What Is Brachytherapy?
Two primary types of radiation therapy are available for treating prostate cancer today. External beam radiation therapy (EBRT) uses radiation produced outside of the body that is then focused on to the prostate. Brachytherapy, on the other hand, is a form of radiation therapy where tiny radioactive implants are placed directly in to the prostate.
This treatment is sometimes called “seed therapy,” because the most common type of radioactive implants are the size of tiny “seeds."
The prefix brachy means short. Thus, brachytherapy refers to radiation treatment that is given over a short distance — from the radioactive implant in the prostate to the nearby prostate cancer cells.
Is This Treatment Commonly Used?
While brachytherapy has been around for a number of years now, recent technological advancements, a desire by men for more convenient treatment options and more acceptance by the medical community have resulted in brachytherapy being used far more commonly today.
For instance, between 1995 and 1999, the number of men who underwent brachytherapy at some point in their treatment increased from 4 to 36%. The percentage of men who undergo brachytherapy today is likely even higher.
Why Are More Men Choosing Brachytherapy?
Today, more radiation oncologists and urologists are comfortable with brachytherapy and offer it to their patients as a treatment option.
The primary reason why more men are choosing brachytherapy is convenience. Brachytherapy usually involves a single visit to the physician for implantation of the radioactive implants in to the prostate and then a few follow-up visits to ensure that no complications have arisen.
Alternatively, with EBRT, men must go to a radiation treatment center every day for a number of weeks (usually around seven weeks) in order to receive the appropriate dose of radiation.
Is Brachytherapy as Effective as Surgery or EBRT?
The general consensus among most physicians is that, yes, brachytherapy is as effective as surgery or EBRT. Similar cure and mortality rates are seen between all three options when pretreatment variables like PSA level, stage, Gleason score and the presence of other illnesses in the patient are all taken in to account.
Brachytherapy is not for every man, however, and only through careful consultation with your doctors can the right option be chosen for you.
What Are the Complications of Brachytherapy?
The most common symptoms that appear with the first few days after source implantation for brachytherapy are urinary symptoms, such as urgency, frequency and pain with urination. These symptoms are thought to be due to swelling and irritation of the prostate from the implantation procedure.
Persistent urinary symptoms are uncommon, but possible. A certain percentage of men will have long-term urinary incontinence, urinary voiding irritation or other urinary problems that require further treatment.
Bowel symptoms, such as rectal urgency, bowel frequency, or bleeding in to the stools, can also occur. Some studies have found that these symptoms tend to get better over time, though.
Impotency (erectile dysfunction) is also a complication in a fair number of patients treated with brachytherapy.
All of these complications can also be seen with radical prostatectomy or with EBRT. Discussing the risk of these complications with your doctor is very important before making your choice among treatment options.
Gelblum DY; Potters L. Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2000 Aug 1;48(1):119-24.
Mabjeesh NJ; Chen J; Stenger A; et al. Preimplant predictive factors of urinary retention after iodine 125 prostate brachytherapy. Urology. 2007 Sep;70(3):548-53.
Wallner K; Roy J; Harrison L. Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma. J Clin Oncol 1996 Feb;14(2):449-53.
Zelefsky MJ; Moughan J; Owen J; et al. Changing trends in national practice for external beam radiotherapy for clinically localized prostate cancer: 1999 Patterns of Care survey for prostate cancer. Int J Radiat Oncol Biol Phys 2004 Jul 15;59(4):1053-61.