Prostate Cancer Treated With Brachytherapy

Brachytherapy is a treatment option for prostate cancer in which radioactive "seeds," or pellets, are implanted directly into malignant cells in order to shrink the tumors. The success rate is dependent upon a man's age, the type of tumor and the expertise of the radiation oncologist. Brachytherapy has shown significant positive outcomes as an effective therapy for localized cancers, but it is important for the patient to weigh the pros and cons and side effects before making an informed treatment choice.

Procedures

• Three weeks before implantation, a series of tests are administered to determine the number and location of radioactive pellets to be placed. On the day of the procedure, the patient is given an epidural, or spinal, anesthetic. A metal template is positioned between the scrotum and the rectum, and sharp, hollow needles are inserted through holes in the template and into the prostate. The pellets are guided by ultrasound into the needles and dropped directly into the cancerous cells. Depending on the dose of radioactive material, the pellets can target the cancer for months while leaving the nearby area unharmed.

  Brachytherapy is commonly used for small, localized cancers while the stronger high-dose rate (HDR) treatment has shown success on very large tumors. Nicknamed the Andy Grove method, after the Intel cofounder who chose this procedure for his own cancer, HDR involves implanting powerful radiation doses into the prostate through slim tubes.

Advantages

• The primary advantage of brachytherapy is convenience. You do not need a catheter as you do with surgery. In addition, it is usually a same-day procedure with minimal pain which does not require the six-week recovery period that surgery necessitates.

Disadvantages

• Brachytherapy is not used for cancer that has spread beyond the confines of the prostate gland. Short-term side effects include diarrhea, rectal pain, urinary incontinence, bowel problems and impotence. Long term risks include sudden inability to urinate requiring long-term use of a catheter. Radiation urethritis, a condition caused by the accumulation of radiation leading to painful urination, bleeding, burning at the tip of the penis and lower abdominal pain, has been reported in 20 to 40 percent of patients, as reported by Memorial Sloan-Kettering Cancer Center. Additionally, the shrinking of the prostate gland by the radioactive seeds reduces ejaculation. Some men may experience painful ejaculation, and, obviously, the ability to father a child is lost. A five-year study conducted by Memorial Sloan-Kettering, indicated that up to 53 percent of men suffer from erectile dysfunction post-treatment.

  The treatment is discouraged if you live or work with young children, pregnant women or the elderly.