Using The Seeds Of Brachytherapy For Malignant Prostates
The patient is anesthetized. A medical doctor makes several injections with needles containing these radio-active seeds, through the perineum (between the base of the scrotum and the anus). The seeds are either iodine-125 or palladium-103, depending on the needs of the patient. An ultrasound is used to guide the placement of the seeds. This procedure is most of performed as an out-patient procedure, with a very quick recovery time. Most patients are able to return to their daily activities within just a few days.
Not all prostate cancer patients are candidates for this procedure. Brachytherapy is for patients in the early stages of prostate cancer. The cancer must be localized within the prostate gland, and has not spread to tissues outside of the gland. For patients that have a high risk of extraprostatic extension (meaning that the cancer may have spread microscopically to the immediate surrounding tissues), Brachytherapy is still a viable option. Today’s technology allows the doctor to place the seeds right up to the edge of the prostate gland, so that the surrounding tissue can be irradiated as well. In these cases, it is also recommended that a procedure that allows for greater flexibility in the modulation of the radiation intensity be used. This technology is called Intensity-Modulated Radiation Therapy, or IMRT, and while it is more expensive and extends the time of the actual treatment, ensures the medical provider greater control over the amount of radiation used. Studies have also shown that patients that undergo External Beam Radiation Therapy (EBRT) seem to have greater health problems when the therapy is done in conjunction with Brachytherapy. The most recent data further suggests that there is little if any improvement when these treatments are combined.
This technology is still fairly new making long term prognosis difficult. However, at this point, 12 year studies by the American Society of Clinical Oncology show a survival rate of those that have remained in remission after the procedure to be anywhere from 81%-93%. Some patients have reported urinary and rectal complications with less that 2% reporting persistence of those conditions for more than a year. Some bruising and slight bleeding may occur at the injection sight, which can be treated with analgesics and ice. 40% of patients report some erectile dysfunction in varying degrees, with studies on impotence ranging from 2.5%-25% effected.
Over time, patients who have undergone this treatment are shown to have the same quality of life as patients who have undergone radical prostatectomy. While the technology is still new, and there still no long term data, the out look for those that fit the criteria for Brachytherapy is very good.