How does brachytherapy compare?

  • LDR brachytherapy (seed implantation) is one of three radical* treatments for men with low risk or intermediate risk localised prostate cancer. The other treatments are surgery (radical prostatectomy - complete removal of the prostate gland) or external beam radiotherapy.

 

  • The time spent in hospital is shorter with LDR brachytherapy, often only a day or two rather than many repeat visits and/or stays, and the recovery time is fast.

 

  • LDR brachytherapy is associated with fewer complications than the other radical* treatments; overall side effects are not as serious and men can return to their usual daily activities more quickly.

 

  * Radical means treatments which are designed to remove or kill the cancer cells

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Localised prostate cancer can be treated in several different ways. Your doctor will discuss appropriate options with you based on the stage of your cancer, your age, possible side effects and whether your disease might potentially develop over time, and of course, your own personal preferences. You are likely to have a number of different tests carried out before and after your diagnosis is made. These tests will also help to monitor your treatment to see how well it is working. When the results of your tests are first received there will typically be a number of options available to you. If your disease is mild to moderate but still localised (i.e. contained inside the prostate gland) you may be offered one or more of the therapies discussed below.

 

In February 2008 the government issued guidance to doctors through the National Institute of Health and Clinical Excellence (NICE), on how best to treat prostate cancer (see NICE guideline CG 58). For men with localised prostate cancer (cancer which has not spread outside the prostate gland) they listed 5 options.

 

Watchful waiting: Prostate cancer is usually slow-growing and in the early stages it may not cause any problems, therefore your doctor might suggest that you wait to see if there is any change (your doctor will continue to keep an eye on you).

 

Active surveillance: This means that whilst you will have no treatment for the cancer, you will be kept under close observation and continuous monitoring by your specialist. If there is any evidence of disease progression a radical* treatment - either prostatectomy, brachytherapy, or radiotherapy (see below) - will be discussed with you.

 

The radical treatments are all similar in terms of long-term disease-free survival but there are differences in the impact on a man's quality of life.

 

 

 

Radical Prostatectomy

 

What Is It?

Radical prostatectomy is surgery to remove the whole prostate gland. It is a complex and major operation.

 

How long does it take? The patient usually stays in hospital for 3-7 days and may go home with a urinary catheter (tube) in place through which urine is passed. It may be necessary to stay home from work for up to 6 weeks, and driving is not usually possible for 4 weeks.

 

Advantages:   

  • Surgery - usually a single operation   

  • Knowing the tumour has been removed

 

Disadvantages:

  • It is major surgery and patients have to stay in hospital for up to 1 week.

  • It is not well tolerated in older men or in men who are not in overall good health

  • The side effects from surgery include impotence (inability to have an erection) in a high percentage of patients, and incontinence (a loss of urinary control) in a small number of men

 

External Beam Radiotherapy (EBRT)

 

What Is It?

EBRT involves beams of radiation passing through the body, targeted on the prostate, which is a procedure similar to having an x-ray. It is used to treat localised disease and also to slow the progression of more advanced cancers.

 

How Long Does It Take?

The treatment is given on an out-patient basis with patients attending their local cancer centre for 5 days a week for 4-7 weeks. At each visit, the patient will receive a small fraction of the radiation dose until the course of therapy is complete.

 

Advantages:   

  • It is reasonably well tolerated in elderly men

  • You do not have to stay overnight in hospital

  • When compared to radical prostatectomy, the risk of impotence is lower and the incidence of incontinence is small

 

Disadvantages:

  • You have to make several visits to the hospital over several weeks. This can cause significant disruption to your normal routine at work and home

  • There is an increased likelihood of impotence

  • It can cause a variety of side effects and complications due to radiation damage to healthy tissue (e.g. tiredness, frequent and painful urination, diarrhoea and rectal irritation or bleeding)

LDR brachytherapy

 

LDR brachytherapy (seed implantation) (described in detail in other sections of this website) does not involve major surgery.

 

What is it?

Small radioactive seeds, each the size of a grain of rice, are placed in the prostate gland through fine needles. The seeds give off low levels of radiation for up to 1 year which kills the cancer cells.

 

How long does it take?

One hospital visit for treatment planning, and one hospital visit for insertion of the seeds. However, increasingly both of these procedures are being done on the same visit, which may then involve an overnight stay. For the first few days afterwards you should not take part in any strenuous activity or heavy lifting, but after this you will probably be able to carry on as normal.

 

Advantages:

  • The seeds can be positioned throughout the prostate gland with a high degree of accuracy

  • Each seed only affects a small area and relatively little radiation reaches the near-by organs. These include the rectum, which is directly behind the prostate gland, and the bladder, which lies on top of the gland. Therefore it may have fewer serious side effects on passing urine or on bowel motions than other treatments

  • Recovery time is fast, and most men return to work and daily activity within a few days

 

Disadvantages:
  • You may need two general anaesthetics
  • You may experience difficulty with urination for the first 6 months or so
 

LDR brachytherapy is usually given on its own but in certain circumstances it may be given in combination with external beam radiotherapy (EBRT) or after a course of hormonal therapy, which is sometimes used to shrink the size of the prostate gland.

 

References:

  • Buron C, Le Vu B, Jean-Cosset J-M et al. Brachytherapy versus Prostatectomy In Localized Prostate Cancer: Results of a French Multicenter Prospective Medico-Economic Study. Int. J. Radiation Oncology Biol. Phys. 2007, Vol. 67, No. 3, Pp. 812-822

  • Frank SJ, Pisters LL, Davis J et al. An Assessment of Quality of Life Following Radical Prostatectomy, High Dose External Beam Radiation Therapy and Brachytherapy Iodine Implantation as Monotherapies for Localized Prostate Cancer. J Urol 2007. Vol. 177, 2151-2156

  • Langley SEM, Laing R. Prostate brachytherapy has come of age: a review of the technique and results BJU International 2002;89:241-249