Prostate brachytherapy

Overview:

Prostate brachytherapy is a kind of radiation therapy to treat prostate cancer. Brachytherapy treats cancer by placing radioactive isotopes that emit radiation at a particular distance. It can be used alone or can be used along with other treatments. There are many ways brachytherapy treatment is done for the prostate. 

The Technique of Brachytherapy: 

Brachytherapy is a technique that uses radioactive devices. These devices are inserted near the tumors to deliver high doses of radiation that can destroy and reduce the tumorous cells. Brachytherapy is delivered in two ways which are High-dose brachytherapy (HDR-BT) and Low-dose brachytherapy (LDR-BT). 

In High-dose brachytherapy, radioactive sources are placed in the prostate gland to deliver a high radiation dose temporarily for a few minutes. This is done in many sessions. A radioactive substance called iridium-192 is used for temporary implants. 

In Low-dose brachytherapy, radioactive seeds are placed in the prostate gland to deliver a low dose of radiation regularly and permanently for a longer duration. It is kept for 2-3 months. This uses iodine-121 or palladium-103 as permanent implants. 

Indications: 

Prostate brachytherapy is one of the treatment options for prostate cancer. It delivers the radiation dose to the tissues without damaging the adjacent tissues. International associations gave the following recommendations for brachytherapy in prostate cancer. 

LDR-BT is preferred in 

• Prostate cancer which is restricted to the prostate and in its early stages
• Prostate-specific antigen (PSA) levels are ten or less than that 
• Small tumors and Less aggressive tumors 
• Small prostate gland with good urinary function 

HDR-BT is preferred in 

• Advanced cancers 
• Individuals with intermediate and high-risk cancers

Contraindications: 

Prostate brachytherapy is not indicated in individuals who underwent recent prostate surgeries or have severe urinary issues. 

Advantages:

Prostate brachytherapy targets only the affected tissue by decreasing the chance of radiation effects on other body tissues or organs. It is equally effective as other types of prostate cancer treatment. 

Before the procedure:

Before undergoing brachytherapy, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. The HCP will prescribe medicines before undergoing brachytherapy.

Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual. Advanced imaging techniques like MRI, CT scan, or ultrasound may be done to study the extent of the tumor spread or the damage and decide on the type of brachytherapy to be given. Brachytherapy is done on an empty stomach. Hence it is advisable to stop eating or drinking 8 hours before the procedure. 

During the procedure:

Based on the extent and the stage of prostate cancer, the type of brachytherapy is planned. If LDR-BT is advised radioactive sources called seed implants are placed permanently in the prostate. Under anesthesia, a special probe-like instrument is sent through the rectum to the prostate, and ultrasound-like images of the prostate are obtained. 

Later using a special long needle multiple grain-like radioactive seeds are placed at different locations in the prostate. The needle is passed through the area between the scrotum and the anus, called the perineum. These implants are left in place for a few months so that they give radiation to the tumor tissue of the prostate for a few months without affecting the other organs.  

If HDR-BT is planned, the radioactive material is sent to the body at high speed for a few minutes and then removed. Anesthesia is given to the individual before undergoing HDR-BT. Thin tubes are sent into the prostate through the perineum at specific locations of the tumor. The tubes are connected to a machine that sends wires from the radioactive source to the prostate. These are left in place for a few minutes and then removed. Based on the calculated dosage of the HDR-BT, this procedure can be done several times. 

After the procedure: 

An individual may have mild swelling and pain after the procedure which can be subsided by taking medications and applying ice packs over the area. Instructions like avoiding heavy weights and strenuous exercises should be done. It is better to avoid pregnant women when an individual has seed implants. It is advisable to wear a condom during sex. 

Effectiveness of brachytherapy:

The success of brachytherapy is determined during the follow-up visits where prostate-specific antigen tests are used. After brachytherapy, the PSA levels rise and then suddenly fall. This is called PSA bounce. But it should not continuously rise. A continuous increase in PSA levels indicates the recurrence of prostate cancer. 

Side effects:

Prostate brachytherapy has immediate and short-term side effects. Immediate side effects are pain and swelling in the perineum area. Short-term side effects like having difficulty urinating, urge to urinate frequently, pain and burning sensation during urination, increased frequency of urination at night, inability to empty the bladder, blood in urine and stools, bleeding from the rectum, urgent and increased bowel movements. 

Risks and complications: 

Some rare complications include narrowing of the urethral passage, abnormal holes or openings in the rectum, and cancer in other body parts like the rectum due to radiation therapy. Erectile dysfunction which means an inability to maintain the erection of the penis is one of the long-term effects. 

Conclusion: 

Prostate brachytherapy is a treatment option for prostate cancer. It has a high success rate as it does not affect adjacent tissues and can be delivered using high-dose or low-dose radiation therapy. It is a common treatment for prostate cancer that can increase the survival rate and quality of life of the affected individuals. 

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