Using Internal Radiation Therapy to Treat Prostate Cancer

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Using Internal Radiation Therapy to Treat Prostate Cancer

There are various types of treatment available for prostate cancer other than surgery. One such option is radiation therapy. Radiation therapy is an efficient way to destroy cancer cells with fewer side effects compared to surgery. This treatment is given very precisely to the area of the prostate where cancer cells were found during the biopsy.

Radiation oncologists often lead the prostate cancer treatment process. They will choose to use one or two types of radiation therapy. 

  • External beam radiation therapy delivers radiation to the affected area from a machine outside the body.
  • Internal radiation therapy is also known as implant radiation or brachytherapy. In this type of therapy, radioactive material is implanted in the prostate either temporarily or permanently.

Who is a Candidate for Prostate Brachytherapy?

Brachytherapy makes it possible to place the radiation therapy directly into the prostate, minimizing the effect of radiation on nearby organs such as the rectum and bladder.  Less damage to healthy tissue helps reduce the side effects associated with the treatment. 

Internal prostate radiation therapy is used most often for men whose cancer is considered early-stage and slow-growing. However, for men who have a higher chance of cancer developing outside of the prostate, brachytherapy is used along with external beam radiation therapy.

There are some cases where brachytherapy is not recommended, even if it’s slow-growing and early-stage, including:

  • Men who have had a transurethral resection of the prostate (TURP) procedure for urinary tract conditions are more likely to have urinary side effects from brachytherapy.
  • It’s more difficult to accurately place radiation seeds in men with an enlarged prostate gland. Some men will use hormone therapy to shrink the prostate first so that brachytherapy can be used.

Types of Prostate Brachytherapy

There are three types of brachytherapy, each with a different way of delivering radiation into the prostate.

High-Dose-Rate (HDR) Brachytherapy 

High-dose-rate brachytherapy is a temporary type of internal radiation that delivers concentrated doses of radiation in a short time through the use of radioactive pellets inserted into the prostate. Sessions usually last between 10 and 20 minutes and can be scheduled twice daily for up to five days.

Your oncologist will determine where to place the radioactive pellets by using computed tomography (CT scans) and magnetic resonance imaging (MRI) data. After each session, the radioactive materials are removed to protect you and those around you. HDR brachytherapy is typically an outpatient procedure.

Low-Dose-Rate (LDR) Brachytherapy 

Low-dose brachytherapy involves using lower-dose radioactive pellets (or seeds) over a longer period of time. These tiny grains of radiation can remain in the prostate permanently or can be removed after each session.

Temporary Low-Dose Prostate Brachytherapy 

Imagery is used to guide the radiation oncologist so they can place the radiation into the prostate. You may have sessions spanning one to seven days, and you may need to stay in the hospital during this period. After the treatment is complete, your oncologist will remove the radioactive material. The tubes used to deliver the radiation therapy will also be removed after the last session.

Permanent Low-Dose Prostate Brachytherapy 

Permanent brachytherapy uses tiny, rice grain-sized implants, which are inserted into the prostate through a surgical procedure. The seeds then release low doses of radioactivity over weeks or months, treating the slow-growing prostate cancer. After several months, they will no longer emit radiation and will most likely not cause discomfort. There is no need to remove the seeds.

The radiation emitted from these seeds stays contained to the prostate, targeting the tumor while minimizing damage to nearby healthy tissues. While the seeds are actively releasing radiation, it’s best to keep a distance from children and pregnant women. Avoid sex until your doctor says it’s safe to do so. And when you do, it’s a good idea to use a condom in case any pellets leave your body.

What Happens After Brachytherapy Prostate Cancer Treatment?

In addition to some soreness and swelling in the area where the seeds were implanted, prostate brachytherapy can lead to some side effects. The most common include: 

  • Radiation proctitis (rectal irritation) 
  • Bowel urgency or diarrhea
  • Rectal bleeding or blood in stool
  • Blood in the urine which may look bright red or reddish brown
  • Difficulty starting urination
  • Urinary burning or incontinence
  • Erectile dysfunction

For most men, side effects will improve with time. In some cases, rare complications may occur. Men may experience urethral stricture, which is a narrowing of the urethra (the tube that carries urine out of the bladder). Fistulas or ulcerated channels may also form within the rectal wall. 

Does Prostate Brachytherapy Lead to Erectile Dysfunction?

Both internal and external radiation therapy can cause erectile dysfunction while going through treatment. However, the risk of erectile dysfunction is lower with radiation therapy compared to surgery. 

There are various options available to assist those with erectile dysfunction due to brachytherapy, such as using a vacuum constriction device to enhance blood flow, taking oral or injectable medications, or undergoing penile implant surgery.

Certain patients who take alpha-blockers or medications for specific heart problems may not be able to take drugs that reverse erectile dysfunction. Additionally, men with other health issues, such as diabetes or cardiovascular problems, may need a longer recovery time before resuming sexual activity. 

Men should prioritize their overall health when considering medications or surgery for erectile dysfunction. Speak with your doctor about whether you are a candidate for either of those options. Your doctor can help discuss your situation so you can make an informed decision. 

Prostate Cancer Treatment at New York Oncology Hematology

If you or a loved one receives a prostate cancer diagnosis, talk with an oncologist before making the decision for surgery. Most patients have time to review various treatment options. Schedule a consultation with one of our prostate cancer specialists, who will discuss various options based on the state of your cancer, your Gleason score, and the likelihood of it growing beyond the prostate.

Our locations throughout Albany, Troy, Amsterdam, Clifton Park, and Hudson make it convenient for you to receive treatment close to home in the Capital District.