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Prostate Cancer

Prostate cancer has become the second leading cause of cancer deaths in men in the United States with 317,100 men diagnosed with the disease and 41,400 men expected to die of prostate cancer during 1996. Many urologists consider radical prostatectomy to be the gold standard for the treatment of localized prostate cancer. This modality, however, is best suited for surgical candidates with a life expectancy greater than 10 years and, of course, disease favorable for local therapy.

Recently however, as more experience with the complications of surgery arise and the lack of scientific evidence supporting its benefit, many patients are reluctant to proceed with surgery. Brachytherapy with paladium103 or iodine125 radioactive seeds has recently undergone a revival as newer techniques for the placement of the seeds has improved the effectiveness of this therapy thus making it an option for those individuals who are either not surgical candidates or do not wish to risk the potential complications of surgery.

Percutaneous technique of good placement

In the 70's and early 80's, seed implantation was performed blindly through an open incision in association with a pelvic lymph node dissection. Results with the open technique was less favorable than surgery or external beam therapy and was largely abandoned. With the development of transrectal ultrasound, placement of radioactive seeds became more accurate and provide more even dosing throughout the prostate than was possible with the open approach. This is felt to have improved the results for seed therapy making it a viable alternative therapy for prostate cancer. Percutaneous interstitial brachytherapy has also provided another benefit; hospital stays have been largely eliminated as the operation is performed as an outpatient and patients can return to work often within 24 to 48 hours.

Brachytherapy

Brachytherapy for prostate cancer is performed over two outpatient sessions. The first procedure is a prostate volume study which determines the dose and number of seeds that a particular individual will require. This can be performed with light sedation. It provides an accurate volume of the prostate and also a "map" for seed placement. Once this information is obtained, the number of seeds and their placement is calculated to provide a uniform dose throughout the prostate. The seeds are then manufactured at a separate site and once completed, the implant is then performed.

It usually takes about 6 weeks (due to availability of the seeds) from the time the volume study is performed to the moment the seeds are ready for implantation. The second procedure then places the seeds in their previously determined positions. This requires either a spinal or general anaesthetic as the seeds are inserted through 20 to 25 needles placed through the perineum and guided to their correct position in the prostate under direct visualization with transrectal ultrasound.

Post operatively the patient only requires a light dressing for the needle sites and an ice pack on the perineum in the recovery room and is discharged with minor restrictions often returning to normal activity within 24 to 48 hours. The above procedure is performed as a combined effort from the urologist, radiation oncologist, and radiation physicist. This team approach is essential for a successful outcome for this procedure.

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