Prostate seed implantation with brachytherapy is a minimally invasive procedure for treating prostate cancer in which radioactive seeds are placed in the prostate gland by a radiation oncologist in order to destroy cancer cells, while maximizing the preservation of healthy tissue. This is done by inserting needles into the perineum (the area between the scrotum and anus) and accurately placing small radioactive seeds throughout the prostate. By placing the radioactive seeds directly into the prostate, brachytherapy can achieve higher doses of radiation to maximize cure rates while minimizing the exposure of radiation to the surrounding organs to reduce the risk of long term complications. Most patients return to their normal activities by the next day.
Brachytherapy involves the implantation of tiny seeds into the prostate gland that emit a dose of targeted radiation. LDR Brachytherapy (low-dose rate) uses multiple small radioactive seeds that are permanently implanted into the prostate, delivering radiation over the course of several weeks to months. LDR Brachytherapy can be an alternative to more invasive, surgical treatment, or other forms of beam oriented radiation therapy.
Western Radiation Oncology (WRO) use a state-of-the-art approach to brachytherapy with Variseed, by Varian. has been successfully treating patients with LDR Brachytherapy since 1999.
Definitive Brachytherapy Treatment
In early stage prostate cancers, brachytherapy alone can be used for treatment (without the use of androgen deprivation therapy or external beam radiation therapy).
Combined Modality Treatment
For patients who have more aggressive or advanced stages of prostate cancer, the treatment must be directed at both the prostate and the surrounding areas where cancer cells may have spread. This may include the extracapsular area (immediately outside the prostate) and/or the pelvic lymph nodes. To accomplish this, a prostate seed implant is typically combined with a 5 week course of external radiation following the implant. Hormonal therapy may be recommended as well. This highly-effective combination therapy results in broader coverage and improved cure rates similar to those seen in patients seen with early stages of cancer.
Real Time Intraoperative Brachytherapy Planning
Real-time intraoperative planning allows the physician to achieve tremendously accurate dosing to the prostate while at the same time monitoring the dose to the critical normal structures including the rectum and urethra. This technique allows the physicians to adjust the placement of the seeds during the procedure according to any size, shape, or position of the prostate at the actual time of surgery. The “live calculation” of the radiation dose using a sophisticated treatment planning computer intraoperatively results in improved coverage of the prostate gland and avoidance of nearby healthy tissues. The live monitoring of the dose distribution to the gland prostate, urethra and rectum assures proper seed placement in every case.
What can a patient expect from LDR Brachytherapy?
The procedure is performed under general anesthesia. An ultrasound probe is placed into the rectum and images of the anatomy are captured on the treatment planning computer. The prostate, urethra and rectum are contoured on the computer creating a 3-dimensional reconstruction of the actual anatomy. The Radiation Oncologist will then plan how to place the needles and distribute the seeds in order to optimize the radiation to the prostate while minimizing the radiation to the normal tissues. The needles are inserted through the perineum (the area between the scrotum and anus) and the seeds are distributed via the needles to the prostate.
The procedure takes about 30 minutes in the operating room and the patient can go home shortly after. Within four weeks of implantation you will have a CT scan performed in order to verify the proper placement of the seeds.
Can LDR Brachytherapy patients benefit from SpaceOAR?
Yes. WRO offers SpacerOAR, a procedural insertion that creates space, and protects the rectum from the negative side effects attributed to radiation therapy. This is usually inserted 1-2 weeks prior to LDR brachytherapy treatment. Click here for more information on SpaceOAR (LINK TO SPACE OAR).
Advantages of LDR brachytherapy treatment
- Swift recovery. Patients can typically return to normal activities the next day.
- Real-time intraoperative planned prostate brachytherapy can achieve higher cure rates and lower rates of long term complications compared to external beam radiation therapy or surgery for patients with low risk or intermediate risk prostate cancer.
- For unfavorable intermediate and high risk patients, when combined with EBRT, cure rates with combination therapy are greater than with surgery or EBRT alone.
- Same-day procedure
- There is minimal, if any, post operative pain, and no incisions or stitches.
- There is usually less risk of unnecessary radiation exposure to surrounding organs. This risk is further minimized through the use of SpaceOAR, offered by WRO doctors.