Wednesday, December 7, 2022

How Is Brachytherapy Done For Prostate Cancer

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How Can I Reduce Skin Reactions

Brachytherapy for Prostate Cancer
  • Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Do not rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
  • Try not to scratch or rub the treated area.
  • Do not apply any ointment, cream, lotion, or powder to the treated area unless your radiation oncologist or nurse has prescribed it.
  • Do not wear tight-fitting clothing or clothes made from harsh fabrics such as wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers such as cotton.
  • Do not apply medical tape or bandages to the treated area.
  • Do not expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
  • Do not expose the treated area to direct sunlight, as sun exposure may intensify your skin reaction and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.

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.

What Are The Benefits And Side Effects Of Prostate Seed Implantation

Unlike major surgery, daily radiation treatments, or external beam radiation therapy, seed implantation:

  • Causes little interruption in your daily activities.
  • Usually preserves continence.
  • Less frequently causes erectile dysfunction.

The radiation can cause side effects, which may last for two to 12 months after the implant and will decrease gradually as the seeds lose their radioactivity.

Side effects, all of which are treatable, may include:

  • Discomfort during urination

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

Questions To Ask Your Doctor Radiographer Or Nurse

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  • Will I have a planning session at a different time to the treatment, or immediately before?
  • Will I have external beam radiotherapy or hormone therapy as well?
  • What side effects might I get?
  • How will we know if the treatment has worked?
  • What should my PSA level be after treatment and how often will you test it?
  • If my PSA continues to rise, what other treatments are available?

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Getting Ready For Your Procedure

You and your care team will work together to get ready for your procedure.

Help us keep you safe during your procedure by telling us if any of the following statements apply to you, even if youre not sure.

  • I take a blood thinner, such as:
  • I smoke or use an electronic smoking device .
  • I use recreational drugs.
  • Side Effects And Complications

    Common side effects of prostate brachytherapy include:

    • Blood in the urine: This is normal and should resolve within a few days
    • Bruising and tenderness of the perineum
    • A burning sensation when urinating: Drinking plenty of fluids will help to minimise this and will help prevent urinary infection
    • Difficulty passing urine, or an urge to pass urine quickly or more often
    • A temporary increase in the frequency of bowel motions
    • Fatigue: this is common to all types of radiation treatment.

    These side effects are at their most troublesome four to six weeks after the procedure. However, for most patients they will subside completely over a period of a few months. More serious side effects can occur, including:

    • Urinary incontinence
    • Rectal bleeding
    • Ulceration of the rectum
    • Erectile dysfunction
    • Prostate brachytherapy may result in infertility.

    The risks and side effects of brachytherapy should be discussed with the specialist prior to treatment and should be considered when deciding whether or not to opt for this treatment. More detailed information about the treatment and radiation safety guidelines will be given by the specialist performing the procedure.

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    How Effective Is Brachytherapy

    A large study from Germany including 718 patients reported that HDR brachytherapy ensures a great outcome: biochemical control in prostate cancer after 8 years 90%, and metastasis-free survival 97% .1 Biochemical control means that 90% of patients were free from an increase of PSA after 8 years. Metastasis-free survival means that 97% of patients had no metastases after 8 years.

    Picture 1. Biochemical control and survival in patients with prostate cancer treated with HDR brachytherapy2

    Results of the UK trial comparing external beam radiation therapy alone and EBRT + high dose rate brachytherapy shows advantages in relapse free survival when brachytherapy is added to the treatment 2: 55% and 71% at 6 years and 27% and 48% at 12 years.

    It means that when brachytherapy was added to the treatment, 71% of patients didnât experience cancer in the next 6 years and 48% didn’t experience cancer in the next 12 years.

    Picture 2. Relapse-free survival in patients with prostate cancer treated with EBRT + HDR brachytherapy and only EBRT2

    How Long Does The Radiation Last

    Prostate cancer: Brachytherapys fight for survival

    How long the radiation lasts will depend on the type of treatment given. Your health care provider will determine the brachytherapy type based on:

    • The type of cancer you have

    • The location of the cancer

    If the brachytherapy implant is a low dose implant, it may be left in for several days. High dose implants may be removed after only a few minutes.

    Some implants are permanent. If you have one, you may need to stay in the hospital for a few days. The radiation gets weaker each day. This means you will most likely be discharged after a few days. There may be certain safety measures to be taken at home. Your health care provider will give you specific instructions, if needed.

    Your doctor may remove temporary implants after you have the complete dose of radiation.

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    What To Expect When The Catheter Is Removed

    Once you finish treatment with LDR or HDR implants, the catheter will be removed. Here are some things to expect:

    • You will get medicine for pain before the catheter or applicator is removed.
    • The area where the catheter or applicator was might be tender for a few months.
    • There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near youâeven young children and pregnant women.

    For a week or two, you may need to limit activities that take a lot of effort. Ask your doctor what kinds of activities are safe for you and which ones you should avoid.

    Complete A Health Care Proxy Form

    If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

    A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

    • For information about health care proxies and other advance directives, read Advance Care Planning.
    • For information about being a health care agent, read How to Be a Health Care Agent.
    • If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

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    Possible Risks And Side Effects Of Brachytherapy

    Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

    There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

    These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

    Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

    How Is Prostate Seed Implantation Done

    Migration of a strand of four seeds in low

    Brachytherapy works more effectively on small and moderately sized prostate glands.

    Men with large prostates often undergo a three- to six-month course of hormone therapy to shrink the prostate prior to implantation.

    A urologist and radiation oncologist work together to perform the implant.

    Prior to implant surgery, you will have a transrectal ultrasound.

    The urologist is responsible for the transrectal ultrasound and the radiation oncologist prepares and performs the brachytherapy treatment.

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    Brachytherapy For Prostate Cancer

    Radiotherapy for prostate cancer is sometimes given from inside the body. This is called internal radiotherapy or brachytherapy.

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    Brachytherapy gives high doses of radiation directly to the prostate. Areas close by, such as the rectum and the bladder, get a much lower dose.

    Brachytherapy can be given:

    • on its own to treat low-risk prostate cancer or with hormonal therapy
    • before or after external beam radiotherapy for early prostate cancer or locally advanced prostate cancer. This is sometimes called a boost.

    With early prostate cancer, you usually have boost brachytherapy if the cancer is intermediate-risk and high-risk. If you have locally advanced prostate cancer you will have brachytherapy with external radiotherapy.

    There are 2 ways brachytherapy is given:

    • Radioactive seed implants or low-dose rate brachytherapy Small radioactive seeds are placed in the prostate. This is the most common type of brachytherapy for early prostate cancer. You have this treatment done in a day.
    • High-dose rate brachytherapy Thin tubes are placed in the prostate attached to a machine that sends a radioactive source into the tubes. You may have this with external radiotherapy to treat early or locally advanced prostate cancer.

    You usually have antibiotics before brachytherapy and for a few days after to help prevent infection. You may also be given tablets to help you pass urine more easily after treatment. Brachytherapy may not be suitable if you have a lot of urinary symptoms.

    About The Radioactive Seeds

    The radioactive seeds will be made of radioactive iodine or palladium and covered with titanium. Your radiation oncologist will tell you which is the best choice for you. Your healthcare provider will place 50 to 125 seeds in your prostate. How many they place depends on how big your prostate is.

    A radiation safety officer will give you a card to keep with you after your procedure. The card says youre getting radiation therapy and has the date when the radiation will be done. If you need to go to a hospital for any reason before the date on the card, tell the healthcare provider youve had radioactive seeds implanted.

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    How Hdr Brachytherapy Is Performed

    There are different ways to perform HDR prostate brachytherapy:

  • Insertion of needles can be done under guidance of Computed Tomography – conventional approach.
  • Insertion of needles can be done under guidance of Ultrasound throughout the whole procedure – real-time brachytherapy.
  • A difference between conventional and real-time prostate brachytherapy is that for real-time procedure the patient doesn’t need to be moved for CT and back to the treatment room, everything is organized in one room. The total duration of the real-time procedure is 1 approx. 1 hour, for conventional treatment this will take longer due to patient movement.

    Follow Your Healthcare Providers Instructions For Taking Aspirin

    Update on Brachytherapy for Prostate Cancer 2020

    If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your procedure. Aspirin can cause bleeding.

    Follow your healthcare providers instructions. Do not stop taking aspirin unless they tell you to.

    For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.

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    What The Results Showed

    After five years, there were no significant differences in survival associated with any of the selected treatments. Just one man in the favorable risk category died from prostate cancer during the study, and there were eight deaths from the disease in the unfavorable risk group.

    Many men in the study had initial problems with sexual, bowel, urinary, and hormonal functioning. Brachytherapy caused more irritative urinary problems during the initial six months than the other treatments, but then those symptoms steadily improved. Brachytherapy and EBRT were associated with minor bowel symptoms such as urgency, bleeding, frequency, and pain that resolved within a year in men from both risk groups.

    Dr. Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, agreed the study provides a valuable resource that adds to existing information. Yet he cautioned against brachytherapy, warning that this particular treatment in some cases has long-term urinary side effects that can significantly alter a patients quality of life. I do not routinely recommend brachytherapy, Garnick said. This is especially true in patients with a pre-existing history of urinary tract infections or prostatitis.

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    Who Should Consider Taking Radiopharmaceuticals

    Radiopharmaceuticals are given through a vein to men with metastatic prostate cancer that has spread widely to the bone. Strontium89 and Samarium-153 are radiopharmaceuticals given to reduce the pain caused by the bone cancer. Radium-223, or Xofigo®, is a radiopharmaceutical given to prolong life.

    The side effects associated with radiopharmaceuticals are mainly the suppression, or lowering, of white blood cell and platelet levels in the blood. Your doctor will be able to assess whether your body can handle this side effect before you are given the treatment and will monitor your levels after you receive it. Your doctor, specialist nurse, or nuclear medicine practitioner will be able to give you more information about the treatment and possible side effects.

    If your doctor has told you that your bone metastases have spread, you may be a candidate for a radiopharmaceutical. Speak with your oncology team to see if one of these treatments may be right for you.

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    Prepare Your Nulytely Bowel Preparation Solution

    On the morning of the day before your procedure, add lukewarm water to the NuLYTELY, filling it to the top of the line on the bottle. Add a flavor pack, if you choose. Use only a flavor pack that was provided with your NuLYTELY.

    With the cap on, shake the NuLYTELY bottle until the powder is dissolved. The mixture will be clear, even if you used a flavor pack. If you prefer, you can place the bottle in the refrigerator to chill it. Many people have told us that NuLYTELY tastes better cold. Dont mix the NuLYTELY earlier than the morning before your procedure.

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    Is The Radiation Safe

    Cureus

    The radiation is released into your prostate gland over the first few months. After about 12 months, the seeds are no longer active. The seeds can stay in your prostate without doing any harm.

    • It is safe for you to be around other people and pets during this time.
    • As a precaution it is best to avoid close physical contact with small children or pregnant women for the first 2 months after treatment.
    • Follow the advice from the hospital about any specific precautions you need to take.

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    Brachytherapy: A Highly Targeted And Effective Option For Treating Prostate Cancer

    Prostate cancer is the second most common cancer in American men, with about 250,000 new cases diagnosed each year. It starts when cells inside the prostate gland, which is located below the bladder and in front of the rectum, begin to grow out of control.

    While prostate cancer affects around 1 in 8 men during their lifetime, the good news is that there are effective treatment options, including a treatment called brachytherapy.

    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 it’s safe for them to have anesthesia, then they can do either.

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