Prostate: Brachytherapy

Seed implantation with iodine-125 seeds (brachytherapy) is a highly effective treatment for men with prostate cancer. In a 10-year survivability study, the success rate of Oncura’s product – OncoSeed™ was demonstrated to be better than external beam radiation and equal to that of surgery.¹⁴ OncoSeed is the only seed that has over 10 years of clinical proof that it is effective in treating men with localized prostate cancer.^18-20 Brachytherapy requires no surgical incision, offers men a shorter recovery time, and has less chance of troubling side effects such as impotence and incontinence.^{5,8,10,13-16,21}

Brachytherapy is an outpatient procedure and most men go home the same day as their treatment. Seed implantation takes only 45 minutes to 1 hour. External beam radiation requires 5 hospital visits each week for about 7 to 8 weeks.¹ With brachytherapy, most men can return to their normal activities a few days after treatment. Surgery requires hospitalization and takes many weeks to heal.¹

Seed implantation with OncoSeed gives a lower dose rate of radiation than palladium-103.⁶ and as OncoSeed works in your body longer than palladium-103, it is ideal for treating slow growing tumors such as most prostate cancers. When prostate cancer spreads to the tissue that immediately surrounds the prostate, many doctors choose RAPID Strand. The unique way the seeds are linked together in RAPID Strand™ allows doctors to securely place seeds directly in and adjacent to the surrounding tissue, to treat cancer that has extended outside of the prostate.^10,11 Rapid Strand benefits from the same long term data as OncoSeed.

Is brachytherapy right for patients?

Patients with localized prostate cancer, who want minimally invasive treatment that offers less chance of impotence and incontinence,^{5,8,10,13-16,21} should be informed about brachytherapy.

Why choose brachytherapy?

There are two types of radioactive material (called isotopes) that are commonly used in seed implantation — iodine-125 and palladium-103. Only OncoSeed has over 10 years of survival data²⁰ — considered a “ benchmark” in prostate cancer treatment. Iodine-125 works longer than palladium-103 and with a slower radiation dose rate.⁶ This makes OncoSeed ideal for most prostate cancers that are generally slow growing tumors. Also available is RAPID Strand, allowing doctors to securely place seeds at the border of and adjacent to the prostate to treat cancer that has extended to the surrounding tissue.

How is an implant performed?

Before an implantation, an ultrasound volume study to see the size and location of the prostate as well as the surrounding organs. During the pre-plan a predetermination is made of how many seeds a patient will need and exactly where they should be placed based on the size and shape of the prostate. At the beginning of the implantation, the patient will be administered anesthesia. To guide the precise placement of the seeds, an ultrasound probe is placed in the rectum so that an image of the prostate appears. Usually 80 to 100 seeds are placed inside needles that are inserted in to the prostate. The ultrasound probe ensures that the needles are guided with maximum accuracy based on the plan.

How long does implantation take?

The entire implantation procedure usually takes only 45 minutes to 1 hour. After the seeds are implanted, the patient will stay in a recovery room. Since seed implantation is an outpatient procedure, the patient can usually go home after the anesthesia wears off.

When can the patient go back to work?

While surgery can take as long as 5 weeks to heal,¹ most men who receive implantation can return to their normal activities — including work and exercise — in just a few days.

Are there any side effects?

There is little discomfort after the implantation. As might be expected, there may be some mild soreness, some blood in the urine, and/or bruising or swelling between the legs.⁷ These symptoms usually go away in a few days. Some men may experience discomfort while urinating, or the need to urinate more frequently. These symptoms usually begin 1 to 2 weeks after implantation and gradually decrease over time as the seeds lose their strength.^8-12 Drinking lots of fluids and avoiding caffeine and alcohol may help relieve these symptoms. A small percentage of men, particularly those who have had previous prostate surgery, may experience incontinence. Impotence may also occur in some men, particularly those over the age of 70. However, the rates of impotence and incontinence are lower with OncoSeed than with other treatments.^{5,8,10,13-16,21}

Does the patient need to take special precautions after the implantation?

Although seeds contains radioactive material, the patient is not radioactive. One of the benefits of seeds is that almost all radiation stays within the prostate. After implantation, the patient can continue to enjoy physical contact with other adults. As a precaution, the physician may suggest using a condom during sex for a few days after the procedure. A physician may also recommend that patients avoid close contact with small children and pregnant women for the first 2 months after treatment.

Références :
1. American Cancer Society. The Prostate Cancer Resource Center: Prostate Cancer, Section 1. Atlanta, Ga. 1999:1-38.
2. National Cancer Institute. What You Need To Know About Prostate Cancer. Bethesda, Md: National Institutes of Health; 1996. NIH Publication No. 96-1576.
3. American Cancer Society. What To Do If Prostate Cancer Strikes: A Helpbook for Patients. Atlanta, Ga. 1999.
4. Pound CR, Partin AW, Epstein JI, Walsh PC. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin North Am. 1997;24:395-406.
5. Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: a prostate cancer outcomes study. JAMA. 2000;283:354-360.
6. TheraSeed Radiation Seed Implants booklet. Indigo Medical, a Johnson & Johnson Company. 1999:1-13.
7. Storey MR, Landgren RC, Cottone JL, et al. Transperineal 125-iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity. Int J Radiat Oncol Biol Phys. 1999;43:565-570.
8. Strum SB, Scholz MC. Brachytherapy: implantation of prostate cancer with radioactive isotopes: analysis of the Seattle experience: May 1996 update. Available at: http://www.prostatepointers.org/seedpods/brachy07.html. Accessed May 12, 2000.
9. Stock RG, Stone NN, DeWyngaert JK, Lavagnini P, Unger PD. Prostate specific antigen findings and biopsy results following interactive ultrasound guided transperineal brachytherapy for early stage prostate carcinoma. Cancer. 1996;77:2386-2392.
10. Peschel RE, Chen Z, Roberts K, Nath R. Long-term complications with prostate implants: iodine-125 vs. palladium-103. Radiat Oncol Investig. 1999;7:278-288.
11. Blasko JC, Grimm PD, Ragde H, Schumacher D. Implant therapy for localized prostate cancer. In: Ernstoff MS, Heaney JA, Peschel RE, eds. Prostate Cancer. Cambridge, Mass: Blackwell Science; 1998:137-155.
12. Kaye KW, Olson DJ, Payne JT. Detailed preliminary analysis of iodine-125 implantation for localized cancer using percutaneous approach. J Urol. 1995;153:1020-1025.
13. Stock RG, Stone NN, Iannuzzi C. Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 1996;35:267-272.
14. Blasko JC, Grimm PD, Ragde H. Brachytherapy and organ preservation in the management of carcinoma of the prostate. Semin Radiat Oncol. 1993;3:240-249.
15. Arterbery VE, Wallner K, Roy J, Fuks Z. Short-term morbidity from CT-planned transperineal I-125 prostate implants. Int J Radiat Oncol Biol Phys. 1993;25:661-667.
16. Stone NN, Stock RG. Prostate brachytherapy: treatment strategies. J Urol. 1999;162:421-426.
17. Wallner K, Roy J, Harrison L. Tumor control and morbidity following transperineal iodine-125 implantation for T1/T2 prostatic carcinoma. J Clin Oncol. 1996;14:449-453.
18. Ragde H, Elgamal A-AA, Snow PB, et al. Ten-year disease free survival after transperineal sonographyguided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma. Cancer. 1998;83:989-1001.
19. Critz FA, Levinson AK, Williams WH, Holladay CT, Griffin VD, Holladay DA. Simultaneous radiotherapy for prostate cancer: 125I prostate implant followed by external-beam radiation. Cancer J Sci Am. 1998;4:359-363.
20. Ragde H, Korb LJ, Elgamal A-AA, Grado GL. 12-Year followup after transperineal brachytherapy of localized prostate cancer [abstract]. J Urol. 2000;163(suppl):336-337. Abstract 1493.
21. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999;162:433-438.