Prostate Cancer Brachy Therapy

Brachytherapy is a procedure in which radiative seeds are implanted directly into prostate cancer cells in order to shrink the tumors. Much of the success of this therapy depends upon on a man's age, the type of tumor and the expertise of the radiation oncologist. As an effective treatment for localized prostate cancer, brachytherapy has shown significant positive outcomes, but it is important for the patient to weigh the pros and cons and side effects of all potential cancer treatment options.

History

• After the discovery of the X-ray in 1895 and radioactivity in 1896, Marie and Pierre Curie began research on the potential use of radiation for the destruction of cancer cells. The origins of brachytherapy were formed when, in 1901, Pierre suggested that inserting radiative compounds into tumors could cause cancers to shrink. Sadly, the couple became the first casualty of the alarming side effects associated with radiation.

  The work was not to be thwarted, however, for in 1905 the first brachytherapy procedure done on patients was performed at the Curie Institute in Paris and at St. Luke's Hospital in New York. Dr. Hugh Hampton Young of John Hopkin's University was the first to practice brachytherapy specifically for prostate cancer. These early free-hand attempts at seed placement resulted in temporary remission of the cancer, but the costs of radiation injuries to patients and medical workers were high.

  Intrigued by promising research in the 1970s, brachytherapy became more popular as a treatment option. Despite the high expectations, the following two decades saw dismal success rates, and, in fact, further studies indicated that brachytherapy proved no better results than watchful waiting.

Traditional Treatment

• Three weeks before implantation, a series of tests are taken to determine the quantity and location of seeds to be placed. On the day of the procedure, an epidural or spinal anesthetic is administered. A metal template is placed between the scrotum and the rectum, and hollow needles are inserted into holes leading to the prostate. The radioactive seeds are guided through ultrasound into the needles and dropped into the cancer cells. Depending on the dose of radioactive material, the seeds can last months targeting the cancer while leaving the nearby area unharmed.

High-Dose Rate (HDR) Treatment

• While brachytherapy is usually used for small, localized cancers, high-dose rate (HDR) treatment has shown success on very large tumors. Nicknamed the Andy Grove method, after the Intel co-founder who chose this procedure for his own cancer, HDR involves placing powerful radiation doses into the prostate through slim tubes.

Advantages

• Convenience is the primary advantage of brachytherapy. You do not need a catheter as you do with surgery, and it is usually a same-day procedure with minimal pain.

Disadvantages

• Brachytherapy is not an option for cancer that has spread beyond the confines of the prostate. Short-term side effects include diarrhea, rectal pain, urinary incontinence, bowel problems and impotence. The treatment is discouraged if you live or work with young children, pregnant women or the elderly.

Side Effects

• Up to 10 percent of men experience a sudden inability to urinate requiring long-term use of a catheter. Radiation urethristis, 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.

  Most men are concerned with the sexual side effects of brachytherapy, and the news is not good. The shrinking of the prostate gland by the implants reduces ejaculation. Some men experience painful ejaculation, and, of course, the ability to father a child is lost after the therapy. In addition, a five-year study conducted by Memorial Sloan-Kettering, indicated that up to 53 percent of men suffer from erectile dysfunction post-treatment.

The Future

• A more accurate procedure, whereby a real-time computer supplies the dose distribution, is in limited use. With increased accuracy should come a reduction in urinary and bowel side effects.