PROSTATE PROS Episode 5: Proceeding to Top Seed

Listen: https://soundcloud.com/prostate-oncology/proceeding-to-top-seed-1 

“Urinary incontinence or leakage is quite rare after a seed implant, but it’s extremely common after surgery.  This is another way that seed implants really shine when comparing the long-term outcomes with the men who undergo surgery.”–Dr. Scholz

Brachytherapy (radioactive seed implants) has one of the highest cure rates and lowest chance of side effects of all prostate cancer treatment options.  Seed implants can be used as a monotherapy or in combination with other treatments. Both newly diagnosed men as well as men who have had previous treatment (besides surgery) are eligible for seed implants.  

Two Types of Brachytherapy

1. LDR: LDR, or low-dose-rate, seeds are implanted in the prostate over a 1-2 hour outpatient procedure.  The seeds will be permanently embedded in the prostate where they will emit a low dose of radiation for 3-8 weeks.  The length of treatment depends on the type of seed: Cesium, Iodine, or Palladium. One potential disadvantage of LDR seeds is that the patient has residual radioactivity during treatment.  This means patients will be advised to limit time spent with at risk groups such as young children and pregnant women. 
2. HDR: During a short hospital stay, there will be several treatments of HDR, or high-dose-rate, seeds temporarily inserted into and removed from the prostate.  During treatment catheters must stay in place, which means the patient will be immobilized. Some studies show that HDR seeds may have slightly higher cure rates because the doctor is able to guide the seeds around the edges of the prostate gland, targeting any potential micrometastasis.  Patients who receive HDR have no residual radiation after leaving the hospital. 

The decision to choose one type of seed over the other comes down to personal preference and the skill of the radiation oncologist.  LDR seeds tend to be the more popular choice due to the simplicity and convenience of the procedure. Seek a doctor who is an expert in brachytherapy for the best results.   

Side Effects

The Journal of Urology published a study comparing side effects from brachytherapy with side effects from surgery.  The researchers asked patients to compare their sexual and urinary function after treatment to their sexual and urinary function before treatment. The study showed that half of the men who choose seed implants said their sexual function returned to the same quality as before treatment, while only one-fifth of the men who had surgery recovered sexual function to the degree before treatment.  Four-fifths of the men with seed implants recovered urinary control to the same degree before treatment, while only half of the men with surgery recovered to the same degree as before treatment.

While side effects from radioactive seed implants are minimized compared to other treatment options, urethritis, stricture, and urinary difficulty (especially for men with pre-existing BPH or urinary difficulty) may occur as short-term or long-term side effects. 

Conclusion

With fewer side effects and higher cure rates, brachytherapy is a great option for many men with prostate cancer.  Unfortunately not all doctors are up to date with the latest studies showing the advantages of brachytherapy. Sadly, because of the financial bias in the prostate cancer industry, doctors will often recommend therapies such as surgery or IMRT which are more lucrative procedures than brachytherapy.  This means that for many men, brachytherapy isn’t presented as an option. This is an excellent reason why all patients need to know their stage and empower themselves with information on all of their options.       

Virginia Study: JB Malcom and others. Quality of life after open or robotic prostatectomy, crybolation or brachytherapy for localized prostate cancer. Journal of Urology 183.5: 1822, 2010.  

Also referenced on page 200 The Key to Prostate Cancer

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The purpose of this podcast is to educate and inform.  The information presented on this podcast and corresponding blog posted on prostateoncology.com/blog should not be used in place of a physician consult.  Guests on the podcasts present their own opinions and conclusions, these views do not necessarily represent that of Prostate Oncology Specialists.