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 Prostate Brachytherapy
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Prostate Brachytherapy

  Technique
  Indications
  Clinical Results
  Side Effects
  Dosimetry
  Literature

Technique

Permanent interstitial prostate brachytherapy is a radiotherapeutic procedure. Encapsulated radioactive sources are introduced into the prostate using needles which have been placed through the perineum under ultrasound guidance.
 

Section through the male hip region. Implantation of seeds using
brachytherapy.

The optimization of the placement of these sources is performed using computer assisted dosimetry software either before or during the procedure. Three to four weeks after the procedure a CT is performed and the dosimetric parameters are verified using computerized dosimetry. The procedure can be performed on an ambulatory basis.

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Indications

Permanent interstitial seed implantation is one of the recommended therapies for early localized prostate cancer. The inclusion and exclusion criteria published by the American Society for Brachytherapy (ABS) Nag (1999), the European Society for Therapeutic Radiology and Oncology (ESTRO) Ash (2000), the Deutsche Gesellschaft für Radioonkologie and the Deutsche Gesellschaft für Urologie Wirth (2002) and are predominately identical
Optimal Optional In the context of clinical investigations
PSA (ng/ml) < 10 10 – 20 > 20
Gleason Score 5 – 6 7 8 - 10
Stage T1c – T2a T2b – T2c T3
IPSS 0 – 8 9 – 19 > 20
Volume (ml) < 40 40 – 60 > 60
Qmax (ml/s) > 15 15 – 10 < 10
Residual. Vol. (mm) > 200
TURP (+/-) +
Inclusion criteria for the permanent interstitial brachytherapy

Permanent interstitial brachytherapy as monotherapy is performed with a curative intent. This is also the goal of combination therapy which may also be used for local control.
In more advanced stages, permanent interstitial brachytherapy can be performed in combination with external beam therapy Ash (2000), Nag (1999), Henkel (2000), Wirth (2002):
  Monotherapy Combination Therapy    
Stage T1 – T2a T2b – T2c
Gleason 2 –6 > 6
PSA < 10 ng/ml > 10 ng/ml
Volume < 50 ml  
Indications for the use of monotherapy or in combination with external beam therapy  


Indications for possible combination therapy with external beam radiation
• Perineural invasion
• Multiple positive biopsies
• Bilateral positive biopsies
• Extra capsular extension as identified on MRI

Permanent interstitial brachytherapy may also be implemented in combination with androgen (testosterone) deprivation or ablation known as hormone therapy in patients with prostate volumes exceeding 50 cc.

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Clinical Results

The effectiveness of interstitial brachytherapy as monotherapy in patients with low risk disease ( ≤ T2a; PSA ≤ 10ng/ml; Gleason ≤ 6) has been well established by 12–15 year follow up studies. Biochemical disease free rate after five years is in the range of 82–96% (Beyer 1997; Ragde 1998; Blasko 2000; Radge 2000).

Morbidity rates are lower than other comparable therapies with lower morbidity.

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Side Effects

Interstitial seed implantation is a therapy associated with very few side effects. It is important to differentiate between early and late or chronic side effects of the radio therapy along with the risks of surgery. Early or acute symptoms usually disappear completely. Brachytherapy is associated with less late or chronic side effects than surgery. The risk benefit ratio of brachytherapy versus surgery should be assessed in conjunction or consultation with your physician.
Urinary incontinence associated with permanent interstitial prostate brachytherapy is approximately 1% and therby significantly less than with radical prostatectomy. If no pre-treatment erectile dysfunction exists there is a 30% less likelihood of developing erectile dysfunction with permanent interstitial brachytherapy than with radical prostatectomy.

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Dosimetry

Hedtjärn H, et al. Monte Carlo-aided dosimetry of the symmetra model I25.S06 125I, interstitial brachytherapy seed. Med.Phys. 27 (5), 2000, 1076-1085, info

Patel N, et al. Thermoluminescent dosimetry of the SymmetraTM 125I model I25.S06 interstitial brachytherapy seed. Med. Phys., 28 (8), 1761-1769, 2001, info

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Literature


Ash D, et al: ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiotherapy and Oncology 57, 2000, 315-321, info

Blasko JC, et al: Brachytherapy for carcinoma of the prostate: techniques, patient selection, and clinical outcomes. Seminars in Radiation Oncology 12(1),2002, 81-94, info

Blasko JC, et al: Brachytherapy for Prostate Cancer: ASTRO Refresher Course No 310C, 2000

Ciezki JP, et al: Cost comparison of radical prostatectomy and transperineal brachytherapy for localised prostate cancer. Urology 55 (1), 2000, 68-72, info

Henkel, et al: Permanent Seed Implantation of the Prostate, an update for 2000; ESTRO 2000 Poster Session

Merrick, et al: Permament prostate brachytherapy: Do Prostatectomy and External beam Measure Up? J Brachytherapy Int. Vol 17, 2001

Nag S, et al: American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 44(4), 1999, 789-799, info

Potters, et al: Permanent prostate brachytherapy: Lessons learned, lessons to learn. Oncology 2000, (14) (7), info

Ragde H, et al: Ten-year disease free survival after transperineal sonography-guided 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, 83, 1998, 989-1001, info

Ragde H, et al: 12-Year follow-up after transperineal brachytherapy of localized prostate cancer [abstract]. J Urol. 2000; 163(suppl), 336-337. Abstract 1493.

Stone NN and Stock RG: Permanent Seed Implantation for Locolized Adenocarcinoma of the Prostate. Current Urology Report 2002, 3:201-206, info

Vicini FA, et al: An interinstitutional and interspeciality comparison of treatment outcome data for patients with prostate carcinoma based predefined prognostic categories and minimum follow-up. Cancer (in press, for publication accepted in April 2002), info

Wirth MP, et al: Empfehlungen zur Durchführung der alleinigen, permanenten interstitiellen Brachytherapie beim lokal begrenzten Prostatakarzinom, Strahlenther Onkol (No 2), 2002, 178: 115-119, info

Further literature on prostate brachytherapy and other topics is available in the SeeDOS Bibliography

 

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Please contact Colin Walters at cwalters@seedos.com if you would like further  information or you have questions

or comments about this web site.4
SeeDOS Ltd, 26, The Maltings, Leighton Buzzard, Bedfordshire LU7 4BS, United Kingdom
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