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Radium Seed Implants For Prostate Cancer

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How Long Does It Take To Recover From Radiation Treatment

Prostate Brachytherapy with Princeton Radiation Oncology

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.

Proton Therapy For Pediatric Cancers

Proton therapy is particularly beneficial for treating children and adolescents with cancerous and noncancerous tumors. Children are at a significantly higher risk of late effects from cancer treatments compared to adults. Two-thirds of children who survive a cancer diagnosis face at least one chronic health condition. One-fourth of pediatric cancer survivors face a severe or life-threatening side effect from treatment that occurs later in life. These include heart damage, lung damage, infertility, cognitive impairment, growth deficits, hearing loss, vision loss, secondary cancers and more.

Thanks to treatment advances, including radiation, pediatric cancer survival rates have dramatically increased to nearly 85% today from 10% only decades ago. One of these advancements, proton therapy, reduces a childs risk of experiencing harmful long-term side effects. Proton therapy limits and reduces radiation doses to healthy tissues and organs while delivering curative doses to the cancer.

We treat a number of childhood cancers with proton therapy. In certain situations, the cancer center will coordinate with Childrens Mercy specialists to develop a care plan suited to the childs individual treatment requirements. Childhood cancers we treat with proton therapy include:

  • Atypical teratoid rhabdoid tumor
  • Rhabdomyosarcoma

What Are Prostate Seed Implants

Seed size comparison. Image courtesy of the Nuclear Regulatory Commission .

Brachytherapy can be used to treat prostate cancer in the form of prostate seed implants. During this procedure, your doctor will place 80 120 small radioactive seeds into your prostate. This procedure may be performed on an inpatient or outpatient basis depending on the individual.

Over the next few months, the seeds release radiation into the prostate gland and shrink the tumor. The radiation from the seeds wears off over time, leaving the seeds inert. The seeds will not be removed following the procedure.

Brachytherapy may be used on its own or with another type of treatment.

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Case For Combined Treatment

For treatment to be effective in patients who have more aggressive or advanced stages of prostate cancer, it must be directed at both the prostate and the surrounding areas where cancer cells may have spread. To accomplish this, a seed implant is typically combined with a few weeks of IGRT and/or a temporary hormone blocking medicine.

The seed implant delivers a high dose of radiation to the prostate, where most or all of the cancer cells reside. The IGRT not only treats the cancer in the prostate, it also attacks cancer cells that may have spread outside the prostate.

Possible Side Effects Of Ebrt

Intraoperative treatment planning for radioactive seed implant therapy ...

Some of the side effects from EBRT are the same as those from surgery, while others are different.

Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

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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?

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.

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Radiating From Within Seed Implants Treat Prostate Cancer

Trends among medical professionals have favored some treatments for younger men diagnosed with prostate cancer, but a new study by scientists at The Feinstein Institute for Medical Research and North Shore-LIJ Health System have found that age doesn’t make a difference in the long-term therapeutic outcome.

Louis Potters, MD, chairman of radiation medicine at North Shore University Hospital and LIJ Medical Center, and his colleagues identified 2,119 consecutive prostate cancer patients treated between 1992 and 2005, and narrowed their selection to men under 60 years old.

Their treatment regimens consisted of permanent prostate brachytherapy with or without hormone therapy, permanent prostate brachytherapy with external beam radiation, or a combination of those therapies. The 237 patients had been followed for an average of 56 months after treatment. They wanted to see whether there was a difference in the rate of progression among the treatments and if it had anything to do with the age of the patient or disease-related risk factors.

Age didn’t seem to factor into the treatment equation, said Dr. Potters. Findings of the study were published in The Journal of Urology. “There is a whole politic to prostate cancer treatments,” added Dr. Potters. “But the bottom line is that brachytherapy is an appropriate option for men at any age.”

Scientists at The Feinstein Institute are now studying the effect of the radiation dose on long-term outcome.

How Is The Procedure Performed

Which is Better – Surgery vs. Radiation for Prostate Cancer?

The prostate cancer seed implant is performed as a same day procedure. It lasts about 45 minutes to one hour and is done in the operating room under spinal or general anesthesia.

The physician will place radioactive seeds, about the size of a grain of rice, into the prostate gland. The seeds are placed using thin needles passed into the prostate gland through the skin. The needles are viewed on an ultrasound machine to accurately guide their final position. These seeds give low-energy X-rays that are capable of destroying the cancer in the prostate.

Before the implant procedure, the radiation oncologist will determine the number of seeds needed to treat the cancer and exactly where they should be placed using a prostate ultrasound scan and VariSeed computer technology.

Within three to six weeks following the procedure, a CAT scan is performed to determine that the prostate gland is receiving the proper amount of radiation throughout the entire gland.

For more information, contact your physician. For a physician referral, call 800-443-4605.

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What Is Prostate Seed Brachytherapy

It is estimated that 1 in 9 men will develop prostate cancer during their lifetime. If prostate cancer is detected early, there are several methods of treatment currently available which provide a good chance of a cure. Choosing the treatment option that is best for you should involve obtaining enough information to allow you to understand what each treatment involves.

You should make an informed decision in close consultation and discussion with your doctor.

This procedure involves the insertion of radioactive seeds directly into the prostate gland where they remain. The seeds emit low level radiation for approximately 1 year after implantation. Each seed is 4.5mm in length and 0.8mm wide and resembles a grain of rice, grey in colour.

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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 Are The Benefits Of Prostate Seed Implantation

Many men are candidates for prostate seed implants as an alternative to external beam radiation therapy or surgery. Sometimes prostate seed implants are used as a boost following external beam radiotherapy. This one-time procedure is less invasive than surgery without the inconvenience of daily radiation treatments for several weeks. This form of radiation treatment is also called permanent intersitial brachytherapy in which small radioactive seeds are placed into the prostate gland in the operating room and then release radiation gradually over a period of several months.

Using real-time imaging and treatment planning with a transrectal ultrasound, these radioactive seeds can very accurately be placed to ensure effective treatment. With more than 1000 prostate seed implants performed, we have a great deal of experience with this convenient, minimally invasive approach in the management of prostate cancer.

For the right person, prostate seed implant can offer equally good cancer control as radical prostatectomy or external beam radiation therapy.

Currently, Radiation Oncology Associates performs prostate seed implants at the following locations:

How Long Has This Procedure Been Around

REVIEW: Self

Using internal radioactive sources to treat cancer is not a new concept it emerged over 100 years ago. However, radioactive seed localization specifically is a relatively new technique the first procedure in the Ottawa Hospital Radioactive Seed Localization Program was on April 21, 2015. Our hospital was the third centre in Canada to have this program, and we are a leader in the procedure, with other healthcare centres looking to us for guidance.

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A Brief History Of Prostate Treatment From Surgery To Radiation

Surgery has been the standard of care for prostate cancer for the past 150 years. Although effective, radical prostatectomies are invasive and not without complications. But then, shortly after the discovery of X-rays and radium at the turn of the last century, physicians began to explore how these modalities might improve survival and decrease potential side effects from the radical surgery. In 1917, Dr. Benjamin Barringer, chief of urology at what is now known as Memorial Sloan Kettering Hospital, espoused the use of radium needles for prostate cancer.

Initially, radioactive seed implantation was performed via free-hand technique, using direct visualization of the prostate to guide the radiation oncologist with seed placement. However, the results of this preliminary approach were hampered by suspect dose distribution in the prostate.

In 1987, Dr. John Blasko from Seattle described a reproducible system to implant radioactive iodine seeds in the prostate. This Seattle system employs a rectal ultrasound probe to directly visualize the prostate and a plastic template placed on the patients perineum . The template guides the placement of the needles that are loaded with radioactive seeds. This technique allows a reproducible, uniform dose distribution to the prostate.

At Princeton Radiation Oncology, our radiation oncologists have been performing the prostate seed procedure since 1997. We use the Seattle groups criteria for implant selection.

Side Effects Of Brachytherapy

Brachytherapy causes the same types of side effects that external beam radiation therapy does, such as erectile dysfunction.

In some instances, side effects to the bowels may be less severe than those caused by EBRT. Side effects that impact the bladder, however, may be more severe.

High-dose brachytherapy may cause temporary pain and swelling. It may also cause your urine to look red or brown for a short period of time.

Brachytherapy presents with some risks that external beam radiation therapy does not. If you have permanent brachytherapy, you may emit radiation to others for several weeks or months. Your doctor may advise you to stay away from pregnant people and small children during this time.

Occasionally, the seeds may migrate away from their original placement. For this reason, you may also be instructed to wear condoms during sexual activity, to protect your partner.

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Results With Prostate Brachytherapy: 12

At Northwest Hospital, 229 patients with stage T1/T3, low-to-high Gleason grade prostate cancer underwent prostate implants with I-125 or Pd-103 between January 1, 1987 and September 1, 1989. Patients, whose median age was 70 years , were divided into two groups based exclusively on clinical stage and Gleason grade. Pretreatment PSA measurement was obtained in all patients but did not impact upon the treatment group assignment.

Group 1 consisted of 147 lower stage/grade patients treated with an implant alone and Group 2 comprised 82 patients deemed to have higher risk of extra-prostatic extension of the malignancy. Group 2 patients, in addition to receiving a seed implant, were also treated with 45 Gy external beam radiation to the pelvis . None of the patients underwent operative staging, and none received concurrent androgen manipulation.

Fourteen patients were lost to follow-up: Seven by death from non-cancer causes within 18 months post-implant, and seven because of incomplete PSA follow-up, leaving 215 patients for complete evaluation. The median duration of post-treatment follow-up was 110 months.

The observed disease-free survivals of the two groups combined at 12 years was 70% 66% in the monotherapy group and 79% in the combination therapy group. Figures , , and show the disease-free survival results graphically.

Preparing For The Implant

Med Moment – Prostate Seed Implants

Two or three weeks before your implant surgery, your urologists staff will call you to schedule you for routine blood work and a chest x-ray. It is important to have these done promptly, since your seeds have been ordered.

Be sure to tell your doctor if you take aspirin, aspirin products, or blood thinners, such as coumadinĀ®. Your doctor will instruct you on when to stop taking these medications before your surgery.

Your urologists staff will give you instructions regarding what you may eat and/or drink the day before your implant surgery. You will also be given instructions on the use of a laxative and/or enema. A nurse from the Same Day Surgery Department will call you the afternoon before the day of your surgery. The nurse will go over your instructions and will tell you where to park and when and where to report. Please plan to have a friend or family member come to the hospital with you on the day of your surgery, because you will not be able to drive home.

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Kansas City Is Proton Therapy’s Newest Home

The Proton Therapy Center at The University of Kansas Cancer Center, 1 of 53 National Cancer Institute-designated comprehensive cancer centers in the nation, is the only one of its kind in Kansas, Kansas City and the surrounding region. There are no other proton therapy centers in Kansas or the surrounding states of Iowa, Nebraska, Colorado and Arkansas. Now, your cancer patients and their families no longer need to leave the region to receive this advanced form of targeted radiation treatment.

Permanent Seed Brachytherapy For Prostate Cancer

Permanent seed brachytherapy is when your doctor puts very small radioactive metal seeds into your prostate gland. The seeds slowly release a low level of radiation into the area of the prostate over a few months. It is a type of internal radiotherapy.

With brachytherapy, your doctor puts the radioactive source or seeds as close to the cancer as possible. So that the cancer gets a high dose but nearby tissues and further away the levels of radiation are low.

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Success Rates And Side Effects

Treatment success rates for prostate cancer brachytherapy have been excellent, especially for men diagnosed with an early stage of the disease, for which survival rates are generally comparable to those produced by prostate surgery. In addition, the new intraoperative computer-based conformal optimization approach, and the enhanced precision it allows, reduces the likelihood of both urinary and rectal side effects when compared to external beam radiation. Another benefit of treating prostate cancer with brachytherapy is that the time commitment required to perform it is dramatically less than that required for external beam radiation, which is usually delivered in about 50 sessions over the course of ten weeks.

We are one of a few institutions in the world using this particular intraoperative CT scanning device on a regular basis to help us to optimize the quality and accuracy of the seed implant procedure, Dr. Zelefsky notes. We think it may be appropriate for many forms of brachytherapy, and we are exploring the use of these procedures to treat a variety of other cancers.

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