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Internal Radiation Therapy for Prostate Cancer


Also called sealed source radiotherapy or Brachytherapy, Internal Radiation therapy is a form of radiotherapy consists of implanting tiny radioactive sources near or directly into the treated area. The radioactive source comes most of the times in the form of "titanium capsules" or “seeds” about the size of a rice grain. They contain a tiny amount of iodine-125, and act by releasing radiation into the tumor to kill the DNA of cancer cells, thus preventing them from reproducing. However, this radioactivity decreases over time and with distance. 


The radioactive seeds are implanted into the body but well located to avoid damage to surrounding health tissue. This allows the radiologist to provide high dose of radiation in the prostate to destroy cancer cells while minimizing damage to surrounding healthy organs such as the rectum or bladder. Internal radiotherapy is not a negligible form of prostate cancer treatment. In recent years, Internal Radiation therapy has become the treatment ideal for prostate cancer.  


As for all major medical procedures, the therapy requires some preparation. In fact, Brachytherapy has more prerequisites than external radiotherapy.  


Imagine Techniques - A transrectal (inside the rectum) ultrasound is essential for accurate analysis of the tumor and to determine the volume and structure of the prostate gland. The screening also allows the physician to assess the extent of the tumor in the prostatic wall, and set the number of radioactive seeds needed for effective treatment. In general, the implantation of the seeds is done under anesthesia. After which, a urine test (urinalysis) will be performed to ensure their sterility, absence of infection. 


Hospitalization – Hospitalization is also a part of the preparation for the Internal Radiation therapy. In general, the admission lasts about two days. Patient will stay in a single room, well controlled, while carrying radioactive material. The patient is recommended to be fasting from midnight from the preceding night. The main role of the hospitalization is to set the radioactive seeds under ultrasound guidance, using a needle. The number of seeds implanted varies between 60 and 100. Their repartition in the prostate is calculated by appropriate software. A urinary catheter is in place during the surgery and will be removed the next morning. 


Follow-up Testing medical visits after the procedure is very important. 4 to 6 weeks after the surgery, a scanner will be performed to control the position of the radioactive seeds in the prostate gland and evaluate the progress of the therapy, the dose of radiation the prostate is receiving. The PSA will be measured regularly; its normalization is relatively slow and tends to occur over several years. 


Internal Radiation Therapy Side Effects  


Internal Radiation therapy is, unfortunately, associated with side effects. Right after awakening from anesthesia, most patients have a feeling of a gene in the perineum, the area between the anus and the scrotum in the male and between the anus and the external genital organs (vulva). In addition, urine may contain traces of blood. Most of the times, however, this bleeding is not disturbing and is temporary. However, persistent Blood in urine (hematuria) should not be overlooked, and requires immediate medical observation to ensure that this is not a complication. Even in the absence of complications, there are urinary problems: frequent urination, difficulty emptying the bladder, and others. Urinary problems are common and can last for weeks or months. Even in case of Urinary problems it is still advised to drink plenty of water and natural juice. 


The implantation of the radioactive seeds is permanent, but some can be eliminated. Therefore, it is advised to filter the urine for 2 to 3 weeks after surgery and to use condom during intercourse. In addition, it is important to take all necessary precautions that have been given by the Urologist.  


Advantages of Internal Radiation Therapy


There is no doubt that among the therapeutic modalities used to combat prostate cancer, Internal Radiation therapy is surely one of the most powerful weapons. In fact, this approach of fighting malignant prostate tumors has considerably increased in recent years in the U.S.  However, Internal Radiation therapy may not be used in all forms of prostate cancer. When prostate cancer is localized, three major treatment options can be considered: prostatectomy, which involves surgically removing the prostate and seminal vesicles; external beam radiation therapy; and finally Internal Radiation therapy (also known as internal radiation therapy), consisting of irradiating the tumor using radioactive implants.  


Internal Radiation therapy cannot be performed on all patients having prostate cancer. To be eligible, patients must have: 

  • A PSA less than 10 ng/ml, which indicates the tumor is confined to the prostate 
  • A tumor diagnosed at an early stage and well differentiated with a Gleason score 6 or less. 
  • A small prostate having a volume less than 50 cc. The larger prostates (50-70 cc) can be reduced using a short-term hormone therapy. 

Unlike other therapies such as surgical therapy, Internal Radiation therapy reduces the side effects encountered in other treatments such as erectile dysfunction and incontinence. The planning of the treatment area shall be assisted by ultrasound-guided [Transperineal Ultrasound Guided Radiation Implantation of the Prostate Gland (TPI)] to simplify and make more accurate three-dimensional distribution of the radiation doses.

Disadvantages of Internal Radiation therapy 

Internal Radiation therapy has certain disadvantages worth to be mentioned. Certain patients may experience infection and bleeding. Those are often resulted from the surgical procedure.  As in any surgery involving general anesthesia, death is also a risk. But this is extremely rare with Internal Radiation therapy.