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Brachytherapy - Pellets for the Prostate

Effective Treatment for Prostate Cancer

Prostate cancer is the most common cancer in men and the second most common cause of death due to cancer, 40,000 men a year in the United States. That's the bad news. The good news is that prostate cancer if detected early can be cured.

The best treatment for prostate cancer that is confined to the gland itself is radical surgery or radiation therapy. Radiation therapy can be delivered external to the body but the high energy radiation waves also may cause injury to the surrounding tissue such as the bladder and the rectum. In the last few years a new treatment option has been added which makes use of tiny radioactive pellets, about the size of a staple, which is directly place into the prostate using hollow needles. These implants deliver a highly concentrated radiation dose into the cancer and a much lower amount of radiation is applied to the surrounding tissues. There are two types of radioactive seeds, iodine and palladium.

Who are candidates for seed implants?

Most men can tolerate the implantation which is usually done on a one-day stay basis and can even be accomplished under local anesthesia. Most men leave the hospital the same day of the implant. The procedure is done by a radiation specialist or oncologist in conjunction with a urologist, a specialist in prostate cancer. An ultrasound exam is done first to determine the size of the prostate gland and the radiation oncologist then plans how many seeds are needed and where the seeds are to be inserted. Radiation seeds alone are used for men with a PSA, the screening blood test for prostate cancer, less than ten. Men with a higher PSA level are usually treated with a combination of radioactive implants and supplemental external radiation following the seed implantation.

What are the side effects of seed implants?

General radiation side effects are unusual with prostate seed implants because the radiation is limited to such a small area of the body. Radiation only extends to about an inch from seed and diminishes to almost nothing after several months. Fatigue can occur, but is usually minimal. Hair loss and nausea do not occur.

Implants occasionally induces inflammation of the urethra and results in frequent urination, which is usually self-limited or can be easily controlled with medication. A feeling of rectal irritation with frequent bowl movements, two to three per day) are common, but diarrhea does not usually occur. The implant side effects are usually not significant enough to keep men from their normal activities.

Rarely more serious complications such as loss of urine, rectal damage or impotence occur. These complications may occur up to six months after the implants. Approximately 10% of the men develop post-implant impotence which results from damage to the small nerves or blood vessels that are required for an erection. There are now improvements in the implantation technique and fewer men will experience post-implant impotence in the future.

What are the results of implantation therapy?

The results of radiation implants is highly dependent upon the pre-treatment PSA. Using the PSA test to detect persistent or recurrence of the cancer, approximately 80-90% of patients with pre-treatment PSA below ten remain cancer-free over ten years after treatment. This is a cure rate similar to that of patients who have radical surgery to remove the prostate gland.

Favorable ten-year follow-up is encouraging many patients to chose seed implant over other treatments. With follow-up approaching 15 years, it is likely that this treatment option will become the first line of therapy even in younger men.

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Reprinted with permission from Dialog Medical, dialogmedical.com and Neil Baum MD, neilbaum.com.

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