High Dose Rate Brachytherapy in the Treatment of Prostate Cancer

Provided by Alta Bates Summit Medical Center located in Oakland and Berkeley, California in the East Bay Area.

When we are discussing carcinoma of the prostate, if the prostate tumor is what we call low risk, that is a low Gleason score, a low PSA, and a low stage the patient may be a candidate for any number of treatments options including radical surgery, external beam radiation, permanent seed implant, or high dose rate Brachytherapy.

Unlike external beam radiation, where the treatment comes from the outside in, with high dose rate brachytherapy the treatment is from the inside out. And we do that by inserting hollow, thin surgical plastic catheters into the prostate gland through the skin of the bottom. And a sealed radiation source is afterloaded into the hallow catheter. So the prostate tumor is radiated from the inside out in as opposed to the outside in as with external beam radiation. It takes about an hour to do the procedure. Then the patient goes to the recovery room and then after that we bring the patient up to our department and do a CT scan which will show us that array of catheters and the surrounding normal anatomy, the bladder, the rectum and urethra which runs directly through the middle of the target. Using that information we come up with a treatment plan to optimize the dose to that specific anatomy. Once the calculations are complete the patient is moved to a treatment room and attached to a treatment machine called an afterloader which is a computerized robot that will run a miniature radiation source about the size of a tip of a pencil lead into those hollow.

The first treatment is done that afternoon. Then patient stays overnight in the hospital at bed rest.

The next morning we do treatment number two and that afternoon, a few hours later, treatment number three. Then all the catheters are removed and the patient is discharged home.

For low risk disease, that process is repeated one week later. So, there's two overnight stays in the hospital. That procedure is the equivalent of a radical prostatectomy, or nine weeks of external beam radiation. The results are equal and excellent across the board.

If the patient has more advanced disease, we can combine the high dose rate brachytherapy with external beam radiation or with hormone suppression.

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Science & Technology

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