Brachytherapy is a further evolution in radiation therapy for the treatment of localised prostate cancer. Assoc. Professor Appu is one of a handful of urologists to have completed a formal brachytherapy fellowship with the international pioneer brachytherapy Dr. Juanita Crook at the University of Toronto.
Brachytherapy involves the insertion of radioactive seeds placed within the prostate near the tumour itself to allow a localised by high dose radiation to eradicate the tumour. In low grade cancers the results are equivalent to the surgical removal of the prostate. The initial potency rates are also better but longer term studies suggest that the curves equalise to surgical outcome.
Prostate brachytherapy can be further divided into temporary brachytherapy which involves placing radioactive wires within the prostate gland for a few minutes before being removed. Permanent prostate brachytherapy involves permanent radioactive seeds which slowly release radiation over a period of time.
Prostate brachytherapy is generally not used for advanced prostate cancers due to the higher risk of recurrence but also the subsequent inability to surgically remove the prostate in the event of tumour recurrence.
- Difficulty passing urine. All patients for brachytherapy are carefully assessed regarding the size of the prostate and any potential obstruction as this can be a problem in larger prostates or in patients with pre-existing obstruction to their flow.
- Frequent need to urinate and blood in the urine.
- Narrowing of the tube carrying urine through the penis (stricture).
- Long term bleeding and diarrhoea in the stools (rectum).
- Erectile dysfunction (longer term).
To prepare for prostate brachytherapy Assoc. Prof. Appu will plan your treatment with a radiation oncologist. You will need to undergo scans including MRI and 3D reconstructions to accurately characterise the size and anatomy of your prostate. The radioactive seeds will then be inserted under anaesthesia so you are not aware of the procedure and will fee no discomfort. An ultrasound probe is inserted through your rectum and will recreate pictures of your prostate. The needles will be inserted through the skin using a long fine needle to implant the radioactive seeds. Each seed is about the size of a grain of rice and will slowly emit radiation within the prostate.
The procedure will be completed as a day case and you will be allowed to go home the same day. The lower levels of radiation in the seeds are not generally harmful to others but as a precaution you will be asked to avoid close contact with children and pregnant women for a short time.
High Dose Brachytherapy (HDR)
In high dose brachytherapy higher doses of radiation are usually used using wires which will stay in your body for several minutes at a time. This is generally used for more aggressive tumours as an alternative to surgery. The thin tubes are inserted through the skin into your prostate at precise locations after MRI planning. These tubes are connected to a machine that will feed radioactive energy into the prostate and is left in place for a certain amount of time. This usually requires an overnight stay and the treatment is often repeated for high risk prostate cancer. This treatment carries a higher risk of erectile dysfunction and is generally used less than seed brachytherapy.
Brachytherapy is an excellent alternative for patients who are particularly interested in minimising the risk to the erections, however the longer term studies do suggest a gradual decline in erectile function. The subsequent follow up will require long term PSA levels to monitor for trends to assess for treatment success. Brachytherapy is an excellent treatment option in carefully selected patients with the appropriate low risk prostate cancer and prostate anatomy.