Influence Of Seed Migration On Postimplant Dosimetry
The postimplant prostate D90 was not significantly different between patients with and without seed migration. Moreover, in 15 patients who had multiple migrated seeds, the postimplant prostate D90 was relatively acceptable, and no supplemental seed implantation was required. These results indicate that seed migration did not have a significant effect on postimplant prostate dosimetry in the present study. Possible reasons are as follows. First, in most patients with seed migration, only one or two seeds had migrated, which would have less effect on the dosimetry of the prostate. Tapen et al. have suggested that the loss of a few seeds may not have a significant effect on dose homogeneity or total dose to the prostate . Second, seed migration would have much less effect on the dosimetry of the prostate than other mechanisms of seed loss, such as seed misplacement to the seminal vesicle or perineum and being voided in the urine postoperatively. Merrick et al. have reported that seed migration to the chest accounted for only 10% of total seed loss from the prostate region, highlighting the importance of other mechanisms of loss .
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Proton Therapy Versus Prostatectomy
Early-stage prostate cancer can sometimes be treated by removing all of the prostate gland along with some nearby tissues a surgery called radical prostatectomy. This comes with numerous risks and potential complications, including infertility, erectile dysfunction and urinary incontinence.
Proton therapy, in comparison, is a noninvasive procedure that does not remove the prostate or the tumor. It precisely targets radiation at the tumor to disrupt its DNA, so that it cannot grow or spread, and eventually it is eliminated. Proton therapy for prostate cancer also carries risks of erectile dysfunction and bowel and urinary problems, but its less likely to cause urinary incontinence and complete impotence.
Your doctor will discuss pros and cons of proton therapy, prostatectomy and other treatments for your prostate cancer type and stage.
Zapping Prostate Cancer With Radiation: How Does It Work
If a man decides on radiation to treat his early-stage prostate cancer, he has two basic choices: external-beam radiation or radioactive-seed implantation. Both seem equally effective.
Prostate cancer patient Bob Booth recently began a series of external-beam radiation treatments, also known as intensity-modulated radiation therapy, or IMRT. It delivers a high dose of radiation to just the right areas through a focused beam.
“We literally have the ability to sculpt radiation around different structures and say, ‘This area we want to get full-dose radiation, and we want to protect these adjacent structures,'” said Dr. Eric Horwitz, an associate professor and director of the radiation oncology training program at the Fox Chase Cancer Center in Philadelphia.
What makes IMRT advanced is the preplanning. First, the prostate, bladder and rectum are located through magnetic resonance imaging, or MRI. The information is then loaded into a computer.
“We’re making sure his prostate gets 100 percent of the radiation,” Horwitz said, “but we’re really able to limit the radiation both to his rectum and his bladder.”
“Each day they’re going to retarget my prostate, so it’s a very focused radiation treatment over a period of time,” explained Booth.
But IMRT isn’t for everyone, as it’s a five-day-a-week treatment that lasts seven to eight weeks.
The other option, radioactive-seed implantation, is typically used for men with lower-grade tumors, and yields good results, doctors say.
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Why Choose Memorial Sloan Kettering For Brachytherapy
Memorial Sloan Kettering has long been a leader in brachytherapy, pioneering many advances in the field. In fact, MSK doctors were the first to use brachytherapy to treat cancers in the early 20th century.
That expertise continues today, as our medical physicists work with radiation oncologists to design the safest, most precise way to administer the brachytherapy using mathematical modeling and advanced computer programs. Through this collaboration, MSK specialists have developed highly specialized brachytherapy methods for specific diseases.
What To Expect For Your Treatment
Youâll get ERBT at a hospital or clinic. Youâll likely not have to stay overnight. The total length of time for your treatment depends on the type and dose of radiation, as well as why you are getting it. For instance, if youâre getting radiation as the main treatment for an early-stage prostate cancer, youâll likely get treatments 5 days a week for several weeks in a row. If youâre getting radiation therapy to treat bone pain, youâll probably need fewer treatments.
Each treatment is much like getting an X-ray, but the radiation is stronger. You lie on a table while the machine delivers the radiation. The actual treatment is quick and doesnât hurt, but getting you into the proper place for treatment each time takes longer. When you are in the right position, the radiation therapist leaves the room and controls the machine. The therapist can see you. And you can talk with and hear the therapist the whole time.
Your radiation oncologist or nurse can tell you what to expect during treatment.
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Clinical & Imaging Findings
Prostate brachytherapy is considered a minor procedure with a high success rate and minimal complications. Short-term complications arise in several hours to several weeks and most commonly include urinary urgency, frequency, retention and incontinence. Long-term complications such as erectile dysfunction, rectal toxicity and urethral stricture, often require over a year to ensue . Seed migration is considered a relatively common complication however, it is underreported because most cases of seed migration are clinically silent. They rarely cause symptoms at the ectopic site and do not appreciably affect the post-implant dosimetry or efficacy of the procedure . The most common site of migration is the lung it is thought that seeds follow the venous circulation, passing from the periprostatic venous plexus through the inferior vena cava into the pulmonary arterioles. However, seeds can reach the arterial circulation and end up in virtually any anatomical location if a patent foramen ovale, pulmonary arteriovenous shunt, or other right-to-left shunt is present .
Migrated seeds can be identified with plain radiography or computed tomography they present as small linear hyperdensities simulating the intraprostatic seeds. Identification can be difficult given their small size in our case, multiplanar and 3-D reconstructions greatly aided localization and diagnostic certainty.
Long Term Side Effects Of Brachytherapy For Prostate Cancer
Brachytherapy for prostate cancer can cause some long term side effects such as passing urine more often and difficulty getting an erection.
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Tell your doctor or nurse if you have any of these problems. They can help you to find ways of controlling the effects.
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What Type Of Technology Does This Treatment Use
We use real time, 3-dimensional imaging to carefully place each seed at a predetermined location and depth. In this way, we cover the entire gland and the cancer site. The number of seeds implanted into your prostate will depend on your unique anatomy.
We place an ultrasound probe in your rectum to image the prostate. We also use continuous X-ray imaging. Together, these provide a magnified, 3D view of your prostate during the procedure. After the implantationand while you are still anesthetizedwe will check your urethra and bladder and retrieve any seeds found in your bladder.
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.
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The Earlier The Detection Of Prostate Cancer The Better The Patients Chance Of Survival Is
Heres an overview of the radiation therapy side e. Learn about radiation therapy for prostate cancer here. The earlier the detection of prostate cancer, the better the patients chance of survival is. Radiation therapy is a common treatment for several types of cancer. Prostate cancer is one of the most common types of cancer diagnosed in men. Learn more about this treatment option with this basic guide. The hormones that your thyroid gland produces help regulate several of your bodily functions. Although screenings for prostate cancer are one tool for early detecti. However, as with other types of cancer,. Unless otherwise noted, the information in this guide is sourced from the mayo clinic, the md. Does anyone know about this therapy ?side effects ? Prostate cancer is a common type of cancer in men, according to the mayo clinic. Proton therapy is a cancer treatment option thats just as futuristic as it sounds.
One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime prostate cancer radiation treatment. These include your blood pressure, heart rate and metab.
But hearing the words can still be scary. However, as with other types of cancer,. Here are 10 more facts about prostate cancer.
But hearing the words can still be scary. Learn about radiation therapy for prostate cancer here. Please understand that our phone lines must be cl.
When You Might Have Permanent Seed Brachytherapy
Permanent seed brachytherapy is a treatment for early stage prostate cancer. This means the cancer hasn’t spread outside of the prostate.
If your prostate gland is too big you might need hormone therapy for 3 months before the radiotherapy treatment. The hormone therapy shrinks the prostate and makes it easier to put the seeds into the right place.
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What Are The Advantages And Disadvantages
What may be important to one man might be less important to someone else. Your doctor, nurse or radiographer can help you choose the right treatment for you. Theres usually no rush to make a decision, so give yourself time to think about things.
- Recovery is quick, so most men can return to their normal activities one or two days after treatment.
- It delivers radiation directly into the prostate, so there may be less damage to surrounding healthy tissue, and a lower risk of some side effects.
- You will only be in hospital for one or two days.
- If your cancer comes back, you may be able to have further treatment.
- It can cause side effects such as urinary and erection problems.
- You will usually need a general or spinal anaesthetic, which can have side effects.
- It may be some time before you know whether the treatment has been successful.
- You will need to avoid sitting close to pregnant women or children during the first two months after treatment.
Whos Eligible For This Procedure
Permanent implants are relatively low-energy sources, and therefore have limited tissue penetration. A well-done implant treats the prostate and the surrounding few millimeters of adjacent tissue.
The best candidates for this procedure are patients with a cancer within or near the prostate. Patients with prostate cancer thats invading nearby structures like the bladder or rectum arent appropriate for this technique.
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Continued Refinements For Improved Accuracy
Memorial Sloan Kettering doctors and physicists have helped to develop a refined approach, known as intraoperative computer-based conformal optimization. Here, the treatment team including radiation oncologists, medical physicists, and radiation therapists visualize the prostate using CT scans to assess optimal seed placement while in the operating room.
Pioneered at Memorial Sloan Kettering in 1998, the use of sophisticated computer programs in the operating room to help target where and how many seeds to place within the prostate gland allows the optimal radiation dose to be delivered to the prostate, sparing as much normal tissues as possible from radiation exposure. Planning is done in the operating room during the actual procedure instead of weeks before the procedure, as had been previously done.
Using on-site computers and ultrasound images, our medical physicists employ a sophisticated computer program developed at Memorial Sloan Kettering that can examine within minutes millions of configurations of seed-coordinate placement possibilities, says Marco Zaider, PhD, Head of Brachytherapy Physics at Memorial Sloan Kettering. The program selects the placement plan that will deliver the most effective dose to the prostate while keeping the dose delivered to the rectum and urethra as low as possible.
How Long Does It Take To Recover From Radiation Treatment
Theres no doubt radiation therapy can make the difference between life and death for cancer patients, but unfortunately it often comes at a cost.
Radiation therapy is associated with harsh side effects, many of which dont emerge until months or years after treatment. Acute side effects occur and disappear within 14 days of treatment, but long-term effects like bone degeneration, skin ulcers, and bladder irritation take much longer to manifest.
The complications of radiation therapy are frustrating, painful, and often embarrassing, but using ongoing therapy, such as hyperbaric oxygen therapy , can accelerate your radiation therapy recovery in a natural way and stop your symptoms from defining your quality of life.
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What Is The Radioactive Seed Implant Procedure
During the procedure, radioactive seeds are implanted into the prostate gland using ultrasound guidance. The number of seeds and where theyre placed is determined by a computer-generated treatment plan tailored for each patient. About 100 seeds are commonly implanted.
The implants remain in place permanently, and become biologically inert after about 10 months. This technique allows a high dose of radiation to be delivered to the prostate with limited damage to surrounding tissues.
Radioactive seed implants are an outpatient procedure. Compared to external radiation which requires up to seven to seven-and-a-half weeks of daily treatments convenience is a major advantage of this treatment option.
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How Does Prostate Seed Implantation Work
Prostate seed implantation is a form of Low Dose Radiation brachytherapy. This means that the source of radiation is given in a low, continuous dose for a long amount of time.
Prostate seed implant diagram. Image courtesy of Cancer Research UK.
What to expect during prostate seed implantation:
- In most cases, prostate seed implantation is performed on an outpatient basis. In rare cases, you will be admitted to the hospital for the procedure.
- You will either be put under general anesthesia or have an epidural so you cannot feel anything below the waist.
- The doctor will place an ultrasound probe into your back passage to help guide the placement of each individual seed.
- The doctor will then use a fine needle to insert between 80 120 radioactive seeds into your prostate gland.
- The seeds will give off radiation for the next several months before becoming inert.
- The seeds will not be removed after implantation.
After the procedure, you may be sleepy or feel some temporary tenderness. For outpatient procedures, you can generally go home after the anesthesia has worn off. For inpatient procedures, you may stay in the hospital for a day or until advised by your doctor.
How Many Hospital Appointments You Might Have
You might have the treatment during 1 or 2 stages. This depends on what is available at your hospital.
1 stage procedure
If you have the 1 stage procedure you have your brachytherapy planning and treatment on the same day. And you might stay in hospital for a night afterwards.
You’ll also have an ultrasound scan a few weeks before treatment to check you’re suitable for treatment and to work out how many seeds you need.
2 stage procedure
Some hospitals do your planning 2 to 4 weeks before your brachytherapy. At the planning session you have an ultrasound to check how many seeds you need in your prostate.
Then at your second visit your doctor puts in the radioactive seeds. This is called a 2 stage procedure.
Who Is Eligible For Brachytherapy
Brachytherapy is widely used to treat men with all different stages of prostate cancer. Brachytherapy alone is used for men with early-stage and some intermediate risk prostate cancers and in combination with intensity modulated radiation therapy for men with larger prostate cancers. All men should be evaluated to see if it is a good treatment option for them. However, it may not be ideal for men who already have significant urinary issues such as frequency, urgency, or incomplete emptying, since those may be exacerbated by brachytherapy treatments. For patients with larger prostate glands, it can also be harder to accurately place the radiation.
According to Horwitz, there are some instances where traditional, noninvasive radiation therapies may be preferable.
The brachytherapy implant is a small surgical procedure, but it does involve anesthesia, he said. So for people who have a cardiac history, it may not be as safe for them. In addition, people using blood thinners may want to opt for a less invasive treatment.
But if a person is relatively healthy and itâs safe for them to have anesthesia, then they can do either.
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