-time intraoperative planning offers a more accurate way to deliver brachytherapy.

NCI PDQ
See National Cancer Institute information on Prostate Cancer

Real-time intraoperative planning means information is gathered at the actual time of the seed implant procedure. This allows doctors to make changes to the original implant plan as needed - in real time. Changes to the plan will be made, for example, because the prostate's shape can change during the time between the pre-treatment planning and the actual procedure. Other changes allow the doctor to administer more radiation to areas of the prostate that have more cancer.

Studies show intraoperative planning for brachytherapy is more accurate compared to traditional pre-planning. Because of this, recently completed research studies on brachytherapy for prostate cancer show similar long-term survival rates as a prostatectomy.