High Dose Rate Afterloading
Brachytherapy for Prostate Cancer
There are at present two major methods of modern prostate Brachytherapy in use: (1) permanent seed implantation and (2) high dose rate (HDR) temporary Brachytherapy. Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland. They give off their radiation at a low dose rate over several weeks or months, and then the seeds remain in the prostate gland permanently. Patients can be radioactive during the first three months after the procedure and some care has to be exercised particularly around children and pregnant women.
HDR Remote Afterloading
This treatment involves placing very tiny plastic catheters into the prostate gland, and then giving a series of radiation treatments through these catheters. The catheters are then easily pulled out, and no radioactive material is left in the prostate gland. A computer-controlled machine pushes a single highly radioactive iridium seed into the catheters one by one. Because the computer can control how long this single seed remains in each of the catheters, we are able to control the radiation dose in different regions of the prostate. We can give the tumor a higher dose, and we can ensure that the urine passage (urethra) and rectum will receive a lower dose. This ability to modify the dose after the needles are placed is one of the main advantages of temporary Brachytherapy over High Dose Rate (HDR) Remote Afterloading Brachytherapy. Brachytherapy is a highly effective alternative for prostate cancer (and other cancers) and is a medical term for a radioactive source applied in or near a tumor.
What Does HDR Treatment Involve?
Treatment by the North Cypress Cancer Team frequently consists of a three-pronged attack, known as " tri-modality therapy". This can include a combination of the three following separate therapies:
- High-dose-rate temporary Brachytherapy
- Moderate doses of intensity modulated radiation therapy (IMRT)
- Short term hormonal therapy (occasionally omitted)
It is possible for cancer cells to migrate outside of the HDR Brachytherapy program. Because of this, external beam radiation is often added. This treatment can also be used for many tumors which are considered too advanced for radical prostatectomy. As long as there is no obvious spread to distant areas of the body, like the bones, this treatment can be considered. For early stages, treatment is an alternative to the radical prostatectomy, but with fewer side effects.
Another reason to use external beam therapy is to minimize the chances of permanent complications, especially urinary side effects. By spreading the dose delivery out over internal and external treatments we can minimize the chances of causing a complication by either treatment.
Who can have this treatment?
HDR Brachytherapy program can be used for a wide range of prostate stages, PSA values, and tumor grade. As long as there is no obvious spread to distant areas of the body, like the bones, this treatment can be considered. For early stages, our treatment is an alternative to the radical prostatectomy, but with less side effects. Eligible patients include:
- Any tumor stage (T1 - T3)
- A wide range of sizes of prostate glands (large glands will require hormone therapy prior to Brachytherapy)
- No known spread of cancer to other parts of the body, like bones or lymph nodes
- No set PSA limit
- No set Gleason limit
- Previous Trans-Urethral Resection of Prostate (TURP / TUPR) is acceptable, but there is a higher chance of urinary control problems with any kind of treatment
- Acceptable health
Benefits of HDR Treatment:
- No nausea, hair loss, or diarrhea
- Decreased impotence, incontinence, and urinary side effects
- Decreased damage to adjoining tissue and organs
- Minimal recovery time
- Able to go home safely and return to normal activities within days of procedure
- No special dietary considerations or major pre-treatment preparations
Success of HDR
This treatment has been used extensively worldwide for more than a decade and exceeds the most stringent safety requirements. Studies at the Swedish Medical Center have shown that the temporary implantation radioactive seeds that are inserted, and then removed, in the HDR procedure – used in concert with external beam radiation – have one of the lowest prostate cancer recurrence rates compared to surgery or external radiation alone.
To learn more about HDR Remote Afterloading or another innovative cancer treatment, contact the North Cypress Cancer Center at 832-912-3650.