LESS INVASIVE PROSTATE CANCER TREATMENT
More than 75 percent of prostate cancer tumors are found in males over the age of 65. Today, the Memorial Healthcare Cancer Center offers the latest treatment for this type of cancer in the form of a procedure called Brachytherapy (brake-e-therapy), a procedure involving the placement of radioactive seeds directly into the cancer site. Implantation of this type is an effective and less invasive treatment versus surgical removal of the prostate altogether. It is also more cost-effective. There are other advantages as well. The procedure is done during a convenient outpatient visit - patients generally resume normal activity quickly. The radioactive seeds are inserted directly into the prostate, minimizing exposure to surrounding tissues. The procedure can be done alone or in conjunction with external beam radiotherapy. At Memorial's Cancer Center, patients receive the benefit of the knowledge and experience of cancer specialists including board certified oncologists, Daniel Williams, M.D., Tallat Mahmood, M.D., Vankat Peram, M.D. and Hesham Gayar, M.D., and Jack Nettleton, M.D., radiation oncologists.
How does it work?
The radiotherapy produced by the seeds kills cancer cells by attacking their DNA. Damage to these cells causes the tumor to die as it tries to grow. When enough damage has accumulated inside the cells of the tumor, they are no longer able to split themselves into new cancer cells. Instead, they split apart. Normal tissues commonly recover from any DNA damage caused and are spared.
Who is eligible?
Eligibility for prostate seed implantation is measured using guidelines established by the treating radiation oncologist. At Memorial Healthcare, Hesham E. Gayar, M.D., board certified radiology oncology specialist, sorts out candidates using basic rules weighing the benefits of this procedure against other procedures and sorting out those patients who would be better served for an alternative therapy. Taken into consideration are the patient's age, daily activity level, cancer status, urinary history, medical history and quality of life issues. Also considered is the size of the tumor, its grade and stage, the patient's PSA level and any history of prior surgeries. Patients who are ineligible for Brachytherapy, may be offered high doses of Three-Dimensional Conformal Radiotherapy.
Once Brachytherapy has been recommended, several tests must be conducted. A measurement is taken of the prostate tumor using a transrectal ultrasound probe. This will help determine the number of radioactive seeds to be implanted. Hormonal therapy may also be recommended in an attempt to reduce the tumor size before the final number of seeds is determined. Patients also receive an blood work analysis, chest x-ray, EKG and a complete physical examination.
How does placement occur?
Implantation of the radioactive seeds is usually done on an outpatient basis with no overnight stay. The procedure typically takes about 60-90 minutes to complete. Both the radiation oncologist and urologist are present during the procedure. The patient is usually asleep during the process of general anesthesia, although there are exceptions depending on the medical history of the patient. Typically 50-150 seeds are inserted targeting the entire prostate.
Are there any side effects?
A patient may notice a tinge of blood or blood clots in the urine initially, although this clears up quickly. Frequent urination and bruising around the scrotum may also be experienced following the removal of the catheter and insertion of the needles used to place the seeds. This usually disappears within a few days or weeks. Many patients are concerned about sexual dysfunction. Brachytherapy offers the lowest risk of all treatment options, although ultimately dysfunction tends to vary based on the patient's age, health status and sexual performance history.