Prostate Brachytherapy: An Overview

Introduction

Brachytherapy for the prostate is a type of radiation therapy that is utilized to treat prostate cancer. Brachytherapy of the prostate entails the implantation of radioactive sources within the prostate gland, where they can eliminate cancer cells with minimal harm to adjacent healthy tissue.

What Is the Purpose Behind It?

Prostate brachytherapy is employed for the treatment of prostate cancer. The treatment involves the placement of radioactive sources into the prostate, ensuring that the cancer cells get the majority of the radiation while minimizing the radiation dosage to nearby healthy tissue. If one has localized prostate cancer in its early stages with a low risk of metastasis, brachytherapy may suffice as the sole treatment.

In cases of more extensive prostate tumors or those with a higher likelihood of metastasis, brachytherapy may be employed in conjunction with other treatment modalities, such as external beam radiation therapy (EBRT) or hormone therapy. Prostate brachytherapy is typically not employed for advanced prostate cancer that has metastasized to the lymph nodes or other distant sites.

What Is Prostate Cancer?

Prostate cancer is a malignancy that develops specifically in the prostate gland. The prostate is a little gland in males, resembling the shape of a walnut, responsible for producing seminal fluid, which serves to nourish and facilitate the transportation of sperm.

Prostate cancer is most prevalent among cancer types. Several prostate tumors exhibit a sluggish growth rate and remain localized within the prostate gland, potentially posing minimal harm. Nevertheless, whereas certain forms of prostate cancer exhibit a modest growth rate and may require minimum or perhaps no intervention, other forms are highly aggressive and have the potential to metastasize rapidly.

The prognosis for successful treatment of prostate cancer is highest when it is diagnosed at an early stage while it is still localized within the prostate gland.

What Are the Types of Prostate Brachytherapy?

Prostate brachytherapy techniques exhibit variations depending on the type:

• High dose rate (HDR) brachytherapy refers to a type of cancer treatment that involves delivering a high dosage of radiation to the tumor site using a radioactive source. HDR brachytherapy is a transient form of prostate brachytherapy wherein radioactive sources are inserted into the prostate gland to administer a concentrated dose of radiation within a brief timeframe, after which the sources are extracted. A customary course of treatment may encompass multiple sessions.

• Brachytherapy is administered at a low dosage rate (LDR). LDR brachytherapy refers to a form of permanent prostate brachytherapy in which radioactive seeds are permanently implanted in the prostate gland. These seeds gradually emit radiation over several months.

What Are the Typical Adverse Effects?

Side effects associated with prostate brachytherapy may consist of the following:

• Inability to initiate urinating.

• Constantly experiencing the impulse to urinate.

• Aching or pain during urination.

• Urinating during the night with blood in the urine and an inability to completely cleanse the bladder.

• Deficiency of erection.

• Bleeding originating in the rectum.

• Violent feces prolonged bowel movements.

• Frequency of gastrointestinal movements.

• Physicians frequently prescribe medications to mitigate treatment-related adverse effects. Over time, numerous adverse effects of prostate brachytherapy become less evident.

What Are the Uncommon Complications?

Although uncommon, significant complications may arise following prostate brachytherapy. They consist of:

• Narrowing of the urethra, the conduit responsible for transporting urine from the bladder to the body's exterior.

• An anomalous aperture (fistula) in the rectum wall.

• Bladder or rectal cancer induced by radiation.

What Are the Advantages of the Procedure?

The cure rates for low-risk patients are comparable to those of surgery or External Beam Radiation Therapy (EBRT). However, for intermediate and high-risk patients, the combination of hormone therapy and EBRT results in higher cure rates compared to surgery or EBRT alone.

• The operation is performed on an outpatient basis and does not require the use of a catheter.

• There is no need for surgical cuts or sutures. Negligible, if any, pain after the operation. Incontinence rates are below one percent.

• More than 80 percent of men who had a normal erectile function before treatment will continue to retain their erections.

• Adjacent normal tissues may be exposed to a lower radiation dose than external beam radiotherapy, reducing the likelihood of harm.

• The recovery process is reasonable, allowing for a prompt resumption of regular activities within a few days.

What Are the Disadvantages of the Procedure?

• Temporary urinary irritation, including increased frequency and urgency, is the most prevalent side effect. The duration of these symptoms typically ranges from a few weeks to a few months and can be alleviated with the use of drugs, such as alpha-blockers.

• The determination of therapeutic success may require a significant amount of time. The prostate-specific antigen (PSA) is assessed biannually and may exhibit variability within 18 months, known as PSA bounce. A PSA rebound is more prevalent in younger males and typically indicates that the treatment is exerting an impact on the cells of the prostate. Typically, during three years, the PSA level drops significantly.

• LDR brachytherapy involves the permanent placement of radioactive seeds, which emit radiation within the body for six months. However, after this period, the seeds become inactive and do not pose any further issues.

• During LDR brachytherapy, it is conceivable that individual seeds may dislocate from the prostate and migrate to other parts of the body or be excreted in the urine. However, due to the minimal radiation emitted by each seed, this occurrence is harmless and does not impact the overall effectiveness of the treatment. One effective method to prevent seed movement is the utilization of 4D brachytherapy, which involves the usage of seeds connected in a biodegradable strand of material surrounding the periphery of the gland.

• HDR brachytherapy necessitates multiple radiation treatments, which may entail a minimum of six hours of bed rest between treatments, with the tubes remaining in the prostate. Certain individuals may experience discomfort, necessitating an overnight hospital stay for HDR treatments.

Conclusion

Brachytherapy is an exceptionally efficient therapy for individuals diagnosed with prostate cancer that falls within the low- to intermediate-risk range. This therapy may additionally enhance the prognosis if one has prostate cancer of moderate to high risk and is undergoing external beam radiation therapy (EBRT).

The prognosis for those who undergo brachytherapy as a treatment for prostate cancer is highly favorable in the long run. If one is diagnosed with prostate cancer, a physician can inform about the possible treatment options. One can devise an optimal treatment regimen tailored to one’s circumstances, ensuring long-term well-being.