What is Permanent Seed Brachytherapy?
Permanent seed brachytherapy, also known as low dose-rate (LDR) brachytherapy, is a form of radiotherapy where tiny radioactive seeds are implanted into the prostate. Each seed is about the size and shape of a grain of rice and remains in the prostate permanently, delivering a steady dose of radiation over several months. The radiation from these seeds damages the prostate cancer cells, preventing them from dividing and growing. While cancer cells cannot recover from this damage, healthy cells can repair themselves more effectively.
How Does Permanent Seed Brachytherapy Work?
The radioactive seeds release most of their radiation in the first three months. By 8 to 10 months, almost all the radiation has been emitted. After this period, the remaining radiation is minimal and has no significant impact on the body. Permanent seed brachytherapy is as effective as surgery (radical prostatectomy) or external beam radiotherapy in treating localised prostate cancer with a low risk of spreading.
Who is Suitable for Permanent Seed Brachytherapy?
- Localised Prostate Cancer: Suitable for men whose cancer has not spread outside the prostate. The localised radiation targets cancer within the prostate effectively.
- Combination Therapy: For some with locally advanced prostate cancer, brachytherapy may be combined with external beam radiotherapy and hormone therapy to enhance effectiveness. This combination is often called a "brachytherapy boost."
When is Permanent Seed Brachytherapy Not Suitable?
- Locally Advanced Prostate Cancer: Not suitable if the cancer has spread just outside the prostate unless combined with other treatments.
- Advanced Prostate Cancer: Not an option if the cancer has spread to other parts of the body.
- Large Prostate: Men with a significantly enlarged prostate may need hormone therapy to shrink the prostate before treatment.
- Severe Urinary Problems: Those with severe urinary issues, such as frequent urination, weak urine flow, or difficulty emptying the bladder, may find these problems exacerbated by brachytherapy.
- Inflammatory Bowel Disease (IBD): This treatment may worsen bowel problems for men with certain types of IBD.
- Recent TURP Surgery: Men who have recently undergone transurethral resection of the prostate (TURP) might need to wait at least three months before considering brachytherapy.
- General Health Concerns: The need for general anaesthesia during the procedure means it's not suitable for men with specific health issues that increase surgical risks.
What are the Advantages of Permanent Seed Brachytherapy
- Quick Recovery: Most men can return to normal activities within a day or two.
Targeted radiation delivers radiation directly to the prostate, reducing damage to surrounding healthy tissues and lowering the risk of some side effects.
- Short Hospital Stay: Typically requires only one or two days in the hospital.
- Further Treatment Possible: Other treatment options are available if cancer returns.
What are the disadvantages of Permanent Seed Brachytherapy?
- Side Effects: Potential for urinary and erectile problems, and less commonly, bowel issues.
- Anesthesia Risks: The procedure requires a general or spinal anaesthetic, which carries its risks.
- Delayed Results: It may take some time to know if the treatment has been successful.
- Radiation Precautions: Avoid sitting close to pregnant women or children for the first two months after treatment.
What Does the Treatment Involve?
Pre-treatment Assessment
- Initial Appointment: To determine if the treatment is suitable.
- Planning Session: Involves an ultrasound scan to map the prostate and plan seed placement.
The Procedure
1. Anaesthesia: Administered general or spinal anesthetic.
2. Seed Placement: Thin needles are inserted through the perineum to implant radioactive seeds into the prostate.
3. Hospital Stay: Most men go home the same day, but some may need to stay overnight.
Post-treatment Care
- Recovery Monitoring: Regular check-ups to monitor recovery and side effects.
- PSA Tests: Regular PSA blood tests to check the effectiveness of the treatment.
- Follow-up Scans: CT or MRI scans to verify the placement of seeds.
How to manage side effects of permanent seed brachytherapy?
Short-term Side Effects
- Urinary Problems: Increased frequency, urgency, and discomfort while urinating.
- Blood in Urine: Possible shortly after the procedure.
- Pain and Bruising: In the perineum area.
Long-term Side Effects
- Erectile Dysfunction: Problems with erections may develop gradually.
- Bowel Issues: Diarrhoea, frequent bowel movements, and rectal bleeding.
Urologist reflection on permanent seed brachytherapy treatment
Permanent seed brachytherapy for prostate cancer is an effective treatment option for localised prostate cancer with a low risk of spreading. It offers several benefits, including a quick recovery time and targeted radiation therapy, but it also comes with potential side effects and specific suitability criteria. It’s crucial to discuss with your healthcare provider to determine if this treatment aligns with your medical condition and personal preferences.
