High-dose brachytherapy is a new technique offered for prostate cancer treatment.
The procedure is quick and has fewer side effects than other treatment methods.
Temporary radiation seeds are implanted in patients via robotic technology.
It can be amazing to watch technology in action when it comes to health care. Advances can occur at a rapid pace, changing the standards of treatment for diseases and improving the chances of optimal patient outcomes. Such is the case with prostate brachytherapy.
There are different ways that men have been treated for localized prostate cancer, such as surgery or an external beam of radiation. A third option is brachytherapy, where radioactive seeds, about the size of a grain of rice, are permanently implanted in the patient’s prostate to provide low-dose radiation over the course of two to three months. The latest option — one which has been offered at Providence Portland Medical Center and Providence St. Vincent Medical Center since the beginning of 2018 — is temporary, high-dose brachytherapy. It’s a process that offers several key advantages for patients over other techniques, say Stephen Bader and Eric Hansen, MDs, who are radiation oncologists at the medical centers.
“New data has come out that suggested we ought to be using this technique more frequently than it had been offered in the past, and that this procedure is so much better tolerated than the permanent seeds that it’s an easier option to offer,” Dr. Bader says. “Like in all cancer care, advances in technology have made treatment easier to do with fewer side effects and better results. I think that’s a trend in all cancer care, and that’s exciting for me and for patients.”
How it works
The high-dose brachytherapy technique takes advantage of the latest technological developments to provide patients with a quick treatment process that generally results in fewer side effects, Dr. Hansen says.
“Overall, a typical procedure takes about two and a half to three and a half hours,” Dr. Hansen says. “We use advanced computer software to map out the prostate so we can tailor the radiation dose and protect the urethra, bladder and rectum better than we previously could. The patient goes under anesthesia and while he’s asleep we put tiny, hollow needles called catheters in the prostate. We attach the catheters and tiny tubes to a robot under computer control, and it sends radiation seeds in and out of the tubes and delivers the desired radiation; that part takes about seven to 10 minutes. Then, we take out the catheters and the patient goes home the same day after they can get up and walk and urinate.”
So far, the main side effect the doctors have observed in patients is a little discomfort post-procedure. “My experience so far since we’ve been doing this is that every patient has very little in the way of problems,” Dr. Bader says. Adds Dr. Hansen, “A few men have said it feels like they are sitting on a golf ball temporarily and the only pain medication they need is Tylenol. There are no limitations on activity.
“The risks of anything severe happening are very slim,” Dr. Hansen continues. “It can cause men to go to the bathroom a little bit more frequently on a temporary basis — it usually takes a few weeks or months to resolve itself. Occasionally, the bowel movements are also more urgent temporarily, but that’s about it. We achieve very high cure rates with this. Each stage of prostate cancer is treated a little differently, but in general by adding in high-dose brachytherapy, you can get equivalent results or sometimes even better results than you would get with other treatment approaches.”
The advantages of high-dose brachytherapy
There are several key benefits to the high-dose brachytherapy technique, both doctors say. Unlike the low-dose method of radiation treatment that lasts for up to a few months, the temporary delivery method means that men don’t have to take radiation safety precautions. Also, the robotic control used during high-dose seed implantation allows for more precise placement of the seeds to better preserve nearby tissues of the rectum and urethra. “In contrast to permanent seed implants, this procedure is much better tolerated with fewer urination symptoms,” Dr. Bader says. Also, permanently placed seeds have the potential to shift and move around, which could lessen the effectiveness of the treatment.
When it comes to external beam radiation, men are often treated with hormone therapy afterwards, which can cause side effects. The high-dose brachytherapy can sometimes replace the need for more external beam radiation, which means fewer hormones are needed for treatment.
Not every patient is eligible for high-dose brachytherapy. The patient’s prostate should be small to medium in size, there shouldn’t be any pre-existing urinary issues and preferably no history of transurethral resection of the prostate (TURP), also known as the “roto rooter” procedure. The technique also wouldn’t be used if the cancer is in advanced stages or if it has spread outside the prostate.
“We individualize all treatments in our program,” Dr. Hansen says, adding that a patient is usually put in a defined risk group that helps determine the treatment plan. For instance, someone in a lower risk group may get high-dose implants two times, separated by one to two weeks between procedures, while higher risk patients may have brachytherapy in combination with another treatment. “It’s a way to intensify treatments and improve high cure rates and reduce the need for hormone treatments,” Dr. Hansen says.
Dr. Bader adds, “For instance, today I saw two new patients and what I do for them is to walk them through all the different options and guide them in the decision-making process. Having this brachytherapy procedure gives me a new option that’s easier to do for the patient and for myself. In the past, doing brachytherapy and adding external beam radiation was very effective, but the permanent seeds had more side effects. This way of doing it has fewer side effects.”
Dr. Bader says that high-dose brachytherapy is far better and less complicated than the old technology. “The main thing I see is that for aggressive prostate cancer, treating patients with radiation in this way is as good as surgery, which may require radiation afterwards, and is better than external radiation without brachytherapy as far as prostate cancer control. How wonderful that technology continues to improve and that we are able to offer these new treatment techniques to our patients.”
MT: Montana Cancer Center at Providence St. Patrick Hospital and Providence St. Joseph Medical Center
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.