Monday, May 23, 2022

How Successful Is Brachytherapy For Prostate Cancer

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Who Is A Candidate For Brachytherapy

Brachytherapy offers “excellent results” in fight against prostate cancer | Vancouver Sun

Despite all of the advantages, not everyone will be a good candidate for Brachytherapy or external beam radiation treatment. A patient with a large prostate and extensive urinary symptoms will not be an ideal candidate, shared Dr. Sylvester. Age is also a factor, as older patients tend to have a larger prostate.

He pointed to the upcoming study that shows an 8% risk of urethral strictures and other urinary side effects with Brachytherapy treatment, compared to a 2.5% risk with external beam radiation alone. But the physician added a strong caveat to this stating: You have to consider the 48% chance of a reoccurrence with external beam radiation. If that happens, a patient might have to go on hormones for the rest of their lives. This means the potential for much greater side effects, including impotency, hot flashes, metabolic syndrome, effects to blood sugar, increased risk of Alzheimers, weight gain, risk of osteoporosis, and cardiac issues. When considering long-term health, keep in mind that all of the data shows Brachytherapy has the best cure rates for intermediate and high-risk prostate cancer.

Where Can Patients Find Brachytherapy

Brachytherapy currently is practiced in major metropolitan areas, such as Boston, New York City, Chicago, Seattle and San Francisco. That list has grown to include Charleston, SC, Green Bay, WI, Dubuque, IA, Longview, TX, Norfolk, VA and others. Dr. Sylvester suggests that patients living in an area that does not have an effective center for treatment receive external beam radiation locally, then travel to an area offering Brachytherapy to boost the effectiveness of the overall treatment plan. He recommends checking with the companies that produce radioactive seeds, such as Isoray, to find a quality Brachytherapy treatment location.

Dr. Sylvester strongly recommends seeking treatment from a physician that performs the procedure often. With almost any major medical intervention, the higher the volume, the better you are at the procedure, he explained. If the provider is doing less than 20 cases a year, you should probably avoid it. In my case, I am performing 15-20 cases per month on average.

A CT scan should also be used to adjust the placement of the implant, he continued. This enables placement to be corrected in the operating room. When Brachytherapy is done correctly, you get hard data on the quality of the procedure.

Patients & Families

Hdr Brachytherapy As Monotherapy

Despite promising initial results in the single-fraction experience, such treatment remains investigational, and the optimal single-fraction dosing regimen continues to be investigated. Specifically, the 19 Gy single-fraction dose was predicated on the assumption of the extremely low alpha-beta ratio for prostate cancer . Evidence shows that radioresponsiveness of prostate cancer may be heterogeneous and that certain cancers may, in fact, have alpha-beta ratios that are higher.28 For such tumors, 19 Gy may prove to be an insufficient dose , and continued evaluation of the optimal single-fraction HDR treatment approach is necessary.

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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.

To learn more, see the Radiation Therapy section of our website.

Putting In The Brachytherapy Seeds

Prostate Cancer Death Risk Higher After External Beam ...

You will be taken to an operating theatre to have the seeds put in under a general or spinal anaesthetic. An ultrasound probe is first put in your back passage to show up your prostate. Then about;60 to 120 radioactive seeds are put into your prostate through the skin between your scrotum and anus using a fine needle. You will not be cut. It takes about 90 minutes to put in all the seeds.

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Effects On The Bladder

These can be a problem after brachytherapy. If you already have difficulties passing urine, you will not usually have brachytherapy, as it may make bladder problems;worse.

It is normal to see some blood in your urine and semen for a few weeks after treatment. If bleeding gets worse or you have large clots, tell your doctor straight away. Drinking plenty of water helps flush your bladder and prevent blood clots.

You may also:

  • have discomfort or pain passing urine
  • need to pass urine urgently and more often.

Drinking plenty of water and avoiding caffeine and alcohol will help improve these symptoms.

Not being able to pass urine

Brachytherapy may cause swelling of the prostate. This may make it difficult to pass urine. If this happens, you may need to have a catheter put in your bladder until the swelling goes down.

Sometimes radiotherapy can narrow the urethra . This causes difficulties with passing urine. This may happen weeks, months or even years after treatment finishes. A stricture can be treated by passing a thin, plastic tube through the urethra to widen it.

See also

Questions To Ask Your Doctor Radiographer Or Nurse

  • 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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Inflammation Of The Back Passage

Inflammation of the back passage is a long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.

Bleeding is usually slight but can be more severe for some people. Talk to your radiographer or nurse;if you have proctitis.;They might suggest you use treatments such as steroid suppositories for a short time. This might reduce the inflammation.;

What Types Of Brachytherapy Can Be Used For Treatment Of This Cancer Type

HDR Brachytherapy for Prostate Cancer

There are two types of brachytherapy which can be used to treat prostate cancer:

  • Low Dose Rate brachytherapy â also referred to as ‘seed therapy’ or âpermanent seed implantation’. Tiny radioactive seeds, about the size of a grain of rice, are permanently placed inside the tumor. The seeds give out low levels of radiation for a few months, killing the cancer cells.
  • High Dose Rate brachytherapy involves the temporary placement of a radioactive source to treat the tumor. In contrast to LDR, no radioactive material is left in the prostate after treatment.

HDR brachytherapy has been shown to be an effective treatment for low, intermediate and high risk prostate cancer.

It is often given in combination with external beam radiotherapy , as it can provide an additional dose of radiotherapy to help prevent the cancer from returning.Some centers offer HDR brachytherapy as the sole method of treatment as it is a very effective and quick treatment, making it very convenient for many patients. Your doctor will be able to advise you if HDR brachytherapy is a possible treatment option for you.

LDR brachytherapy has a longer history of clinical usage than HDR brachytherapy. LDR and HDR brachytherapy show similar results for treatment of prostate cancer. However, since LDR radioactive seeds remain in the body, the radiation protection for patients and families could be an issue. Moreover, active seeds can migrate outside the prostate.

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Hdr In Conjunction With External Beam

When first used for prostate cancer, HDR brachytherapy was predominantly implemented to boost the prostate as an adjunct to pelvic EBRT. This was considered particularly advantageous when first being used given the contemporary EBRT doses of 66-70 Gy that were considered standard at the time. Several single-institution experiences reported on the safety and efficacy of such treatment, and a prospective, randomized trial published by Hoskin et al6 demonstrated superior biochemical control in patients receiving HDR brachytherapy boost treatment relative to those patients treated with EBRT alone.

Biological analyses of responses to changes in HDR dosing/fractionation suggested a high sensitivity of prostate cancer cells to increasing fractional doses. That is, prostate cancer has a low alpha-beta ratio, and biologically equivalent dose , it was found, could be dramatically increased through relatively small increases in HDR fraction size. In fact, evidence of dose response in terms of enhanced biochemical control was demonstrated across a range of HDR fractionation regimens increasing progressively from as low as 550 cGy x 3 fractions up to 1150 cGy x 2 fractions.7 More recently, HDR boost regimens given in a single fraction of 1500 cGy 8,9 has gained favor and is the recommended dosing in the most recent open Radiation Therapy Oncology Group protocol to allow HDR brachytherapy as a boost.

Benefits Of Brachytherapy For Prostate Cancer

Brachytherapy for prostate cancer is internal irradiation of the prostate. This treatment option is primary in case of non-metastatic cancer. It allows preserve the prostate and avoid complications. Brachytherapy is an alternative therapy to radical prostatectomy.

The advantages of brachytherapy in case of prostate cancer are the following:

  • minimally invasive procedure
  • A patient is under general anesthesia. The operating area is sterilized.
  • A doctor inserts the catheter to withdraw the urine.
  • The special probe is placed in the rectum to make images of operation and transmit them on the screen.
  • A specialist inserts 15-30 needles into the prostate. Their quantity depends on the prostate size.
  • Through each needle it is possible to place 1-6 radioactive seeds.
  • The brachytherapy for prostate takes 1-2 hours.
  • Then a patient is hospitalized. The next day after brachytherapy, a doctor examines mans health and removes the catheter. A patient returns home.

Process of brachytherapy for prostate cancer

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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.

How Effective Is Brachytherapy

About Brachytherapy  Prostate Cancer

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

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Radioactive Seed Therapy Returns 80

Active retiree Larry Fenster is a problem-solver. So when he was diagnosed with prostate cancer, he searched for solutions. Mr. Fenster, 80, soon found out that he was a prime candidate for brachytherapy . The treatment would allow him to avoid surgery and traditional radiation therapy.

For several years, the Manhasset resident an avid golfer who enjoys traveling with his wife watched his concentration of PSA rise from a normal score below 4.0 nanograms per milliliter all the way up to 10.

A prior biopsy did not show cancer, but his urologist, Robert Waldbaum, MD, of Northwell Healths Smith Institute for Urology, ordered parametric magnetic resonance imaging .

The scan revealed a mass in Mr. Fensters prostate, and a directed re-biopsy confirmed that he had Stage II cancer. Dr. Waldbaum referred him to Louis Potters, MD, Northwells chair of radiation medicine and deputy physician-in-chief of radiation medicine for the health systems Cancer Institute.

C How Much Radiation Is Enough

The total amount of radiation the prostate gland will receive depends upon the amount of radiation in each seed and the total number of seeds deposited. A typical implant usually requires approximately 60 to 100 seeds, depending on the size and shape of a patients prostate gland. The extent of treatment that a patient requires is dependent upon the risk that his cancer is confined to the prostate. As a rule, low-risk patients require one treatment, such as permanent;seed implant. Hormone therapy in this group of patients may be used to reduce the overall size of a large prostate gland.

It is often recommended that men at intermediate risk for cancer that has spread undergo more aggressive treatment. At a minimum, this means a combination of hormone therapy plus a seed implant. In some cases, even more aggressive measures, such as adding five weeks of external beam radiation therapy to a seed implant, may be indicated. The purpose of the additional EBRT is to kill any cancer cells that may have escaped the prostate and are in the tissue around the prostate. High-risk patients can also benefit from brachytherapy, but this is usually done in combination with EBRT and hormone therapy.

D. What are the Advantages of Brachytherapy?

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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.

Advantages

  • 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.

Disadvantages

  • 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.

If you are having;external beam radiotherapy;or;hormone therapy;as well as permanent seed brachytherapy, think about the advantages and disadvantages of those treatments as well.

How Often Is Brachytherapy Treatment Given And How Long Do The Sessions Last

Brachytherapy to Treat Prostate Cancer – Hadi Zahra, MD CHI Health

For LDR brachytherapy, the radiation sources have to remain within or next to the cancer for an extended period of time. Because of this, treatment is usually spread out over the course of one week and requires a stay in the hospital.

For HDR brachytherapy, the treatment is given in one or two brief sessions, delivering radiation directly to the tumor. After the final treatment, the catheters are removed and you can return home.

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Brachytherapy for prostate cancer is carried out under local or general anesthesia. A doctor installs the needles in the prostate to put in the radioactive sources – seeds. The procedure is controlled by the visualized diagnostic units. It takes about 1.5 hours.

After the operation, a patient is hospitalized for 1 day. Then a doctor examines a patient and removes the catheter. A patient returns home.

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