Who can have high dose rate brachytherapy?
High dose rate (HDR) brachytherapy is suitable for men whose prostate cancer has not spread outside the prostate gland (localised) or is beginning to spread through the wall of the prostate or into the seminal vesicles (locally advanced). This is called T2 or T3 disease. The treatment is generally used to treat men with a Gleason score of more than 6 and a PSA of 10 or higher. However the cancer must not have spread to other parts of the body. There is no limit on the size of prostate gland that can be treated. Large glands are shrunk with three to six months of hormone therapy before treatment starts. You may have HDR brachytherapy together with a few weeks of external beam radiotherapy. This will give a higher total dose of radiotherapy to the prostate and the surrounding tissues. You will also have hormone therapy before and after the radiotherapy.
How does high dose rate brachytherapy treat prostate cancer? HDR brachytherapy is suitable for treating cancers that have a high risk of spreading outside the prostate gland. It delivers short, high doses of radiation to the prostate, while limiting damage to the surrounding tissues. HDR brachytherapy is used together with external beam radiotherapy to give higher doses of radiation to the whole gland as well as to the area just outside the prostate.
What are the advantages and disadvantages?
• Delivers a higher dose of radiation to the prostate gland • Limits damage to the surrounding normal tissues
• Shorter course of external beam radiotherapy needed Disadvantages • You may need a general anaesthetic
• You will need to stay in bed whilst the needles are in your prostate • You will need to spend three to four days as an in-patient in hospital
What does treatment involve?
You may have a shortened course (up to five weeks) of external beam radiotherapy together with HDR brachytherapy.
Before the treatment
The brachytherapy team is made up of:
• An oncologist Doctor who specialises in cancer treatment • A urologist Doctor who specializes in treating diseases of the urinary system including the prostate gland
• A physicist Specialist in planning radiotherapy treatments
• A radiologist Specialist in ultrasound
• One or more specialist nurses Assist with the treatment and are responsible for your care before and after treatment The team will discuss the treatment with you to make sure that you understand what is involved and that it is the right treatment for you. If you are happy to go ahead, you will go into hospital on the day of, or the day before, your treatment. You will be given some medication (an enema) to clear your bowels, followed by a tablet to stop you needing to open your bowels when the implant tubes are in place.
In the operating room, you will have an anaesthetic so that you do not feel any pain. You may be asleep during the procedure (general anaesthetic) or you may be awake but unable to feel anything (spinal or epidural anaesthetic). An ultrasound probe is then gently inserted into your anus so that the specialist can see your prostate.
The doctor will pass thin plastic tubes through the area of skin between your testicles and back passage (perineum) into the prostate gland and the surrounding tissues. Once these are in the right position, they are secured in place.
A catheter is passed through the penis into the bladder so that urine can pass out easily and you will not have to get out of bed while the tubes are in place. The whole process takes about 45 minutes to an hour.
You will then have a CT scan or ultrasound scan, which shows the outline of the prostate and the surrounding tissues. This is painless and takes about 20 minutes. The specialist team use the scan to plan the doses of radiation needed for your treatment. You will then have your first treatment.
You will be taken to the brachytherapy room for each treatment. Flexible tubes from the brachytherapy machine are attached to each of the plastic tubes that are inside you. A high energy radioactive source travels down the tubes into the prostate. The radioactive source is programmed to give a measured dose to the prostate by spending an exact amount of time in each centimeter section of the plastic tubes. This way, a higher dose of radiation can be given to the tumor than to the normal surrounding tissues.
Treatment takes about ten minutes and is completely painless. You will have two or three treatments in total, with a gap of around six to eight hours between each one. You will need to stay in bed on the hospital ward until you have had the last treatment. The plastic tubes and catheter are then removed and you will be able to go home the next day. No radioactive material is left in the prostate so it is perfectly safe for you to be around other people, including children.
What happens afterwards?
Your follow-up appointment Four to six weeks after you finish your treatment, you will be invited back to the hospital for an appointment with the specialist team. They will monitor how well you are recovering from the treatment, check your PSA level and ask about any side effects. After treatment Your PSA level and any symptoms will be checked regularly either at the hospital or at the GP surgery. Hormone therapy will lower your PSA. Once you stop hormone therapy your PSA may rise a little. This is because some normal prostate cells may have recovered from the treatment and may release small amounts of PSA. If the treatment has been successful your PSA level should drop to less than 2ng/ml. Speak to your doctor if you are worried about your PSA level.