Brachitherapy in Prostate Cancer | Top Cancer Treatment in Istanbul Turkey

Brachitherapy in Prostate Cancer

Prostate Cancer Treatment in Turkey, Prostate Cancer Surgery in Turkey, Advanced Prostate Cancer in Turkey, Prostate Cancer Radiation in Turkey, Prostate Cancer Screening in Turkey, Prostate Cancer Prognosis in Turkey, Prostate Cancer Symptoms in Istanbul, Treatment of Prostate Cancer in Istanbul, Prostate Cancer Brachytherapy in Istanbul, Prostate Cancer Diagnosis in Istanbul, Prostate Cancer Cure in Istanbul, Prostate Cancer Risk in Istanbul, Surgery for Prostate Cancer in Istanbul

One of the alternative treatments in prostate cancer, brachitherapy is based on the principle of placing radioactive sources inside the prostate tissue which subject the cancerous tissue to slow but continuous beam emission at low dosages.

One of the alternative treatments in prostate cancer, brachitherapy is based on the principle of placing radioactive sources inside the prostate tissue which subject the cancerous tissue to slow but continuous beam emission at low dosages. Compared with other therapeutic methods, brachitherapy has fewer side effects and it is particularly successful in carefully selected patient populations.

Prostate cancer is the most frequently observed type of cancer in men over the age of 50. Therefore, particularly in the case of those men with a family history of prostate cancer, it is recommended that they start regular screenings as of 40 years of age. Those men with no family history of the disease are recommended to start routine screening for prostate cancer as of 50 years of age. A review of the statistical data reveals that there have been more than 200 thousand newly-diagnosed cases of prostate cancer in the USA last year. Approximately 1 million cases of prostate biopsies taken over a period of one year have resulted in approximately 20 per cent of the cases being diagnosed with prostate cancer. It is possible to completely cure prostate cancer provided that the disease is identified in its early stages. However, because the disease does not cause much discomfort except for difficulty in urinating, the number of patients who apply to a physician at the early stages of prostate cancer is rather low.

Dr.Hakan Özveri, a urologist at Acıbadem Kozyatağı Hospital emphasises the importance of starting routine screenings for PSA as of 40 years of age. PSA is a test which determines the level of prostate specific antigen in the bloodstream. PSA is produced in the cells found in the prostate gland and released into the blood stream. The presence of cancer or any other kind of damage in the structure of the gland elevates the PSA level in the blood. If the PSA value of the patient turns out to be high, a biopsy is taken from the patient for tissue diagnosis.

TREATMENT OPTIONS
Prostate cancer has three basic treatment methods: Radical prostatechtomy surgery, radiotherapy or beam treatment and brachitherapy. The most classical treatment method of prostate cancer is radical prostatechtomy surgery. Still in widespread use in our day, this method involves the resection and the removal of the entire prostate, along with the surrounding semen sacs. Here, the cancer-inflicted organ is removed from the body in its entirety. In radiotherapy, also called beam therapy, the patient is subjected to external beams. In brachitherapy, the patient is subjected to internal beams emitted from the radioactive seeds placed inside the body. None of these two types of beam therapies involve the removal of the prostate. Dr.Özveri points out that the answer to the question of which treatment to go for is influenced by a variety of factors such as the life expectancy of the patient, his age, his perspective on the disease and the physician?s perspective on the disease. He says, "We discuss the pluses and the minuses of each therapeutic method with the patient and arrive at a joint decision. However, brachitherapy involves a more selected patient group. Brachitherapy is a more successful treatment in the case of those patients who fulfil the suitable patient criteria. Otherwise, the three methods used in the treatment of prostate cancer are very similar with respect to their therapeutic outcomes. When we carry out an individual assessment of the patients who have either undergone surgery or received brachitherapy and radiotherapy, we observe their 15 year survival rates to be very close to one another".

From time to time, hormone treatment is also used in the treatment of prostate cancer. The aim of administering hormone therapy prior to brachitherapy or radiotherapy is the reduction of the prostate, whereas the external or internal application of radiotherapy targets the reduction of the damage inflicted upon the surrounding organs. Dr. Özveri explains this as follows: "The prostate is located so deep that the large intestines around it, the bladder a little further back, and the neighbouring nerves which allow the erection of the male organ are all in a position to be potentially impacted by radiotherapy. In order to avoid all likely side effects such as incontinence, excretory problems, diarrhoeas, bleedings in the bladder region and constrictions, we administer hormonal medication treatment to the patient for a period of 3 to 6 months. At the end of this period, we proceed to administer brachitherapy and radiotherapy."

Professor Işık Aslay, a specialist in radiation oncology at Acıbadem Kozyatağı Hospital, points out that brachitherapy is currently gaining popularity as an important alternative in the treatment of prostate cancer. He describes the method as follows:"Brachitherapy is a method which can also be described as the administration of beams to the patient internally. This method involves the placement of radioactive sources inside the prostate tissue which subject the cancerous tissue to slow but continuous beam emission at low dosages."

WHO IS SUITABLE FOR BRACHITERAPY?
Not suitable for all patient populations, brachitherapy treatment has certain inclusive criteria. One of these criteria requires that the cellular structure of the identified criteria should not be excessively primitive or conducive to malignant proliferation. In brachitherapy, we are favouring a patient group whose cancerous formations demonstrate the characteristics of benign cellular structures which are not aggressive, and which proliferate at a slower rate. Another criterion is for the PSA blood test value to be below 10 in general, meaning that the disease should be identified at an early stage. If the prostate size of the patient proves to be suitable as well, these patients may be treated with brachitherapy by itself, without necessitating any additional treatments. Other criteria the specialists investigate in detail are for the prostate not to be too large, preferably below 60 grams in weight, and the absence of excessive prostate complaints from the patient. Performed studies indicate that in those patient groups who suffer from what are generally known as prostate complaints, such as excessively frequent urination and frequent urinations throughout the night, these complaints worsen following brachitherapy and may even necessitate one more prostate intervention. Prostate brachitherapy option should be carefully examined in the case of these patients and it should not be applied too often.

WHAT ARE THE BENEFITS?
The biggest advantage of brachitherapy is that it speeds up the healing process and the patient does not lose much time in returning to his daily life and activities. Following a procedure of 1-2 hours, the patient gets discharged from the hospital on the day of the surgery or the following day. Because the radioactive sources are directly placed inside the prostate tissue, the beaming process is 2-3 times more concentrated compared to external radiotherapy. Incontinence is observed in less than 5 per cent of those patients with no history of previous prostate surgery. With respect to its impact on sexual functions, while 25-30 per cent of the patients report some sexual dysfunction over the five years following the treatment, the remaining 70-75 per cent report no impact on sexual function. Furthermore, it is widely known that with the help of supplementary medications, this protection rate may increase up to 85 per cent levels. If it is possible to perform nerve-protecting surgery, sexual functions do not suffer much damage. However, because it is important to bring the cancer under control, it may not always be possible to perform nerve-protecting surgery.

Dr.Özveri emphasises that in our day, the most important aspect of any treatment recommended to the patient is its impact on the patient?s quality of life. He continues as follows,"If you end up with a patient cured of his cancer but suffering from excessive incontinence, a non-existent sex life and a highly disturbed quality of life, then this does not qualify as successful treatment. When we present our patients with treatment options, we take care to clarify their potential impact on their quality of life and try to plan the treatment accordingly."

According to Dr. Özveri, younger patients favour brachitherapy more often because brachitherapy has a lot less side effects on those prostate cancer patients under 60 years of age, and return to normal life is much faster following the treatment. When one considers its reduced negative impact on the quality of sexual life and its minimal impact on incontinence, brachitherapy stands out as a method preferred by those prostate cancer patients under 60 years of age who are still working and pursuing an active life style. However, because cancer in this patient group is a bit more aggressive than in the elderly patient group, one has to be very careful in evaluating the brachiterapy requests coming from these young patients. In this case, the physician has to abide by the medical criteria even though the patient may request brachitherapy.

HOW IS BRACHITERAPY PERFORMED?
Professor Işık Aslay, a specialist in radiation oncology at Acıbadem Kozyatağı Hospital explains the application of Brachitherapy as follows:

  • At first, a rectal ultrasonography is performed on the patient under short acting anaesthetics. The images thus obtained allow for the performance of dosimetric studies for the patient. In other words, this is the calculation of the radioactive substances or, put in another way, the seed count (the source of the light) required by the patient during the procedure. Here, the distance between the seeds, the size of the prostate and the seed activity are taken into consideration to determine the seed count necessary for the application. This count depends on the prostate size of the patient.
    The initial planning allows for the recognition of the patient?s structural characteristics, thereby eliminating any surprises or unexpected events during the administration of the procedure.
  • The seeds used in brachitherapy are 4.5 mm long, 0.8 mm in diameter, titanium-coated substances containing radioactive matter. The seeds are penetrated through the soft tissue between the anus and the scrotum and placed in the prostate with the help of the needles and under the guidance of a coordinate system. Once the needles reach the prostate tissue, this can be observed on the ultrasound and the seeds are thus placed with a high degree of accuracy.
  • Once each and every needle finds its accurate position inside the prostate, the sources are released into the prostate and the needles are withdrawn.
  • The energy of the implanted seeds is quite low and they continuously beam the area they have been placed in. The seeds are permanent implants and remain there throughout the patient's life.
  • Brachitherapy application is teamwork. It takes a radiation oncologist, a radiologist, a urologist and two radiation physicists to perform the procedure.
  • Dr. Hakan Özveri, specialist in urology at Acıbadem Kozyatağı Hospital says, "The most important superiority of brachitherapy is that it yields more successful therapeutic outcomes in selected patients and has fewer side effects."

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The Acibadem Health Group  2009-04-15   Articles/Press Releases

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