Brachytherapy, often referred to as internal radiation, is a radiation therapy technique in which a radioactive source(s) is placed directly into or adjacent to a cancer. Brachytherapy is commonly used in the treatment of prostate cancer. For prostate cancer, there- are two Brachytherapy techniques: a permanent seed implant known as low dose rate brachytherapy (LDRB) and a temporary seed implant called high dose rate brachytherapy (HDRB). With LDRB, a number of radioactive seeds are placed within the prostate. The seeds emit a low dose of cancer-killing radiation over a period of months, and the seeds are not removed at the end of the radiation treatment. In contrast, HDRB is a procedure where one small radioactive source is moved in and out of the prostate via small tubes (catheters) delivering a high dose of radiation in a matter of minutes. Whether you choose LDRB or HDRB, the goal is to kill the cancer within the prostate in order to cure the patient.
High Dose Rate Brachytherapy (HDRB): What You Can Expect From Monotherapy
HDRB for the treatment of prostate cancer is a process, as it involves several steps to accomplish its purpose. The steps in the process include:
THE IMPLANT: an outpatient procedure performed in the operating room under anesthesia to implant, or place, small catheters in the prostate.
RADIATION TREATMENT PLANNING: the behind¬ the-scene efforts of the radiation oncologist and radiation physicist to ensure the radiation treatment is individually customized to each patient's needs.
THE HDRB MONOTHERAPY TREATS\~IENT: two 30-minute HDRB treatments in the radiation therapy department each separated by four to six hours. Following the second treatment, the catheters are removed prior to going home, and the entire process beginning with the implant is repeated one week later.
The Implant: A Closer Look
The implant is approximately an hour-long outpatient procedure performed in the operating room by your urologist and radiation oncologist. On the day of the HDRB procedure, you will meet with the anesthesiologist to discuss how to deliver anesthesia. The goal of anesthesia during the implant is to ensure you do not have any discomfort from the procedure and that you hold perfectly still for the doctors to precisely place the brachytherapy catheters into the prostate. Spinal anesthesia allows you to be awake while ensuring you do not move your hips and legs during the procedure. Some patients prefer to go completely to sleep with general anesthesia. The anesthesiologist will discuss the pros and cons of each approach with you in detail.
Once in the operating room, anesthesia is started, and you are placed on your back with your feet in stirrups in the "birthing" position. A catheter is placed in your bladder, and a rectal ultrasound probe is placed in the rectum in order to visualize the prostate.
A 4 x 4 inch guidance template is placed at your perineum (the skin between the scrotum and anus) and sutured in place for stability. Under direct visualization from the rectal) ultrasound, 15 to 20 very thin catheters are placed through the template and perineum and into the prostate. The number of catheters used depends on the size and shape of the prostate. It is through the catheters that the radiation will be delivered.
