Prostate Cancer Canada Network

In The News

Well-Done Meat Consumption May Increase Prostate Cancer Risk
Research into the dietary habits of about a thousand men from the Cleveland area has found that a high consumption of meats, especially of red meat prepared by grilling, is positively associated with an increased risk of developing aggressive prostate cancer. This particular study, which was led by Dr. John Witte of the University of California, San Francisco (UCSF), has a number of limitations, but it does add support to other investigations connecting meat consumption with cancer risk.

Toronto researchers speculate regarding a link between prostate cancer and oral contraceptive use
Very preliminary and speculative research, designed to spark further inquires, suggests that there may be a connection between oral contraceptive use and rising rates of prostate cancer. One theory is that the widespread use of birth-control pills in various populations may result in a higher level of estrogen in the environment, which might, in turn, increase prostate cancer risk.

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Brachytherapy

Brachytherapy is also radiation therapy. However, instead of delivering radiation from outside the body, as in external beam radiation, brachytherapy delivers it from within. There are two main methods of brachytherapy. The first, usually referred to simply as brachytherapy, involves the insertion of permanent radioactive material directly into the prostate. The second, called high dose rate (HDR) brachytherapy, involves the temporary insertion of catheters into the prostate that then deliver relatively higher doses of radioactivity. HDR brachytherapy will be described briefly after the following description of the more commonly used permanent implant method.

In brachytherapy that uses permanent implants, tiny radioactive seeds are inserted directly into the prostate. Each seed is about the size of a grain of rice (less than 5 mm by 1mm), and between 80 and 100 seeds are usually implanted. Each seed emits radiation steadily at a low-energy level over a long time (usually about 6 months or more). The time that seeds remain radioactive depends on the dose and on the radioactive material selected.

Seeds before Implantation

This treatment is usually recommended to men only when their prostate cancer is contained within the prostate gland. Other factors also indicate that brachytherapy may not be appropriate. For example, men with a Gleason score over 6, with a Gleason grade pattern of 4 or 5, or with a PSA reading over 10 may be counselled to consider other treatments. Previous radiation to the pelvic area, previous urinary tract difficulties, or a large prostate may also indicate that brachytherapy is not the best treatment.

Implanted Seeds are White

WHAT TO EXPECT
Some weeks before seeds are implanted, you will likely have a planning session during which a transrectal ultrasound is used to map the prostate and help doctors calculate the best sites for seed implantation.

The night before, you may be asked to begin medicine to empty your bowels and to ensure the free flow of urine.

During the procedure, which is most often performed as an outpatient procedure, you will be placed under either general or local anaesthesia. In other words, you may be unconscious (general anaesthesia) or awake but "frozen" in the area undergoing the procedure (local or regional anaesthesia). A transrectal ultrasound probe helps physicians guide the needles that will insert the radioactive seeds into precise location within the prostate. Implanting the seeds usually takes about 90 minutes to two hours.

Soon after the procedure, the catheter that was put in place before implantation is removed, you are examined and perhaps given pain medication, and, if all is well, you are sent home. Recovery usually takes only an hour or so.

In a day or so, most men are able to return to their normal activities. You may be asked to check to see whether you pass any seeds during urination or ejaculation over the next few days.

About a month after the procedure, you will probably be asked to undergo some tests or scans to ensure that the seeds are still appropriately placed and that dose calculations are accurate.

Several months after the procedure, you will begin follow-up appointments to monitor the efficacy of this treatment. These will include regular PSA testing and digital rectal exams.

BENEFITS, DISADVANTAGES, SIDE EFFECTS

Benefits

Convenience is a major benefit. This procedure avoids both the lengthy recovery time necessary after surgery and the long-term treatment schedule needed to complete a course of external beam radiation.
Because seeds are implanted as close to the cancerous cells as possible, they can often deliver a higher cumulative dose of radiation to cancer cells while limiting the exposure of healthy cells to harmful radiation.

Disadvantages

The major disadvantage is that, because the prostate is not removed, cancer cells may remain after treatment or a new cancer may grow.
If the treatment is ineffective, other local treatments, such as more radiation or surgery, may be impossible or very difficult.
Brachytherapy is not as readily available as external beam radiation.
Although the radiation from implanted seeds is not harmful to others, generally, it can cause inconvenience. You might wish to carry something that identifies you as an implant patient in case you set off security detection devices, for example, and you may be asked to avoid elective medical procedures until the seeds are no longer radioactive.

Side effects
Side effects from brachytherapy vary from patient to patient and also depend upon treatment factors, such as the dose of radiation, the radioactive material used, and the tumour's location within the prostate. Some effects are the immediate result of the procedure, and some are long term, occurring as a consequence of the cumulative dose of radiation. Not all men experience side effects, and the severity and duration of the side effects experienced will also vary.

Immediate

The procedure itself may cause some discomfort in the pelvic area or perineum.
Some men experience an increase in the frequency and urgency of their urination in the first few months, and there may be some burning with urination or even some blood in the urine a few days after the procedure.
Very rarely, the prostate swells and blocks urinary flow, so a catheter must be inserted.

Long-term

Most men treated by brachytherapy become infertile as radiation shrinks the prostate and reduces the amount of ejaculate.
Some men may experience a gradual loss of the ability to achieve an erection. Estimates of the percentage of men who experience long-term erectile dysfunction as a consequence of brachytherapy are difficult to determine and vary widely. Some say that between 86 and 96 percent of patients maintain sexual potency after brachytherapy, others between 70 and 85 percent, and still others between 50 and 80 percent. What this means is that estimates of the percentage of patients for whom erectile dysfunction is a long-term side effect of brachytherapy range from 4 to 50 percent.
Urinary incontinence is an unusual but possible side effect.
Very rarely, a man will experience rectal pain, burning, and bleeding about 6 months after the procedure.

HIGH DOSE RATE (HDR) BRACHYTHERAPY
As mentioned, HDR brachytherapy delivers high doses of radiation over short periods of time to the prostate. After the treatment has been planned, a medical team (often consisting of a radiation oncologist and a urologist) insert catheters into the patient's prostate using a transrectal ultrasound probe for guidance. Usually, about twelve or more catheters are inserted. When the patient has recovered from this part of the procedure, his catheters are connected to a machine that releases radioactive material into them. In this way, radiotherapy is delivered at high doses directly to problem areas of the prostate.

Sometimes, HDR brachytherapy is used to boost the effects of external beam radiation, and sometimes it is given on its own. This treatment is relatively new and may not be available locally.

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