John J. Bauer, M.D., F.A.C.S.
Prostate Cancer Radioactive Seed Implantation
John J. Bauer, MD, Urologist
General Norman Schwartzkopf, counter-culture guru Timothy Leary, actor Telly Savalas, golf great Arnold Palmer, and rocker Frank Zappa may have little in common except that each battled prostate cancer. The disease claimed the lives of Leary, Savalas and Zappa, however Schwartzkopf and Palmer have survived their bout with the illness.
There are millions of other men - fathers, husbands, brothers, grandfathers, sons and boyfriends - from all lifestyles that deal with prostate cancer. Cancer of the prostate is the most prevalent form of cancer in American men. The American Cancer Society estimates that about 1 in 11 men will develop prostate cancer during his lifetime. More that 300,000 new cases will be diagnosed this year. Cancer of the prostate claims about 40,000 lives every year. More than 80% of all cases are diagnosed in men aged 65 and older, but is not limited to that age group.
Treatment options for prostate cancer include external beam radiotherapy, radical retropubic prostatectomy, cryosurgery, observation alone, and brachytherapy. Brachytherapy uses rice-sized capsules called "seeds" that contain radioactive material. A surgeon and a radiation oncologist work together to implant the seeds directly into the prostate. It is much more precise than many other forms of radiotherapy. Brachytherapy allows for treatment of the cancer with less harm to surrounding tissue.
External beam radiotherapy remains a standard form of treatment for prostate cancer. External beam radiotherapy refers to the use of x-rays to treat prostate cancer. X-rays are delivered externally and pass through the body wall to reach the prostate. Treatment is carried out on a daily basis for a six to eight week course consisting of 30-40 treatments. The dose of radiation is between 5,000-7, 500 cGry. During this treatment, the areas adjacent to the prostate including the rectum (the lower part of the intestine), the bladder, and the nerves responsible for erection can be affected by the x-ray beam as well. Complications of external beam radiotherapy include radiation damage to the rectum (radiation proctitis), to the bladder (radiation cystitis), incontinence (the sudden urge to urinate and the inability to stop the bladder from going), impaired or absent erection, and occasionally nausea and a sense of malaise. External radiation is very effective for the first five years at addressing the growth of prostate cancer. However, as many as 60% of patients will develop a reactivation of their cancer within ten years.
Interstitial Brachytherapy refers to the insertion of radioactive seeds into the prostate. A specified dose of radiation can be delivered to an exact tissue location which allows a more precise treatment than can be achieved with external beam radiation. Brachytherapy provides the opportunity to focus the radiation treatment to the prostate and the cancer with less potential for harm to the surrounding tissue. With the use of interstitial brachytherapy, up to 22,000 cGry can be delivered to the prostate. The combination of high dose radiation delivered with high precision allows more effective treatment with fewer side elects. Studies thus far have shown that Brachytherapy works as well as or better than external beam radiotherapy for localized (organ confined) prostate cancer and can be useful even when cancer has advanced to a stage where surgery is no longer a preferred option.