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Patients who want to pursue brachytherapy
as first
line monotherapy, meaning alone and
without other treatments, should exhibit these characteristics:
Not meeting all of these criteria,
however, does not eliminate brachytherapy as a prostate
cancer treatment option. Read on to see who else is
opting for brachytherapy and why. Then speak with your
doctor to see if brachytherapy is right for you.
Brachytherapy
as Initial Monotherapy for Prostate Cancer
Prostate cancer should be confined to the prostate for
those considering interstitial radiation therapy. This
treatment is most effective when the disease is confined
within the cloud of radiation created by the radioactive
pellets. In most patients, the cloud of radiation will
extend about 5 mm outside the organ.
Patients who want to pursue brachytherapy
as their primary treatment should have Gleason scores
of 6 or less and a PSA scores of 10 or less. They should
also have prostate volumes which are below 60 grams
or 66 cc. Those with benign prostatic hyperplasia (BPH)
are not candidates for prostate brachytherapy. The urinary
side effects associated with brachytherapy are exacerbated
if the patient already has BPH.
Finally, all candidates for brachytherapy should have
a digital rectal exam (DRE) that suggests that the tumor
has not extended out of the prostate gland. Because
of the cloud of concentrated radiation that the radioactive
seeds create, some early extension outside of the prostate
does not eliminate some patients from brachytherapy.
Neoadjuvant Hormone Therapy
and Brachytherapy
Hormone
therapy is sometimes used as neoadjuvant therapy
for brachytherapy patients. Neoadjuvant
refers to a treatment that is given before the primary
treatment to maximize effectiveness. Depending on the
size of the prostate gland, hormone therapy is given
anywhere from 3 to 6 months before brachytherapy. The
use of hormones can shrink the prostate gland so that
the prostatic volume is acceptable for brachytherapy,
unless the patients prostate gland is severely enlarged
(over 100 cc).
Multiple Radiation Therapies
Doctors, however, will still use brachytherapy for patients
who do not meet the above requirements. Internal radiation
therapy is sometimes used with external radiation
therapy, including intensity
modulated radiation therapy (IMRT)
and external
beam radiation therapy (EBRT). External
radiation therapy is rarely used if brachytherapy fails
because the pellets are more powerful than external
beams. If early prostate cancer survives interstitial
radiation therapy, the cells are most likely radioresistant.
Ages of Brachytherapy Patients
While brachytherapy is an effective prostate
cancer treatment option, men who are much younger
and in good health and who can reasonably expect to
live another 20 years, may want to consider other treatments.
Most of the conclusive data in LDR or HDR therapy does
not extend past the twenty year mark. Most long-term
studies do not extend past 10 to 15 years.
For patients who are older and are wondering if they
can tolerate this form of radiation therapy, should
consider that age is only a relative factor when choosing
a prostate cancer treatment. Patients should take into
account their general state of health before making
a decision.
Other Factors in the Brachytherapy
Decision
Patients who are obese should talk with their doctors
about whether brachytherapy is right for them. The needles
and the catheters used in the minimally invasive procedure
may not be able to withstand higher weights and still
be effective for seed implantation.
Patients should have a pubic
arch evaluation, which determines whether
a not a patient has pubic arch interference. The pubic
bones grow together to form a V which is in front of
a prostate gland. A narrow pubic arch can make prostate
seed implantation difficult. Patients with pubic arch
interference may want to consider other prostate cancer
treatments.
Patients who have undergone transurethral
resection of the prostate or TURP
before, may not be good candidates. If too much of the
prostatic tissue was removed during TURP, then there
may be insufficient tissue left to plant the radioactive
seeds.
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