How brachytherapy can treat prostate cancer without prostate removal
Healthcare Perspective
Dr Guinot - Prostate Cancer
Dr. Guinot, Physician at Fundación Instituto Valenciano de Oncología in Valencia, talks about how brachytherapy can be used to treat prostate cancer without the need to remove the prostate. He explains how one brachytherapy session can deliver the same benefits as three weeks of external radiotherapy, with the patient often returning home the next day.
Prostate Cancer is More and More Common
Prostate cancer is the second most common cancer in men(1), and one in eight American men is expected to be diagnosed with prostate cancer at some point.
Prostate cancer rates have increased, influenced by factors like the aging population and improved screening practices, such as blood tests that detect tumors earlier.
The Different Types of Prostate Cancer
Prostatic adenocarcinoma (glandular prostate cancer) is the most common type of prostate cancer, which develops in gland cells and is diagnosed in roughly 95-99 percent of the cases.
Other prostate cancer types include:
- Transitional cell carcinomas
- Sarcomas
- Small cell carcinomas
- Neuroendocrine tumors
Dr. Guinot treats many prostate cancer patients with brachytherapy in his hospital and achieves excellent outcomes.
How brachytherapy can treat prostate cancer?
What is brachytherapy?
Brachytherapy is a form of internal radiation therapy used to destroy cancer cells. Prostate brachytherapy involves placing radioactive sources in the prostate gland, where the radiation can kill the cancer cells while causing less damage to healthy tissue nearby.
Two types of Prostate Brachytherapy to kill cancer cells
Dr. Guinot mentions two types of brachytherapy for prostate cancer. The chosen type depends on tumor stage (early or advanced prostate cancer), size, risk level, and patient preferences.
- LDR (low dose rate) brachytherapy
Low Dose Rate (LDR) brachytherapy permanently implants tiny radioactive seeds into the prostate gland. The sources allow for a slow and steady release of radiation for a few months, killing the cancer cells. LDR brachytherapy is typically performed as a one-time procedure.
LDR brachytherapy is commonly recommended for low to intermediate-risk prostate cancer patients and for localized prostate cancer that has not spread. It is also usually more suitable for patients with more minor prostate glands. Finally, some patients may prefer LDR brachytherapy due to its convenience as a one-time procedure that does not require repeated hospital visits.
- HDR (high dose rate) brachytherapy
High Dose Rate (HDR) brachytherapy temporarily places a radioactive source to treat the tumor.
Low Dose Rate (HDR) brachytherapy involves delivering a high dose of radiation using temporary catheters or needles. The radiation source is inserted for a short period, typically a few minutes, and then removed. HDR brachytherapy allows for precise control over the radiation dose and distribution.
HDR brachytherapy is commonly used to treat advanced prostate cancer for intermediate to high-risk prostate cancer patients. HDR brachytherapy can provide better dose distribution for patients with larger prostate glands and allows flexibility in radiation doses to specific areas of the prostate. HDR brachytherapy is sometimes combined with external beam radiation therapy (EBRT) to enhance treatment effectiveness.
Encouraging Outcomes with Brachytherapy
Dr. Guinot notes that LDR brachytherapy has a more extended history, but HDR brachytherapy shows promise too. Although HDR brachytherapy typically requires multiple sessions, technological advancements may reduce the number of sessions needed.
According to Dr. Guinot and clinical studies, the most effective long-term treatment for intermediate or high-risk prostate cancer is external radiotherapy combined with brachytherapy. Results of a UK trial comparing external beam radiation therapy alone and EBRT + high dose rate brachytherapy shows that when brachytherapy was added to the treatment, 71% of patients didn't experience cancer in the next six years, and 48% didn't experience cancer in the next 12 years.(2)
To learn more about brachytherapy for prostate cancers, we have developed resources for patients and their families, such as a patient guide, frequently asked questions, and patients' stories about brachytherapy as a treatment for prostate cancer.
The advantages of brachytherapy for prostate cancer treatment.
- Treat Cancer and Avoid prostatectomy
Dr. Guinot tells us that surgery is often the first treatment option when dealing with more metastatic prostate cancer cells or locally advanced prostate cancer. However, the intervention can lead to several side effects, like urinary and erectile dysfunction (especially when patients receive hormone therapy).
While both complications are potential consequences of prostate cancer surgery, losing urinary function can present more significant challenges if left untreated.
For such cases, brachytherapy combined with external radiotherapy avoids prostate removal. It enables the radiation oncologist to deliver a higher radiation dose to destroy prostate cancer cells. Brachytherapy often enables double the radiation dose that can be achieved with external radiation therapy alone.
- A one-session procedure
Brachytherapy is a quick procedure sometimes completed in just one session. The patient can return home the following day.
The treatment delivers three weeks' worth of external radiotherapy in a single session.
Furthermore, brachytherapy allows treating prostate cancer by precisely targeting the affected area without causing harm to nearby organs, such as the bladder or the bowel, as they can be protected during treatment.
References
(1) https://www.cancer.gov/types/prostate
(2) Hoskin P at al. Radiother Oncol 2021;154:214-19. Available at: https://www.thegreenjournal.com/article/S0167-8140(20)30822-7/fulltext Accessed June 2021.
