Prostate Cancer Brachytherapy
Irradiation has long been used in the treatment of cancer tumors. In humans, cancer cells die under the influence of radiation.
Brachytherapy was developed as an alternative to classical radiation. The essence of all procedures is reduced to the fact that a source of radiation is injected into a cancer-damaged organ and left for a time sufficient to destroy the cancer cells.
The choice between brachytherapy and surgery depends on the stage of prostate cancer. At stage 1-2 of the disease, it is preferable to apply a focused radiation. Good results were achieved even at stage 3 of cancer, provided that the tumor was identified up to 8 Gleason scores.
A comparison of brachytherapy and other prostate cancer treatments has shown that focused radiation is preferable to drug and surgical therapy. The use of this method improves the prognosis of the disease.
Brachytherapy is widely used in Israel. This country was one of the first to introduce a method of highly targeted irradiation; it has developed several successful schemes for treating and recovering a patient.
There are several methods of brachytherapy. The main differences:
- Type of exposure (high dose and low dose).
- The method of introducing a radioactive isotope in the prostate gland.
Each method has its own advantages and features.
Low dose brachytherapy
Low-dose (LDR) brachytherapy for prostate cancer involves the long-term irradiation of glandular tissues by administering titanium microcapsules. The use of radioactive iodine I-125 is recommended as an isotope.
During surgical procedures, about 50 granules are injected into the tissue. Irradiation continues for at least six months and can be extended for individual indications.
In order to ensure the accuracy of the implant placement, the surgeon monitors the actions using magnetic resonance imaging. The implementation of the capsules will be done in a robotic way.
Before starting LDR-brachytherapy, an exact prostate volume is measured in a patient, localization and other tumor parameters are diagnosed. The dose of radioactive radiation is calculated individually using special computer programs.
Surgical procedure lasts about an hour. It is performed under general or spinal anesthesia. The patient is discharged from the clinic the next day.
Advantages of low-dose exposure:
- Restoration of potency is observed in 70-90% of cases. The prognosis is affected by the qualifications of the surgeon who establishes the isotope and the time of diagnosing the problem, and seeking help.
- Normalization of urination - the need to install a catheter is found no more often than in 1% of cases.
The results of low-dose brachytherapy are found over time. The nucleus is injected directly into the gland, which prevents effects on neighboring organs and tissues.
High Dose Brachytherapy
High-dose (HDR) brachytherapy for prostate cancer shortens the period of exposure due to a more radical and strong effect on the tissues. The isotope is placed several times for a short time and taken out of the gland.
For irradiation, palladium Pd-103 and iridium Ir-192 are used. Each element has its own half-life, which is taken into account before the appointment of surgery.
HDR brachytherapy is recommended for aggressive forms of cancer. Recently, traditional isotopes (palladium and iridium) have been replaced by cesium Cs-131. The tests showed a better effect on cancer: a rapid death of mutated cells was observed, a decrease in the likelihood of recurrence, and less harm to the patient’s body.
For the introduction of the isotope used several puncture needles, which are injected into the gland for 8-10 minutes. The isotope is placed at intervals of 3 mm. A week later, repeated brachytherapy is performed. According to indications, the number of procedures is allowed to increase to 3. The total dose of radiation per session is not more than 30 Gy.
What happens to the prostate after brachytherapy
After brachytherapy, in 80% of cases there is a positive change in the volume of the prostate gland. The effect is not immediately apparent. Improvement occurs in 2-3 months. During this period, the following changes occur in the gland:
- Cancer cells are destroyed. Indicators of PSA in this period may increase slightly compared with the preoperative level. This is normal and should not cause concern.
The first blood sampling for a simple specific antigen is done no earlier than three months after irradiation. Due to the large volume of destroyed cells, hematuria of the prostate gland (blood in the urine) after brachytherapy is diagnosed in some patients.
- Enlarged prostate gland after brachytherapy is a normal reaction of the body to tissue damage. As a rule, sizes begin to decline already after a few weeks after radiation therapy.
PSA after prostate brachytherapy should be lower by 0.5 ng / ml. Gradually, the level of antigen will decrease until it reaches the norm.
Over the next two years, clinical trials will show positive trends in PSA decline. If the level of antigen in the blood remains unchanged or only a slight decrease is observed, a relapse of the disease is diagnosed.
How is prostate brachytherapy done
The primary task of doctors during brachytherapy is to ensure patient safety. Excessive exposure can cause the opposite effect and provoke the development of cancer, due to a sharp weakening of the human immune system.
To reduce risks, radiation safety standards of NRB – 2009 were developed in the Russian Federation, describing in detail the maximum intensity of exposure in each specific case.
According to the tables, a single and total dose is calculated for the whole patient's body. Several factors are taken into account: body weight, oncologic formation, general health, radiation exposure. After calculations and determination of probable risks, the decision is made on the expediency of conducting an operative intervention.
Indications and contraindications
Modern technologies have helped to improve brachytherapy, to make it an effective and relatively safe method of treatment. Even narrowly targeted irradiation harms the human body. Therefore, before the appointment, the attending physician will be convinced that there are direct indications for brachytherapy for prostate cancer.
Recommendations for exposure depend on the isotope used. Brachytherapy can be done with the volume of the prostate gland up to 50 cm³. Monotherapy is prescribed for the classification of a malignant formation according to Gleason no more than 7, combined with the classical operation of 8 units.
Radiation from the isotope penetrates into the surrounding tissues by no more than 1.5-2 mm, which leads to some restrictions regarding the treatment of certain stages of cancer. Prostate brachytherapy is performed under conditions that the oncological disease is classified by stage T1 and T2. In other cases, radiation is prescribed in combination with other methods of therapy.
Irradiation is not assigned to men with pronounced problems with urination, in the presence of defeat of the seminal nodules and an increase in PSA over 15-20 ng / ml.
Diagnostics and analyzes
While preparing for prostate cancer brachytherapy, the patient undergoes various diagnostic procedures. It is necessary to differentiate the neoplasm: to establish its volume and localization, to exclude the presence of metastases and to see the feasibility of exposure.
The following diagnostic procedures and tests are mandatory:
- General clinical blood and urine tests.
- Ultrasound of the prostate - for more informative appoint TRUS. During the procedure, the ultrasound sensor is inserted through the anus and is fed directly to the area of the prostate gland.
- Puncture - a histological examination of the prostate helps to classify the aggressiveness of cancer cells and establish the stage of development of the disease.
- PSA - prostate-specific antigen indicates the presence of metastases and is considered a kind of tumor marker.
At the request of the doctor, an MRI scan and any other tests are prescribed to clarify the diagnosis.
The basic principle of brachytherapy is based on the introduction of isotopes directly into the affected tissue. Methods for conducting manipulations are different.
According to the method of introduction of radiation sources, the following types of brachytherapy are distinguished:
- Interstitial (prostate),
- Intracavitary (proctology, gynecology),
- Surface (application),
- Intraluminal (bronchi, esophagus),
Additionally, brachytherapy is divided into two classes, depending on the method of application:
- Automated - sequential remote automated loading of a radiation source is performed by a robotized installation, which leads to better results, due to accuracy.
- Manual - the introduction and removal of the element occurs manually. A special template is used for manipulations.
How exactly brachytherapy will take place is decided by the surgeon according to individual indications and technical capabilities of the clinic.
Consequences of prostate brachytherapy - pros and cons
Long-term complications after brachytherapy are rare, but still occur. The patient, after irradiation should be prepared for the radiation reaction of the body, manifested in headache, fatigue, intoxication. During the week there are temporary side effects:
- Biochemical relapse - PSA level and gland tissue volume increase, with all the ensuing consequences. In the first few weeks, there may be urination problems due to swelling of the prostate.
- Erectile dysfunction - problems with sex: insufficient erection, psychological impotence - are temporary. If erectile function was not impaired in a patient before irradiation, the likelihood of complications is minimal.
Some complications are long lasting. After irradiation, the following diseases may develop:
- Radiation fibrosis of the prostate - healthy tissues are also exposed to radiation, which leads to disruption of the urogenital system, in about 1-5% of cases. The patient develops chronic problems with urination, erection.
- Rectal complications - radiation exposure may cause radiation proctitis - an inflammatory disease of the rectum. Adequate therapy can fully cope with the disease.
Regarding the positive aspects of brachytherapy, studies have shown:
- High efficiency and positive prognosis of therapy. Subject to treatment at an early stage, complete healing in 96% of cases.
- Recurrence rate occurs in no more than 20% of cases.
- Short rehabilitation time after brachytherapy.
- The possibility of re-treatment.
- Recovery of potency after prostate brachytherapy is observed in 80% of cases.
- The need for surgical castration to stop the growth of education is absent.
- The average period of hospitalization, the day.
The group of disability after brachytherapy, as in other cases of oncological diseases, is assumed if the patient has difficulty in performing daily tasks. Narrowly directed irradiation prescribed for stage 1-2 cancer.
There is a high probability of complete recovery of the patient. Violations in urination, catheterization, proctitis - all these problems are considered to be the reason for the appointment of a temporary second group of disability. After recovery, disability is denied.
In which hospitals do brachytherapy to remove prostate cancer?
The isotope introduction procedure itself is not complex. The problem is the need for accurate calculations before the operation.
The attending physician will be required to calculate a biologically equivalent radiation dose, select the appropriate isotope and clearly identify the localization of exposure. To do this, despite the available computer programs and special equipment, is difficult and requires highly skilled surgeon. To agree to undergo brachytherapy at the nearest clinic is at least unwise.
On the territory of the Russian Federation there is the Obninsk Center, which, since the end of the fifties, uses irradiation to combat cancer. Patient reviews indicate that real professionals are working in a radiological clinic. As a disadvantage of the center, you can list the queues for treatment, as well as an insufficient level of service.
In Israel, brachytherapy is performed in several clinics. Popular medical centers Ichilov, Assuta and Wolfson. After therapy, the patient is sent to a sanatorium-resort treatment in a boarding house on the shores of the Dead Sea, which contributes to the rapid recovery.
Benefits of contacting an Israeli clinic:
- Modern high-tech equipment for high-dose brachytherapy of the prostate, reducing the damage to healthy tissue during the procedure.
- Ten years of experience. In fact, Israeli doctors were among those who stood at the origins of the invention of brachytherapy and were the first to introduce the method of treating the prostate gland into this method.
There is only one drawback - the cost of brachytherapy is about $ 32,000, which is approximately twice as high as a similar operation in the Russian Federation.
Reducing the recovery time after brachytherapy of the prostate gland and preventing the recurrence of the disease in the postoperative period depends entirely on the patient. Strict compliance with the recommendations of the attending physician is required:
- In the first month, lifting weights above 10 kg is prohibited. Any physical impact on the pelvic area is excluded.
- Alcohol and smoking are excluded.
- It is forbidden to eat unhealthy fatty foods, take dietary supplements, any drugs that are not agreed with your doctor.
- After brachytherapy, constant monitoring of the patient is established. Blood donation for PSA is performed every 3 months. After diagnosing persistent remission, after six months. The frequency of examinations increases with increasing PSA levels.
- You can not sunbathe and is in the sun for a long time.
Restrictions after brachytherapy of the prostate help to avoid the return of cancer. In general, the patient can lead a rich and fulfilling life.
What to eat after the procedure
In the postoperative period, a strict diet is prescribed after brachytherapy. Salty, smoked and spicy dishes are excluded. Plentiful drink is entered. It is recommended to eat in accordance with the diet of the medical table №5.
Nutrition and diet are calculated so that the patient receives enough nutrients and vitamins. Exhaust yourself with hunger is prohibited. Severe restrictions, stress for the body, adversely affect recovery.
Life after brachytherapy does not require strict restrictions. The patient can maintain a balanced sexual activity, eat normally and consume a small amount of alcohol over time. But during the recovery period, one should strictly adhere to the recommendations of the attending physician.
The first studies in the treatment of prostate cancer using implantation of radioactive nuclei were conducted in 1972 by Dr. Whitmore Jr. The therapy was ineffective, since the lack of equipment for visualization of actions at that time led to inaccuracies in the placement of radiation sources.
With the advent of TRUS (transrectal ultrasound), oncologists began to use percutaneous transperineal brachytherapy in the treatment of prostate cancer. Monitoring the distribution of isotopes in real time allowed us to avoid damage to neighboring organs, reducing the incidence of side effects.
At present, brachytherapy with a low dose of radiation is recommended for patients with localized prostate cancer at early stages of development and a PSA level of no more than 10 ng / ml. Patients with locally advanced type of prostate cancer and abruptly increased PSA levels are carried out by oncologists for high-dose irradiation for 10 sessions.
Irradiation is not applied if a man has a disorder in the process of urination and the PSA level exceeds the value of 20 ng / ml. There are some contraindications for brachytherapy:
- symptoms of incontinence or frequent urination,
- residual urine exceeds 50 ml,
- resection of the prostate due to its increase,
- individual intolerance to anesthesia,
- cancer with a poor prognosis
- the volume of the prostate gland exceeds 60 m³,
- the presence of inflammatory diseases of the rectum.
Advantages of the method
The effectiveness of the method can be compared with the use of radical prostatectomy, but brachytherapy has several specific advantages:
- capsules are inserted into prostate tissue once,
- количество операций значительно меньше, при этом кровопотеря минимальна,
- insignificant side effects over a short period of time,
- a short course of therapy and a fast rehabilitation period,
- the procedure is also applied to the elderly without risk to life,
- high potency retention rate
- high-precision method of treatment in the distribution of isotopes in prostate tissue,
- increase in duration and quality of life.
Some discomfort is possible after anesthesia has been applied and there are some minor side effects that disappear after the six month period. Significantly improves the quality of life of patients, while the majority recorded a decrease in PSA to normal levels, which reduces the likelihood of relapse. Three years after brachytherapy, an increase in the level of PSA in the blood is possible, due to the degradation of prostate tissue. The effectiveness of brachytherapy depends on the competent selection of patients to perform this procedure, it is characterized by minimally invasive treatment, as well as a small number of side effects. The method acts as an alternative to surgery and is often used to reduce the risk of relapse. Due to the point effect on the malignant neoplasm, control over its growth and development is improved, so the treatment is highly effective.
Before brachytherapy, each man undergoes a scan of the prostate gland to determine its exact size and position. The day before the procedure, you should abandon the fatty and smoked dishes, do not engage in heavy exercise and sleep. To get a clear picture, the nurse cleans the patient’s intestines with an enema.
A scan is performed in the operating room under local (spinal or epidural) anesthesia or in the absence of contraindications under general anesthesia. The doctor inserts an ultrasound probe into the rectum and takes several pictures of the prostate. The study takes no more than 20 minutes.
The data obtained allow the oncologist to select the optimal dose of radiation, to determine the number of injected radioactive nuclei and their correct location inside the body. Treatment is prescribed on the same day or after 3-4 weeks.
During the preparation period for brachytherapy, the patient is prescribed some diagnostic procedures. This produces a differentiation of cancer education. Localization of the tumor and its volume is established, the presence or absence of metastases is determined, and a decision is made about the possibility of administering radiation. Mandatory brachytherapy are:
- delivery of general clinical laboratory tests of urine and blood,
- ultrasound or transurethral ultrasound of the prostate gland,
- taking puncture of a part of the prostate to study the aggressiveness of tumor cells and determine the stage of the disease,
- A test for the presence of PSA in the patient's blood helps to identify the formation of metastases in a patient.
MRI and other tests are sometimes used to clarify.
The recovery time after brachytherapy and the occurrence of recurrence of the disease depends largely on the patient's behavior, therefore, it is imperative to follow the exact recommendations of the doctor:
- for three months, it is forbidden to lift weights because of the load on the pelvic organs,
- it is necessary to completely abandon the use of alcoholic beverages and smoking,
- should not eat fatty and spicy foods, do not recommend the use of drugs without the consent of the doctor,
- after the procedure, periodic blood sampling occurs, in order to control the PSA level. The number of procedures increases in case of exceeding the norm,
- not recommended for long stay in direct sunlight.
Some limitations due to brachytherapy help to avoid the recurrence of oncology, so the patient is able to improve the time and quality of life.
Complications after treatment
After brachytherapy, the occurrence of complications is quite rare. As a result of irradiation, men often have headaches, fatigue appears and there is little intoxication. After 10 days, some short-term side effects occur:
- PSA levels increase significantly and prostate edema occurs, so that urinary disturbance often occurs,
- the appearance of problems with erection, which is not long-term, if there is no dysfunction, the risk of serious complications is minimal.
There are complications that are observed for a long period of time after brachytherapy. In this case, the development is possible:
- rectal complications - radiation proctitis develops, but timely treatment completely eliminates the disease,
- Radiation fibrosis of the prostate - after irradiation of healthy tissues, urination disorder and erectile dysfunction occur.
Sometimes a disability group is issued to patients if the patient has difficulties in everyday life. The likelihood of complete recovery remains high. Disorder of urination, the installation of catheters or the development of proctitis are the reason for the appointment of group II disability for some time. After full recovery, the disability is removed.
The incidence of adverse effects is lower compared to prostatectomy. Problems with urination in patients undergoing brachytherapy are observed in half of the patients, but the indices decrease after a few weeks and disappear completely after 3 months. For these purposes, drugs are prescribed Omnik or Kardura, often installing a catheter.
5 years after brachytherapy, the patient has a narrowing of the urethra, but there are not many such cases. Also, according to statistics, 1% of patients are prone to the appearance of ulcers of the rectum.
Defeating severe kidney disease is possible!
If the following symptoms are familiar to you firsthand:
- persistent back pain
- difficulty urinating,
- blood pressure disorder.
The only way is surgery? Wait and do not act by radical methods. Cure the disease is possible! Follow the link and find out how the Specialist recommends treatment.
Varieties of radiation exposure
Before brachytherapy for prostate cancer, urological patients undergo mandatory radiation diagnostics using CT, MRI, ultrasound with the intention of the doctor to get a large X-ray image of the prostate gland. The procedure itself involves the implantation of radiation sources of microscopic size, called grains, or needles with a certain level of radiation directly to the location of the malignant tumor of the prostate.
Brachytherapy for effective treatment of prostate carcinoma can be carried out in two ways of different directions: high-dose and low-dose effects. Each form of application has its own individual indications, features of application and a number of advantages. For proper selection of the method of exposure, the physician individually for each patient finds out the necessary dosage of radiation, the number of grains and the choice of the area of their implantation, based on the results of medical research.
Algorithm of the procedure
After completion of the diagnostic phase, the turn of the operation itself begins. Prostate carcinoma brachytherapy is performed on an outpatient basis or with an inpatient stay, depending on the doctor's prescription. Before the procedure, the patient is given an enema to cleanse the intestines. The anesthesia used is applied spinal or general, while the man lies on his back during the procedure, with his legs bent at the knees wide apart and fixed in the required position on special supports.
The following stages of brachytherapy are distinguished:
- Based on the visual picture of the prostate gland, obtained by computed tomography, the doctor notes the location of the urethra.
- The physicist pre-calculates the dosage of radioactive particles and the location of the needles. Irradiation extends to the entire prostate, but brachytherapy involves applying the maximum dose of radiation to the sites of the cancer.
- Based on the calculations, the needles are set. As a result of this action, the prostate gland shifts slightly, which is taken into account in the next stages of the operation.
- The procedure takes place under ultrasound control, which allows the doctor to visually see the location of inflammation in the prostate. On the three-dimensional image of the specialist determines the location of the rectum and bladder.
- After checking all the calculations, the needles are filled with radioactive microparticles.
- In low-dose brachytherapy, the needles are inserted into the area between the prostate and scrotum and removed after the implantation process, with the radioactive seeds remaining in the tissues. The course of treatment is 1 procedure.
- During high frequency exposure, a needle is inserted between the scrotum and anus and after 15 minutes of irradiation is reached. For this form of brachytherapy requires three sessions, with an interval between them in 2 days.
At the end of the anesthesia, the patient wakes up. After the operation, the anesthesiologist and the surgeon continue to monitor the patient for a while. If the recovery process proceeds normally and no adverse reactions occur, the patient can go home.
Possible adverse reactions
After brachytherapy, short-term adverse reactions may occur during the rehabilitation period. In a situation where negative effects are observed for a week or more, we are talking about the constant nature of the reactions on the part of the patient.
Possible effects of brachytherapy include:
How to avoid complications after brachytherapy of prostate cancer?
The most effective of these tasks helps to solve the most modern version of brachytherapy - high-dose brachytherapy. Due to the accurate delivery of the planned dose to the prostate gland and a small radiation load on the surrounding normal tissues, high-dose brachytherapy reduces the risk of rectal complications to a minimum (0% -2%).
In addition, with such treatment, the most favorable conditions for maintaining the patient's potency are provided and the risk of urinary incontinence is reduced from 15% -20% (surgical treatment) to 0% -1%. These features of high-dose brachytherapy allow recovery of patients with prostate cancer while maintaining normal vitality and minimal risk of serious side effects of treatment.
For example, according to experts from the Research Institute of Oncology. N.N. Petrova, who conducted more than 500 sessions of high-dose brachytherapy, the risk of serious urination disorders was 1.1% (mostly, these complications were observed in patients who underwent transurethral resection of the prostate adenoma) - less than 1%, incontinence was registered did not have.
What should not be done after the occurrence of prostate cancer brachytherapy complications?
Often, patients who have undergone radiation treatment of prostate cancer, including brachytherapy, in the event of complications, are treated in the clinic or in the hospitals of the general medical network. In this case, patients are often offered surgical methods of treatment:
- transurethral resection for urination disorders,
- biopsy of the rectal wall - with complications from the rectum.
It should be remembered that any invasive (surgical) manipulations on the urethra, bladder, rectum after brachytherapy are extremely undesirable. They can only be performed after prior consultation with your primary radiotherapist.
What therapeutic measures can help in case of side effects of brachytherapy?
In most cases, the complications of brachytherapy are temporary transient. They arise during the first few weeks and subside over the next few months. With long-term preservation of undesirable consequences, medicinal treatment methods are usually used. For example, when difficulty urinating, drugs are prescribed from the group of alpha blockers, in the presence of pain in the rectal area, anti-inflammatory drugs, candles, ointments, etc. are actively used.
As already noted, the success of treatment after surgery to remove prostate cancer is largely determined by the stage at which the pathology was diagnosed. At the same time, it is very difficult to detect the presence of a tumor at an early stage of its development, since it does not manifest itself in any way. That is why experts recommend men who have reached the age of 40, annually undergo examinations by doctors.
After the second stage, the neoplasm begins to manifest itself.
Symptoms in this case are similar to the manifestation of inflammation of the prostate:
- delayed urination, the process itself is accompanied by pain,
- possible incontinence or leakage,
- frequent urging to the toilet.
Later, when metastases begin to spread throughout the body, the tumor is easier to diagnose. At this stage, patients note the presence of small blood stains in the urine. In addition, in the perineal region appear severe pain, localized in the prostate. However, even in the later stages of the disease may be asymptomatic.
Prostate Oncology Removal Techniques
To date, there are several treatments for prostate cancer. The removal method is selected after a thorough analysis of the neoplasm, the patient’s individual characteristics (age, tolerability, etc.) and on the basis of other factors.
In modern medicine, to remove oncogenesis, the surgeon cuts the abdominal cavity completely, then removes the prostate, or uses a minimally invasive method, involving several small incisions. At the same time, surgery does not give 100% guarantee that the tumor is completely removed. If this happens, then after surgery, additional radiotherapy is prescribed. This method is usually accompanied by a sufficiently long recovery period, during which the patient faces such troubles as urinary incontinence and deterioration of erectile function, up to impotence. In some cases, the operation is carried out with the help of robots, due to which the recovery period is significantly shortened.
Treatment of prostate cancer takes place through x-ray radiation, which is applied to the prostate tumor through the skin. At the same time, the apparatus (usually a linear accelerator) creates rays that reach the maximum degree of focus when released into the tumor. The result is the destruction of exclusively malignant cells.
With brachytherapy, several radioactive grains are introduced into the body, which act on the oncological focus. This method of treatment has recently gained increasing popularity due to the fact that it, firstly, eliminates surgical intervention, and, secondly, is safe.
The essence of brachytherapy is to bring the maximum dose of radioactive substances directly to the tumor. The main advantages of this method include:
- High efficiency. In the case of a favorable prognosis, about 96% of patients are completely cured of their pathology.
- A small number of relapses. After brachytherapy, only 20% of patients again had a tumor in the prostate.
- Short period of hospitalization. Brachytherapy is prescribed the next day after the patient enters a medical institution. Discharge of the patient is carried out in a day.
- Almost complete lack of consequences. The main side effect (today it occurs in approximately 1.5% of cancer patients) of this method is a sharp incontinence of urine.
- Short rehabilitation period. It takes no more than a few days to recover from brachytherapy for prostate cancer, although in some cases a complete recovery occurs within a few hours.
- Low percentage of impotence. In approximately 20% of patients, there is a violation of erectile function after using this method.
More about the method
Brachytherapy for prostate cancer is performed in one of two modes:
The duration of each of these sessions is 10-20 minutes. Fully radioactive drugs decay in a year. Therefore, during the first two months set aside for postoperative recovery, patients are advised to refrain from sitting children and animals on their knees. It is also recommended to keep some distance from pregnant women.
Что касается противопоказаний, то брахитерапия не назначается при наличии диссеминированного рака предстательной железы, простате, объем которой превысил 50 куб.см., и выраженной инфравезикальной обструкции.
Стоит отметить, что данный метод является наиболее эффективным только на ранних стадиях развития опухоли. Even with the introduction of a high dose of radioactive substances into the body, the tumor is removed if another method is used.
Before a patient leaves a medical facility after a brachytherapy session, local physicists, who determine the current level of radiation, should examine him. This indicator should comply with current government safety standards. In addition, medical workers write out a certificate on the basis of which the patient can freely pass through special detectors that mark the level of radiation. The half-life of substances is about 60 days.
After brachytherapy during the first two weeks you can not lift things, the weight of which exceeds five kilograms.
Also during the recovery period it is recommended to observe several conditions:
- sit no more than two hours in a row
- refrain from exercise
- promptly empty the bladder and intestines,
- refrain from the consumption of alcoholic beverages, fried and spicy foods.
It is worth noting the probability of the release of a radioactive capsule from the urethra. It should not be taken by hand. It is better to use tweezers and hide in some airtight container.
The entire postoperative period, the patient is under the supervision of a physician in order to identify in the early stages of a tumor recurrence and prescribe timely treatment. After about 1.5 months, swelling of the prostate should subside. If this happens, the patient can gradually return to his usual lifestyle. For two years from the time of radiation exposure, it is necessary to consult each time with the oncologist for treatment of any diseases. That is, it is necessary to find out whether these or other methods, prescribed by another specialist, will affect the process of recovery after cancer.
In addition, every three months the patient is recommended to undergo an ultrasound examination and to undergo a blood test for PSA. At the end of the specified period, the patient can gradually increase the daily load, play sports. At the same time, the radiation background formed around the patient does not have a negative impact on others.
Although brachytherapy is a modern method, scientists first refer to it in 1910. Then, at the beginning of the last century, the American surgeons P. Degre and D. Pasto developed a new method of treatment based on the use of a targeted radioactive beam, avoiding the total exposure of the patient's body.
The beam was delivered to the affected organ using a special Ra-226 capsule, trocars (hollow needles), and then radioactive gold.
This went on almost until the end of the 20th century, until in the eighties scientists H. Holm and J. Gammelgard introduced a method of delivering a microsource in combination with transrectal ultrasound scanning.
The new method allowed to control the process of operation and achieve a more effective result. That it is the basis of brachytherapy.
Today, different types of brachytherapy are used in medicine: intracavitary, superficial, intravascular, intraluminal and interstitial, used to treat prostate cancer.
Despite the widespread use in surgery and high rates of performance, brachytherapy for prostate cancer may not be prescribed to all patients. It is effective only if the tumor is localized within the organ itself., since the beam goes directly into the organ and does not go beyond its limits by more than 1-2 mm. In view of this, prostate brachytherapy is performed for cancer in the first and second stages.
Today in surgery, there are two methods of operation:
- Through the introduction of permanent radioactive "grains".
- Through special needles.
First way shown in patients with the initial stage of the disease with a favorable prognosis. Iodine, I-125, is used for irradiation; its half-life is 59 days. Refers to microdosing therapy.
Second way used for temporary brachytherapy. Shown in patients with a combination of adverse factors. Accurate irradiation is carried out by introducing special needles into the prostate gland. The dose of exposure is calculated individually. For the procedure used iridium, Ir-192. Refers to high-dose therapy.
At this stage, it is important for the patient to undergo all the necessary research: CT scan, MRI, TRUS, and also to pass the necessary laboratory tests.
It is important for the physician to know the condition of the patient and to obtain highly accurate images of the affected organ. This will help determine the location of the tumor, and correctly direct the beam.
Consultation with the therapist and anesthesiologist will also be required, since the operation will take place under anesthesia.
Course of operation
The operation is carried out in several stages:
- Initially, the patient is cleansing enema and asked to undergo the necessary hygienic procedures.
- Then the patient settles down on a couch and anesthesia is entered. It can be intraspinal or general (at the discretion of the specialist).
- Next, the specialist starts the operation. During it, the patient is located on the back, legs are bred to the side to the side and rely on special supports.
- The operation is carried out using a transrectal ultrasound sensor, which allows you to visually monitor the progress of what is happening with the help of ultrasound.
- After completion of the procedure, the patient is left for a day in the hospital. In some cases, the operation may take place on an outpatient basis.
If the procedure runs smoothly, the patient is soon allowed to go home:
- For some time, it may experience discomfort and pain, which is well smoothed out with anti-inflammatory and analgesic drugs.
- After anesthesia, you may feel dizzy, sleepy. This is a normal reaction. Need more rest and drink simple cool water. This will flush the kidneys and help cleanse the body.
- Swelling and bruising in the area of needle insertion is a common phenomenon. They disappear after a few weeks, so they should not cause anxiety.
- During the recovery period, it is important for the patient to adhere to the recommendations of the doctor, not to lift weights, to avoid heavy physical exertion, not to live sex until permission of the doctor.
- After discharge, a microcapsule will remain inside the patient’s body, to which metals could react. It is better to take care of this nuance in advance and take an extract from the hospital. It will help to avoid possible problems at airports and train stations on a personal search.
- Do not take pets on your lap for the first 60 days and do not plant small children. Try to avoid contact with pregnant women.
- Do not attend physiotherapy without the permission of an oncologist.
- In the first year it is recommended to take a blood test for PSA every 90 days. Then every half year.
Possible complications, side effects
Complications after brachytherapy of the prostate gland:
- Difficulty urinating. In the first few days, this phenomenon is acceptable and refers to the norm. If the problem persists within the first 5-7 days, you should contact a specialist.
- Frequent urination.
- Burning sensation when urine passes.
- Erectile disfunction.
The effects of prostate brachytherapy are mainly related to relapse, dysfunction of the affected organ and necrotic changes in the surrounding tissues.
The common effects of brachytherapy for prostate cancer are usually associated with an incorrect calculation of the radiation dose. As a result, the patient may experience some symptoms of radiation sickness.
In most cases, the operation gives a positive result and allows you to count on a favorable prognosis. It should be remembered that the prognosis may be individual and depend on the course of the disease, the physical condition of the patient, age and other individual characteristics.
According to the data of American clinics, 10-year survival of patients after brachytherapy is 79%.
Today brachytherapy is one of the alternative methods of radical treatment of prostate cancer.
It is characterized by a fairly high positive outlook, low incidence of complications, and good tolerability.
This procedure is common both in our country and abroad. Modern equipment and a high level of specialist training allow us to carry out the procedure effectively and safely for patients and to achieve not bad results in urological surgery.
Implantation of radioactive nuclei
Low-dose brachytherapy for prostate cancer is performed on an outpatient basis under general anesthesia. After installing the ultrasound probe in the rectum and displaying the image on the monitor screens, the doctor through the perineum with the help of needles performs the implantation of tiny radioactive nuclei. The average number of needles used is from 20 to 35. The entire procedure usually takes no more than an hour.
The final stage of minimally invasive surgery is a computed tomography, which allows you to assess the correct location of the implant. After confirming the results, the man is awakened and transferred to the ward for subsequent observation. They are discharged from the hospital the next day, provided that there are no serious side effects.
Complete information on prostate brachytherapy:
After 5-6 weeks, the patient will undergo CT and MRI scans to check the location of the nuclei. After the examinations, the attending physician will prescribe regular checks of the PSA level in the blood, which, if successfully treated, will drop to the minimum values. Some men may experience short-term increases and decreases in PSA levels within three years after therapy.
The patient can return to everyday life and work after LDR brachytherapy in 2-3 days. At the same time, any physical activity and heavy loads should be avoided. All radioactivity of nuclei is absorbed in the prostate gland, therefore, it is absolutely safe to be near other people.
As a precautionary measure, a man should avoid prolonged contact with pregnant women and children. It is allowed to hold or hug a child for several minutes every day, but do not let him sit on the patient's lap.
There is a small risk that during sexual contact the nucleus may leave the prostate gland and exit through the urethra. Therefore, doctors recommend using barrier methods of contraception during the first weeks after the procedure. Do not be surprised if the sperm turned black or brown. The condition could be caused by bleeding during the insertion of the needle into the prostate.
Disorders of urination after brachytherapy of the prostate develop for 2-3 weeks and reach a peak 2 months after the procedure. Symptoms gradually disappear as the implant radiation decreases during 6–9 months of being in the organ.
The most common side effects are:
- red-rusted or dark colored urine and semen after surgery,
- bruises and pain in the area between the testicles and the anus (disappear after 1-2 weeks),
- nocturia, erectile dysfunction, intestinal problems and fatigue.
Constipation is a frequent side effect after brachytherapy, which occurs as a result of taking pain relief medications. It is also a symptom of inflammation of the prostate gland caused by radiation. Preventing constipation will help:
- a balanced diet with plenty of fruits, vegetables, and fiber foods,
- 2-3 liters of clean, non-carbonated water per day,
- compliance with the recommendations of the attending physician,
- taking medications (laxatives, stool softeners) to prevent the feces from solidifying in the first weeks after surgery.
All problems and complications must be reported to your doctor.
Help and support
The list of organizations that are ready to provide information and assistance in case of detection of prostate cancer:
Service "Clear morning": comprehensive support for people with cancer.
Charitable Foundation "Life": help for children with diseases in the field of oncology and oncohematology.
Phone: 8 (495) 506-79-70