BRACHYTHERAPY - THE SEEDS

VALDESE --
Prostate cancer is second only to skin cancer as the most common cancer diagnosed among American men. Only lung cancer causes more cancer deaths in men. The National Cancer Institute estimates that 32,050 men will die of prostate cancer this year.
The numbers may paint a gloomy picture, but the fact is prostate cancer is usually a slow growing cancer, and most men don’t develop the disease until they are 65 years old or older. The screening tools available today mean prostate cancer can be caught in its earliest stages when it’s more easily cured. If the diagnosis is prostate cancer, several treatment options are available to men, and they are offered at the Cancer Center at Blue Ridge HealthCare.
One treatment is interstitial seed implant also known as prostate brachytherapy or prostate seed implantation. Blue Ridge Urology’s Brian Bauer, MD, a urologist, and the Cancer Center’s Greg Jones, MD, a radiation oncologist, have performed this procedure together for more than 10 years at Valdese Hospital.
While cancer screenings and PSA (prostate-specific antigen) test mean more men are finding out earlier if there is a problem, Dr. Jones said it’s important to make sure the patient is the right fit for treatment.
“If a man is in his 70s, particularly 75, 80 or older, it’s unlikely that early stage prostate cancer will affect his quality of life or overall life expectancy,” Dr. Jones said. “It’s more likely something else will become a life threatening problem. He could live his life never knowing he had prostate cancer. When a man in that age group with multiple underlying medical conditions comes to me, I consider it my responsibility to help him understand he has a choice. He does not necessarily have to go through treatment. Sometimes men have hard time accepting that and want to be treated anyway.”
If Dr. Jones and Dr. Bauer agree that seed implantation is the best option, Dr. Jones and his staff will then develop a computerized treatment plan, decide on the radiation dose and conceptualize a 3-D model of the prostate to see exactly where the seeds need to be implanted. Once completed, the patient is scheduled for outpatient surgery.
The radioactive seeds are similar in size to a grain of rice and are inserted with needles. “If you take a mechanical pencil and extend the tip about a quarter of an inch, that will give you a good idea of what a radioactive seed looks like,” Dr. Bauer said.
The patient is under anesthesia for the procedure. Using ultrasound and fluoroscopy (real time X-ray guidance), the urologist inserts the needles to plant the seeds based on the recommendation of the radiation oncologist.
The radioactive seeds are able to deliver an extremely high dose of radiation directly into the prostate gland. “Typically we use 25 needles to implant about 100 seeds,” Dr. Bauer said. “The seeds stay forever but the radioactivity will decrease over time.”
Brachytherapy allows for a tightly defined radiation dose in very specific areas, Dr. Jones said. “There’s less likely to be any radiation damage to normal tissues,” he said. “But because the dose is very high, there is still risk of complications and side effects. Brachytherapy is a very, very good alternative for prostate cancer treatment.”
Symptoms from the irritation of the urinary tract can often present three to four weeks after surgery, but these generally disappear within several weeks. As with other forms of treatment for prostate cancer, a man may also experience sexual difficulties following brachytherapy.
Another treatment option is intensity modulated radiation therapy (IMRT) using a linear accelerator. “Some cases should not be considered for brachytherapy or surgery, but could utilize external beam radiation. All three are reasonable options,” Dr. Jones said. “There is no discernable difference in cure rates if cases are selected appropriately. Cure rates should be outstanding for early stage prostate cancer as long as the quality of care is good, and we can certainly assure our patients the quality of care here is excellent.”