Andrew Siegel MD 9/14/2019 Prostate Cancer Awareness Month
Radiation can be delivered externally—from a source outside of the body—as reviewed in last week’s entry. Alternatively, radiation can be delivered internally, from a source within the body. This internally-sourced radiation is known by the term “brachytherapy.”
Thank you Marijana1 at Pixabay for image above
Dr. Glen Gejerman, Director of Radiation Oncology at New Jersey Urology
BRACHYTHERAPY
The word “brachytherapy” comes from the Greek word βραχύς brachys, meaning “short-distance” or “short,” since the radiation source is placed in close proximity to the site being treated. Brachytherapy is a minimally invasive procedure in which radioactive sources are implanted directly within the prostate gland. The two techniques are low dose rate brachytherapy and high dose rate brachytherapy.
Low dose rate brachytherapy (LDR) uses titanium-encapsulated radioactive seeds (each about the size of a grain of rice) that are implanted directly into the prostate. After the radiation is “spent,” the seeds that remain are harmless “shells.” LDR brachytherapy is largely of historical interest since it is rarely used anymore.
High dose rate brachytherapy (HDR) uses temporary flexible plastic needles (a.k.a. “after-loaded” catheters) that are placed through the perineum (anatomical area between scrotum and anus) and are used as a vehicle through which Iridium–192 wires are advanced into the prostate gland. A computer-controlled system calculates how long the “hot” wires stay in each dwell position within the needles, which determines the delivered dose. Once each treatment is finished, the radioactive wires are removed from the prostate. Three fractions of high dose rate brachytherapy are delivered over a course of a 24-hour hospital stay. HDR is typically reserved for patients with high risk prostate cancer—Gleason scores 8-10, higher tumor volume and elevated PSA. It is most often done in conjunction with long-term androgen deprivation therapy.
Advantages of HDR brachytherapy:
- Delivery of a high dose of radiation into prostate with minimal radiation to healthy adjacent tissues
- Short hospitalization and rapid recovery
- Ability to treat high risk prostate cancer
Disadvantages of HDR brachytherapy:
- Need for anesthesia and brief hospitalization
- Need for urinary catheter
- Short-term discomfort and blood in the urine from plastic needles sutured into the perineal area
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.
The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Tags: Andrew Siegel MD, HDR brachytherapy, LDR brachytherapy, prostate brachytherapy, Prostate Cancer 20/20, prostate radiation therapy
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