Prostate Cancer: A Man's Health Threat
An estimated 334,500 new cases of prostate cancer are diagnosed in the United States each year.
While it can occur in men of all ages, it is most common in men over 40. The risk of prostate cancer increases with age; over 80% of all prostate cancers are diagnosed in men over the age of 65. Approximately one out of every 10 American men will develop prostate cancer.
When caught early, prostate cancer has an encouragingly high cure rate. Fifty-eight percent of all prostate cancers are discovered while still localized; the five year relative survival rate for patients whose tumors are diagnosed at this rate is 99%. Over the past 30 years, the survival rate for all stages of prostate cancer has increased from 50% to 87%.
How Does Brachytherapy Work?
For patients whose prostate can be best treated by radiation, brachytherapy is the preferred treatment option. Known as radioactive seed implant, brachytherapy is a technique of placing radiation sources directly into the tumor to deliver high doses of radiation to the tumor site, while minimizing the dose to local tissue. The seeds of radiation attack the cancer while you continue your normal routine.
For early stage cancer, brachytherapy offers a treatment option that is far less invasive than surgery.
In some cases, both external beam radiation and brachytherapy are utilized. With the external beam process, radiation is directed through the body to reach the cancer site and may require a series of treatments.
The cost of the seed implants is about one half that of radical surgery and approximately two-thirds that of external beam radiation. Costs are covered by Medicare and by most insurance companies. It would be advisable to verify coverage with your carrier before the procedure.
What Can I Expect?
Before your procedure, your physician will create a map of your prostate using ultrasound scans. This map will be used to design a treatment plan that calculates the exact number of seeds for complete coverage and accurate placement. Precise seed placement that optimizes radiation distribution to the prostate is key to a successful implant.
Implantation of the radioactive seeds is most often performed on an outpatient basis. On the day of treatment, you will likely receive a spinal anesthesia so that you will not feel anything below the waist. A medication to make you feel relaxed and drowsy may also be administered intravenously, although your physician may prefer general anesthesia. An ultrasound probe is positioned in the rectum to accurately reproduce the treatment plan and allow proper needle placement.
Implant needles are introduced through a template guidance device. A predetermined number of seeds are then implanted as the needle is withdrawn from the prostate. When all the seeds have been inserted, the ultrasound image is again reviewed to verify seed placement.
The actual implant procedure takes about an hour to complete. Afterwards the patient is given post-operative instructions and precautions. Usually an antibiotic is prescribed. Few patients require pain medication.
How Effective Is It?
Physicians are now able to monitor response to treatment without relying solely on biopsies or clinical examinations by using prostate-specific antigen tests.
The PSA test is a key indicator in monitoring response to therapy for prostate cancer. In a Northwest Tumor Institute study, 90% of 451 patients treated with seed implants continue to have normal PSAvalues and no evidence of disease at a median follow-up of 37 months. In a comparable series of patients treated with traditional external beam, 68% were reported to have normal PSAs and no further evidence of disease. In a study of surgical patients, no evidence of disease and normal PSAvalues were found in 76% of these patients, predicting a 20% to 30% eventual clinical relapse.
When brachytherapy is used, the likelihood of possible side effects of other forms of treatment is reduced. Incontinence is rarely a concern in patients who have not had prior urinary tract surgery. In patients under 70 years of age, 85% of those who are potent prior to the brachytherapy procedure remained potent afterwards.