Internal Radiotherapy

Internal Radiotherapy: Brachytherapy for Prostate Cancer

Prostate cancer is the most common cancer in men, with over 1.4 million new cases diagnosed worldwide every year. It is typically a slow-growing cancer that starts in the prostate gland and may not show any symptoms for years. However, in some cases, it can be aggressive and spread to other parts of the body. Treatment options for prostate cancer include surgery, radiation therapy, hormonal therapy, and chemotherapy. One of the most established treatments for prostate cancer is internal radiotherapy, also known as brachytherapy.

What is Brachytherapy?

Brachytherapy is a type of internal radiotherapy that involves placing small radioactive implants called "seeds" into the prostate gland. These seeds are typically left in place permanently and deliver a high, local dose of radiation to kill cancer cells in the immediate area. The technique was first tried in the early 1900s and has since been used successfully in many cancers, particularly head and neck cancers.

History of Brachytherapy for Prostate Cancer

Brachytherapy for prostate cancer has a long and varied history. In the 1970s and 80s, iodine-125 seeds were used for the first time. However, the technique required an operation to place the seeds, which added to the side effects and complications experienced by patients. Additionally, doctors placed the seeds by hand, which was not the most accurate approach. Monitoring of prostate-specific antigen (PSA) was then introduced, which revealed that the new technique was not giving the long-term results researchers hoped for, and cancers were recurring. The next development was an automatic device to put the seeds in place. This device was a plastic template covered in rows of holes, and after scans to work out the area affected, the device was placed in front of the patient. Using an ultrasound probe placed into the rectum, the seeds were placed into the prostate through the skin. However, small numbers of high-dose seeds were used, which meant that some areas of the prostate received high doses of radiation, whereas others received hardly any.

Advancements in Brachytherapy for Prostate Cancer

Today, brachytherapy for prostate cancer is experiencing a resurgence, with step-by-step improvements in methods. The use of the plastic template and rectal ultrasound remains, but highly accurate scanning techniques mean that doctors have a great deal of information about where best to place the seeds within the prostate. Larger numbers of smaller-dose seeds are used to completely cover the area affected with uniform doses of radiation, ensuring that all cancer cells are eradicated. This is intended to make sure that all cancer cells are eradicated. The benefits of this treatment should be fewer side effects and decreased healthcare costs. Because the treatment is so localized, the incidence of potency problems and urinary symptoms is the lowest yet for localized treatment of prostate cancer.

Benefits of Brachytherapy for Prostate Cancer

Brachytherapy is suitable for only a minority of men with prostate cancer. As with many treatments, it is the doctors' skill in choosing cases appropriately that makes all the difference. The men who are most helped have prostate cancer that is completely confined to the prostate gland - in other words, very early disease. This is a more localized treatment than external beam radiotherapy to the prostate. If there is any obvious extension of cancer outside the fibrous covering of the prostate (the capsule), it will not work. However, research is continuing to look at combining this treatment with external beam radiation for men who are thought to be at high risk of extension of cancer into the prostate capsule.

Recent Research

The technique has not yet been formally compared to other treatments. The most recent research results are good for the sub section of men with early prostate cancer. Some research puts 10-year disease-free survival at about 65% for brachytherapy alone. With no recurrence of disease after 10 years, the majority of these men will be considered to have been cured.

Availability of Brachytherapy for Prostate Cancer

Until recently, only two centers in the UK provided this treatment - Cookridge Hospital in Leeds and the Royal Surrey in Guildford. Now a further six NHS units are providing the treatment in London, Hertfordshire, Manchester, and Newcastle. Doctors from another 30 hospitals have been trained, and at least another six units are expected to begin treating patients by the end of this year.

Conclusion

Brachytherapy is an established treatment for prostate cancer that has undergone significant improvements in recent years. The technique of placing the seeds using the plastic template and rectal ultrasound remains in use, but advancements in scanning techniques have resulted in more accurate placement of the seeds. Brachytherapy is suitable for only a minority of men with prostate cancer, but for those who are appropriate candidates, it offers a localized treatment with fewer side effects and decreased healthcare costs. With the availability of this treatment increasing, more men will have access to this effective and potentially curative therapy.