Low-dose brachytherapy in treatment of prostate cancer

LDR brachytherapy for prostate cancer. How it works.

Brachytherapy is a minimally invasive technique which has been practiced for 30 years. Today it is considered the most gentle and efficient among the methods of combating cancer: a small seed with radioactive iodine is inserted into the affected organ using a fine needle. The computer imaging system provides precise localization of the source in the vicinity of tumors.

Advantages of brachytherapy:

• Low time of surgery The procedure can be performed on an outpatient basis, or stay at hospital is limited to one day. Most patients can get back to normal work within a week after implantation.
• Preservation of sexual potency
• Low injury  Low percentage of urinary incontinence, rectal complications, a high degree of sexual potency preservation.
• Suitability for patients  Brachytherapy can be used in patients who are contraindicated for radical surgery, and in patients who are contraindicated for external beam therapy due to the presence of intestinal pathology in irradiation areas, especially in patients with inflammatory diseases.
• In addition, this procedure is well tolerated by patients with serious underlying medical conditions, as well as older people.
• Efficiency

Brachytherapy results are equivalent to those of radical prostatectomy in terms of PSA levels dynamics. In patients treated with external beam therapy these figures are worse compared to prostate brachytherapy.

Treatment of the disease gives the maximum effect in the early stages - prostate cancer is important to be identified in time. This makes it possible to localize the process, preventing progression of the disease, and to provide effective treatment. It is therefore very important to take care of your own health through regular checkups.

Indications for brachytherapy for prostate cancer

• Prostate cancer in stage T1 - T3;
• Good or moderate differentiation of malignancy grade;
• No destruction of seminal vesicles according to magnetic resonance imaging (MRI) and computed tomography (CT);
• No signs of pronounced disorders of urination (intravesicular obstruction) - the maximum urinary flow rate at uroflowmetry (Q max) shall be greater than 15 ml/sec;
• No residual urine according to U/S of a prostate and bladder;
• Prostate specific antigen (PSA) should be in the range of 15-20 ng/ml;
• Prostate volume up to 50 cm3.

What you need to know about brachytherapy of prostate cancer

The first two weeks after surgery:

• Do not lift anything heavier than 5 kg. Lift smoothly without sudden movements;
• Do not sit more than 1.5-2 hours;
• Keep from exercise and stress;
• Monitor the timely emptying of the bowel and bladder, preventing them from overfilling;
• Avoid spicy, fried and fatty foods. Avoid drinking beer.
• Do not put little kids on your knees for the first two months after surgery.

Ensure that pregnant women are not located close to you for a long time. It is also desirable to follow this rule for the first two months after surgery.

There is a probability that microsources may go out in the urine. Especially this warning applies to patients who underwent trans-urethral resection (TUR) before brachytherapy. If you manage to catch the source when it goes out, do not take it in hand. Take microsource with tweezers or other tools at hand, put in any container and store in a place inaccessible to children. When visiting our clinic transfer a container with the microsource for disposal.

In case you are assigned a therapy at place of residence for any other disease, please, before performing assignments (especially physiotherapy) consult the oncologist who conducted brachytherapy. During the first two years after the procedure, we ask you to be particularly careful with this recommendation.

Your prescribing physician should provide recommendations upon discharge from hospital.

Rehabilitation period

1-1.5 months after the implantation of microsources, provided that the post-operative swelling of the prostate decreased and its size restored to the pre-operative state (it will be known during mandatory control clinic visit 1-1.5 months after the procedure), and after consulting the prescribing physician, the patient may gradually come back to normal life. You can increase the weight of lifted load; start visiting the swimming pool; gradually, starting with the simplest ones, do physical exercises. As a result, in 3-4 months, you can get back to full socially and physically active life.

In 3 months after the procedure, you must take the PSA test.

In 6 months after implantation the process of radioisotopes decay will be virtually completed, but even after being discharged from hospital the patient is safe for others.       

Further, within the first year the PSA test, and, as appropriate, control ultrasound study should be held every 3 months. In subsequent years, this should be done every six months for monitoring.