More Details About Prostate Cancer Treatment
What should I do if I find out I have prostate cancer?
A diagnosis of prostate cancer can be frightening, but it need not be. Remind yourself that most cancers today are detected in their early stages when adequate treatments provide a cure rate of more than 90%. At our clinic, we have found that several of the following recommendations help patients and families cope with this diagnosis:
- Become informed so that you and your family understand the disease better. The American Cancer Society and National Cancer Institute can provide a great deal of useful information.
- Ask for interpersonal emotional support.
- Turn to faith and trust.
- Figure out what patients and family members can contribute in terms of starting a healthier living program.
- Join one of the many support groups available for prostate cancer patients. USTOO is a good place to start your research.
On the medical side, you and your family may find it beneficial to do the following:
- Study all of your treatment options.
- Seek opinions from your family physician and specialists in surgery, radiation, and medical oncology.
- Actively participate in selecting your type of treatment.
- Recognize that the goal of any treatment should be two-fold: to cure the cancer and preserve the best quality of life.
I have heard that prostate cancer is so slow growing that some physicians recommend no treatment, particularly with surgery or external radiation. Why should I consider treating it at all and specifically with seed implants?
How do I know that I am a candidate for seed implantation?
What is mapping of the prostate?
You sometimes ask for a CT scan for pubic arch evaluation at the time of consultation. Why is this done?
Why do some men receive external radiation in addition to seed implants?
What factors do you consider when picking an isotope?
What is the procedure when I arrive at the hospital?
What happens during the implant surgery?
How do I set up an appointment and what is the waiting period?
What do I need to bring with me to my appointment?
When will I feel back to normal?
My physician said that radioactive implants were tried many years ago and proved ineffective. Is that true?
What is prostate brachytherapy?
How effective is prostate brachytherapy?
What kind of patient is best suited for seed implantation?
Brachytherapy is an effective treatment for patients who have early prostate cancer. It is also an attractive option for patients whose poor health suggests that a radical prostatectomy surgery should be avoided. When a patient’s cancer has spread out beyond the prostate gland, a combination of external radiation and seed implantation provides one of the most effective treatments. The scientific evidence also shows that if the cancer should come back despite the implanted seeds, the patient may be safely and effectively treated with a second implant.
How long does a seed implant take, and how long does it take to recover from the procedure?
The implant procedure is done under anesthesia. It takes from 30 to 45 minutes when done by an experienced physician. At Southwest Oncology Centers, patients generally leave the outpatient facility after a few hours, and most resume their usual daily activities within a day or two.
What are the complications from seed implantation?
Since the seeds are implanted in the prostate with pinpoint accuracy, they pose little risk to nearby, non-cancerous tissues. The result is a low complication rate with seed implants for incontinence or impotence.
What are the complications from the brachytherapy procedure?
Some degree of voiding difficulties, manifested by symptoms such as urinary frequency, urgency and slow stream, occurs in the majority of patients post-implant. The symptoms will generally subside within a few days to a few weeks with minimal or no medical intervention. However, evidence of significant urinary retention, which may occur in about 5% of patients and will require an indwelling Foley catheter or intermittent catheterization. This problem is usually self-limiting, lasting from 1 to 4 weeks.
How common is impotence after brachytherapy?
It has been our experience that only about 5% of patients under the age of 70 have become impotent. Some of these patients have benefited from using Viagra, as have some patients over 70.
How common is incontinence after brachytherapy?
What about having sex after the procedure?
A brachytherapy patient may resume sexual relations whenever he feels ready.
How much radiation is involved in brachytherapy?
To treat prostate cancer, we can implant seeds that emit energies as low as 24-28 KeV*. The energies of diagnostic x-rays are in the realm of 80-120 KeV.
1 KeV=1,000 electron volts. By comparison, if the radiation is delivered by external beam therapy, the energies of several million electron volts are needed to penetrate the tissue between the skin and the prostate.
Can you have a seed implant after or before TURP?
Patients who have had prior transurethral prostate surgery stand some risk of developing incontinence, but the risk can be markedly reduced by a modification of the way the seeds are placed in the prostate. A TURP after a seed implant generally results in a high rate of incontinence. At the Southwest Oncology Centers, patients are advised not to submit to any prostate or rectal surgery without checking back with us.
What are the seeds made of?
The seeds consist of the radioisotopes Iodine 125 and Palladium 103 sealed in minute titanium cylinders.
Which is the better seed? Iodine or Palladium?
Physically the seeds look similar and both produce low-level radiation destroying the cancer cells without harming the normal tissue adjacent to the prostate. Although no clinical trials have been done to scientifically compare their effectiveness, it appears that both isotopes provide equally good results. The main difference between them is the length of radiation. The radiation is completed in 6 months with Palladium, while with Iodine it takes 12 months. Palladium and Iodine require different techniques.
How do radioactive seeds kill cancer?
Radiation in the seeds kills cancer cells by damaging the DNA in the cell nucleus. With damaged DNA, the cell cannot divide to make new cancer cells any more. Seeds emitting energies as low as twenty thousand electron volts can kill the cancer in the prostate. In comparison, if the radiation is delivered by external beam therapy, the energies of several million electron volts are needed to simply penetrate the tissue between the skin and the prostate.
Is it true that young patients suffering from prostate cancer ought to be treated with radical prostatectomy?
A search we made of the medical literature failed to show any evidence that a young patient is better treated with surgery. Other researchers have reached a similar conclusion.
What kind of physician typically performs prostate seed implantation and in what kind of setting?
Prostate seed implantation is usually performed in an outpatient hospital setting by an urologist and/or radiation oncologist.
Is it true that only small prostate glands can be implanted?
Physicians with limited brachytherapy experience would do well to restrict their implantation to smaller glands. With greater experience, relatively large prostates can be implanted without difficulty. At Southwest Oncology Centers, glands over 200 cubic centimeters in volume, about 7 ounces (or a 2.5–3 inch diameter sphere), have been implanted using a special technique we have developed.
Although the early use of hormone therapy has not been studied in the case of brachytherapy, it appears to increase the effectiveness of external beam therapy. Consequently, it may also prove effective in brachytherapy. However, because of the side effects of the hormones, they should probably not be used in low-risk patients.
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