Prostate Cancer

Prostate cancer remains the most common cancer diagnosis for men. Prostate cancer develops when abnormal cells in the prostate gland grow more quickly than in a normal prostate forming a malignant tumour.

It is this increase in prostate size which often results in the following symptoms being experienced:

  1. Increased frequency or difficulty urinating
  2. Pain or burning when urinating
  3. Blood in the urine or semen

TREATMENT OPTIONS

The following are common treatment options for a diagnosis of prostate cancer:

  1. Surgery
  2. Radiotherapy (external beam radiotherapy and brachytherapy)
  3. Chemotherapy
  4. Hormone therapy
  5. Watch and wait

These options are often used in conjunction with each other on the basis of patient case, specialist opinion and patient preference.

There are a number of radiotherapy treatment options for prostate cancer, external beam radiotherapy and brachytherapy (both High Dose and Low Dose).

External Beam Radiotherapy for Prostate Cancer

Radiotherapy treatment for prostate cancer is routinely delivered either as the primary treatment option or in follow up to surgery to provide microscopic disease control.

The external beam radiotherapy standard at Adelaide Radiotherapy Centre is to treat prostate cancer patients with Intensity Modulated Radiotherapy (IMRT) or Conformal Beam Radiotherapy. Both treatment approaches use daily IGRT (Image Guided Radiotherapy) methods thus enabling precise delivery of a higher radiation dose, whilst reducing doses to nearby normal tissue. Each patient’s case is different and patients are encouraged to discuss the better treatment approach for their situation with their radiation oncologist.

Please refer to our Prostate Cancer External beam Radiotherapy Information Booklet for more detail.

Brachytherapy for Prostate Cancer

Whist many men are referred for surgery (robotic or radical prostatectomy) or external beam radiation there are a number who are suitable for brachytherapy which has the potential advantages of convenience, relatively low morbidity and effectiveness.

Prostate cancer brachytherapy involves the delivery of radiation treatment from within the prostate.
Low-Dose Rate (LDR): radioactive seeds are implanted permanently into the prostate gland and deliver the required therapeutic dose over approximately one month. At which time the seeds' radioactivity becomes negligible and they are safe to remain in the prostate.

LDR permanent seed brachytherapy is a very targeted treatment using low energy radiation emitted by Iodine-125. The seeds are no larger than an uncooked grain of rice, and are strategically injected to treat the prostate and minimise dose to surrounding structures. The seeds remain radioactive between three to four months.

LDR seed brachytherapy offers comparable cure results to both radical prostatectomy (including robotic surgery) and external beam radiation treatment. The choice between which treatment option is most suitable for you should be discussed in consultation with your radiation oncologist.

Advantages

  • Cure rates equivalent to surgery and external beam radiation
  • Minimally invasive procedure completed within an hour, requiring minimal hospital stay
  • Incontinence is extremely rare
  • Impotence rates are the vicinity of 20 to 30%

Disadvantages

  • Between one and six months following implantation it is common to experience the need to pass urine more frequently and your urinary flow may reduce. This occurs because there is a lot of swelling of prostate. In some men (less than 5%) it may be necessary to insert a temporary catheter into the bladder. Sometimes you will be recommended to take certain prescribed medications for the first few months after the implant to minimise flow problems
  • Although there are no regulatory requirements to isolate you after implantation, we do advise that for two months after the implantation you minimise contact with children under the age of three and pregnant women
  • Any prostate surgery following seed brachytherapy can be associated with increased risk

The side effects resulting from LDR permanent seed brachytherapy are less severe when compared surgery or external beam radiation. Treatment related side effects begin from one to two weeks after implant include urinary functions, change in bowel habits and sexual dysfunction.

Urinary side effects

Blood in your urine, increased frequency, burning, dribbling and blockage can occur after seed implant. This is due to inflammation in the urethra, swelling of the prostate and irritation of the bladder from the radiation treatment.

Sexual function

One major concern amongst men in choosing treatment for prostate cancer is sexual function. Unfortunately decreased potency and firmness is associated with curative treatment, however this is more common after surgery than after seed brachytherapy.

Bowel habits

Less likely, but not uncommon some men may have diarrhoea or loose bowel motions. This can be managed by consuming a bland, low residue diets.
Please note that side effects do vary between individuals and usually last for three to six months after implantation.

Safety and what happens after your implant

The biggest concern for patients and their families is radiation safety after the implant. Most of the radiation is absorbed by your body, and you would not be discharged unless these were at safe levels. Nevertheless, before leaving hospital, you will be given a medical alert card. In the event of a medical emergency requiring hospitalisation (i.e. a car accident), this card will alert medical officers of your seed implantation.

Picking up a child or hugging a pregnant woman is fine. However, you should avoid prolonged contact for the first two months. For instance:

  • Avoid sitting a child on your lap. Sitting beside you is fine
  • Keep about six feet from pregnant women (or potentially pregnant women)
  • Use a condom during intercourse. Your body fluids are not radioactive and what you touch is not radioactive. The use of a condom is recommended for the very low risk of a seed being passed and it is not uncommon for traces of blood to be found in your discharge.

After your implant, you will be required to have CT scan. This will allow the brachytherapy team to identify all the seeds implanted and to calculate the exact radiation dose given your prostate. The timing of this scan should allow for reduction in swelling of the prostate resulting from your implant.

Please refer to our Prostate Cancer Brachytherapy Patient Information Booklet

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