brachytherapy in the treatment of prostate cancer

Brachytherapy in the treatment of prostate cancer

Brachytherapy is a method of irradiation, where one or several radioactive elements are placed close to or even inside the volume to be irradiated.

The main advantage of this method is the possibility of administering high doses of radiation, in a volume strictly confined to the prostate, minimising damage to adjacent tissue (rectum and bladder).

In the specific case of brachytherapy for prostate tumours, two different procedures can be used: permanent implants or low dosage implants and temporary implants or high dosage implants. Both procedures are performed when the patient is anesthetised.

An ultrasound probe is inserted into the patient’s rectum to visualise the prostate and guide the insertion of applicators through which radioactive isotopes are inserted. This is carried out as an outpatient treatment with a short recovery period.

As the name implies, permanent implants are the permanent implantation of radioactive isotopes or seeds in a well-defined volume. Temporary implants consist of the implantation of radioactive isotopes, in a well-defined volume, for a certain period of time.

The treatment of choice which is most appropriate is based on the patient’s life expectancy, the PSA value, the Gleason score (measures the malignancy of tumour cells through biopsy), the stage of the disease, as well as the patient’s preference, taking into account the possible side effects resulting from each of the therapeutic options.

Some of these parameters, namely the PSA value, the Gleason score and the stage of the disease, allow patients to be stratified into risk groups, according to their chances of recovery and cure.

Radiotherapy can be used as a single, adjuvant or palliative treatment. Depending on the risk group to which the patient belongs, it is possible to select the most effective type of radiotherapy.

In low-risk patients, both external radiotherapy and brachytherapy can be applied. External radiotherapy is the most common and can be considered an alternative to radical prostatectomy since it has similar results in terms of survival rate and quality of life.

Permanent implants prostate brachytherapy is established as a primary treatment option for prostate cancer in low-risk patients.

When selecting patients, the following factors must also be taken into account: the prostate must have a volume of less than 60 cc (if it is larger, hormone therapy can be used before the implants); the patient’s anatomy must be implant-friendly; patients cannot present very severe urinary symptoms; it is not advisable in patients who have undergone transurethral resection of the prostate.

In patients who fall into the intermediate and high-risk groups, external radiotherapy combined with other therapeutic options, such as hormone therapy, surgery or brachytherapy, offers a better possibility of local disease control, with less morbidity. In this method of brachytherapy, temporary high dosage implants are used. In very high-risk patients, external radiotherapy can be used for palliative care in metastatic disease.

At the HPA Health Group, brachytherapy is carried out at the HPA in Gambelas