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Prostate Brachytherapy
About Prostate Cancer


  • What are the possible side effects from brachytherapy?

  • What are the ten-year results for brachytherapy?

  • What is the advantage of "combination therapy"?

  • What is IMRT and why is it better than 3-D conformal therapy?

  • Is IMRT considered experimental?

  • How do you know if you are 'cured'?

  • Why are younger men more often offered surgery but not older men?

  • What is the advantage of seeding over surgery?

  • Is there sufficient data to support the use of seeding over surgery?

  • If I choose seeding now, have I eliminated the option of surgery later?

  • Explain where and how the seeds are implanted.

  • Why not seed first?

  • Am I a candidate for seeding?

  • If I've had external beam radiation or seed placement elsewhere, but am not cured, can I try either again at your Center?

  • If I've had a TURP (commonly called a roto-rooter or reaming), am I a candidate for your procedure?

  • If my surgery failed and my PSA is rising with no evidence of cancer spread to other organs, am I still a candidate for IMRT?

  • If the full course external beam radiation failed, can I be a candidate for your treatment if my cancer is still confined to the prostate?

  • Will all this new technology cost me more?



    What are the possible side effects from brachytherapy?
    The two major side effects of any aggressive prostate cancer treatment are the risk of impotence and incontinence. With seed implants impotence occurs in about 15-20% of cases; incontinence is rarely seen following implants. In contrast, impotence is experienced in most cases of surgical removal of the prostate gland. Up to 40% of surgical cases also result in some degree of incontinence.

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    What are the ten-year results for brachytherapy?
    The ten-year survival rates for patients, who have completed brachytherapy or combination therapy including brachytherapy under the care of a skilled radiation oncologist, are as good or better (typically greater than 90%, depending on the PSA, stage and grade) than those who have had surgical removal of the prostate. The biggest difference is in the quality of life after treatment, with far fewer incidents of impotence and/or incontinence following brachytherapy.

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    What is the advantage of "combination therapy?
    Having the availability of each type of therapy at a single center allows the physician to tailor make a treatment plan specifically for each individual case. Patients have the advantage of using any combination of hormones, IMRT radiation and/or brachytherapy to achieve a maximum degree of cure.

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    What is IMRT and why is it better than 3-D conformal therapy?
    IMRT, or Intensity Modulated Radiation Therapy, takes 3-D conformal radiation therapy to a new level of precision and control. With this increased level of precision, we are able to carefully "sculpt" the beam to reduce the risk of damage to the bowel and bladder, and to preserve the greatest degree of erectile function.

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    Is IMRT considered experimental?
    Absolutely not. This modality is FDA and Medicare approved and is a highly sophisticated by-product of prior radiation delivery systems. Numerous recent studies have already shown that it is possible to escalate doses significantly while decreasing morbidity (negative side effects) dramatically.

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    How do you know if you are 'cured'?
    There has been much discussion of what constitutes a cure. Many physician practices have tried to assign a specific PSA nadir (lowest point) to identify the patient as 'cured. ' However while a low PSA is important, the goal is not merely a low number but a cure. Patients must be wary of being over treated just to achieve a low number.

    The Florida Oncology Network considers a patient cured when his PSA is significantly reduced and remains at that reduced level consistently for the remainder of his life. Most patients achieve a PSA of <0.2, although this is not mandatory. For example, a particular patient of ours has had a PSA of 1.5 for 10 years. We certainly do not think his treatment failed!

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    Why are younger men more often offered surgery but not older men?
    The answer has to do with the ability of an older person to withstand surgery .It is the same with any kind of surgical procedure. The older one is, the more difficult it is to tolerate anesthesia and the trauma of invasive procedures. Older people heal more slowly and are more apt to develop infections and other complications.

    In our practice, we commonly treat men in their early 40's (as well as patients in their 50's, 60's and older). Younger men, after all, have the most to lose -being impotent and wearing diapers for decades.

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    What is the advantage of seeding over surgery?
    As mentioned earlier, the risk of impotence and/or incontinence is greatly reduced with seeding, in comparison to the risks resulting from surgery. The surgical procedure typically requires several days' hospitalization and a lengthy recovery period. Because the surgery requires a major incision, there is an increased risk of infection and other surgical complications.

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    Is there sufficient data to support the use of seeding over surgery?
    Yes, there is. Numerous independent studies have contrasted statistical data from both options. Follow-up studies have been in place since the beginning of our practice in 1990. Other large programs, including the Northwest Tumor Institute and the University of Washington in Seattle report an approximate 80% seeding success rate after 12 years of follow up.

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    If I choose seeding now, have I eliminated the option of surgery later?
    The opposite is true! If you choose surgery first, there are few options left. With seeding, the prostate gland remains intact and patients still have a full menu of options including reseeding, surgical removal (by an expert), cryotherapy and hormonal therapy. Meanwhile, after surgery "broad beam" rather than tightly tailored radiation is typically offered with only 10- 30% (depending on PSA level) of patients being cured, while side effects from the initial surgery are compounded. The low success rate of radiation after surgery may, in part, be a result of the spread of cancer into the bloodstream as a result of the initial surgery. Otherwise, hormones are offered, which not only have side effects in the long run, but also fail to control cancer after 2-3 years because the cancer becomes immune or resistant (like infections becoming resistant to antibiotics over time).

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    Explain where and how the seeds are implanted.
    Each case is different: Depending on the size of the prostate, and the size and location of the tumor, a precise seeding map is designed for the patient. The seeds are tiny, less than a quarter inch long and about the size of a mechanical pencil lead.

    Under an outpatient procedure, the patient is anesthetized and the seeds are implanted through the perineum using a needle-like device. Sophisticated ultrasound imaging technology guides the placement of the seeds into the correct locations.

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    Why not seed first?
    We have learned that by targeting the tumor and its extensions first with IMRT, with or without hormones, the seeding procedure is more effective and serves as a "boost," while not leaving the migrating cells in the regions outside of the prostate untreated. The surrounding "field" is sterilized and cancers are rendered non-viable when IMRT is used upfront.

    Additionally, the available published literature "using seeds before radiation" has reported higher rates of rectal injury. Finally, we are concerned that placing seeds first in intermediate to high-grade cancers may even spread cancer into the blood stream.

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    Am I a candidate for seeding?
    Brachytherapy as the sole treatment modality is indicated for many patients who have been diagnosed with early stage prostate cancer. For intermediate or advanced stage tumors, brachytherapy is typically prescribed in combination with other kinds of treatment ...IMRT, hormones, etc.

    Hormones are often used first to inhibit further growth of the cancer and to shrink the size of the tumor before starting treatment. In addition, there is a growing body of data that suggests that hormones given before, during and after radiation treatment results in enhanced survival rates (contrary to surgical studies).

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    If I've had external beam radiation or seed placement elsewhere, but am not cured, can I try either again at your Center?
    As we are dedicated to finding the highest level of cure for each patient, we will certainly be willing to schedule a consult with you to determine what we might be able to do to help you.

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    If I've had a TURP (commonly called a roto-rooter or reaming), am I a candidate for your procedure?
    Seed implantation even in these difficult situations is possible. Each patient is carefully evaluated to determine their candidacy and to minimize potentially unwanted incontinence.

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    If my surgery failed and my PSA is rising with no evidence of cancer spread to other organs, am I still a candidate for IMRT?
    Yes, IMRT will provide the least dose to normal surrounding tissues and give you a shot at a cure.

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    If the full course external beam radiation failed, can I be a candidate for your treatment if my cancer is still confined to the prostate?
    Yes, not IMRT, but salvage palladium seeding. Your case will be carefully evaluated to determine your candidacy. Hormones are typically used prior to the seeding.

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    Will all this new technology cost me more?
    No. This is truly one time in your life when the newest and best technology will not cost you more than the older, more common approaches. In fact, in terms of a cure, you'll get more for your money!

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