LDR Brachytherapy

ABOUT LDR Brachytherapy

What is LDR Brachytherapy?

Brachytherapy is an effective radiation treatment for low and intermediate grade prostate cancer in which the radiation source is placed throughout the prostate.

 

Low dose rate (LDR) brachytherapy treatment for prostate cancer is commonly referred to as seed brachytherapy because numerous small radioactive seeds are implanted within the prostate. The seeds stay in the prostate permanently releasing a rapidly declining dose of radiation. This form of radiation treatment results in a very high, localised dose of radiation to be delivered to the prostate and less to the surrounding structures. The radiation from each seed only penetrates a few millimetres however, combined, the seeds produce a high level of prostate targeted radiation minimising exposure to the surrounding tissues.

 

LDR brachytherapy is used to treat prostate cancer that is;

  • Localised to the prostate,
  • Gleason score equal to or less than 7 (3+4=7 but not 4+3=7) or ISUP 2,
  • Initial PSA level’s lower than 10ng/ml,
  • Less than 50% of biopsy cores involved with cancer,
  • A prostate volume of less than 40cc is ideal but we can treat up to 60 cc,
  • Minimal associated urinary symptoms,
  • No previous prostate surgery.

Why is LDR Brachytherapy required?

LDR brachytherapy is a precise, stereotactic targeted radiation therapy for prostate cancer, administered with the intention of a cure.

Prostate Cancer

Prostate cancer is a disease cause by abnormal growth of cells in the prostate. These cells have the potential to grow within the prostate and spread to other parts of the body.
PATIENT JOURNEY

What does LDR Brachytherapy involve?

The procedure is carried out by a team consisting of a Urologist, Radiation Oncologist and a Medical Physicist as per Australian radiation safety guidelines.

 

Stage 1 – Treatment planning/ volume studies.
This is where we plan how many seeds are required and where they will be placed in the prostate.

 

This is a day procedure performed under a general anaesthetic.

A volume study specifically measures the size and shape of the prostate which varies between all individuals which in turn allows the brachytherapy team to determine the number of seeds required, where they will be positioned and the radiation strength of the seeds.
These characteristics are very specific to each patient and so the ordering process is referred to as “the prescription dose”. It is patient specific not unlike prescription medications.

 

An ultrasound probe is placed in the rectum. Ultrasound images of the prostate are obtained at 5mm intervals and captured in the planning computer for calculating the number of seeds, their positioning and radioactive strength to ensure the appropriate coverage of the radiation.

 

A cystoscopic assessment of the bladder (look into the bladder via the urethra) will also be undertaken to ensure that there are no abnormal anatomical constraints that need to be taken into account in the treatment planning or that may render the patient unsuitable for a seed implant.

 

What does LDR Brachytherapy involve?

Stage 2 – LDR Brachytherapy implant placement.

About 4-6 weeks following the volume studies, we perform your seed implant (it can be delayed for up to 4 months if circumstances dictate).

 

This procedure is performed under a general anaesthetic.

 

The prescription dose of seeds manufactured in the USA will be inserted using fine needles passed through the skin behind the scrotum and in front of the anus (perineum).

 

A catheter is placed in the bladder and remains overnight. It is removed the next morning after a pelvic CT scan and prior to your discharge the same day.

 

An ultrasound probe will be placed into the rectum so that the prostate can be viewed on a screen.

 

A template is place over your perineum, the area between the scrotum and the anus Using 25 to 35 needles, each containing between 1 to 4 seeds, 60 – 100 (depending on the size of the prostate) will be placed into the prostate under Ultrasound and xray guidance.

 

The needle puncture sites do not need suturing.

 

The template and ultrasound are used to ensure correct positioning of the seeds to match the plan.

 

The seeds are on a strand of soluble suture material to ensure perfect alignment.

What is the recovery after LDR Brachytherapy?

You will be admitted to hospital overnight. A lead apron will cover your pelvis as per hospital radiation protocol. Immediately after the implant you may experience some;

 

  • Mild soreness.
  • Bruising and discolouration between the legs.
  • Slight bleeding or burning beneath the scrotum.
  • Blood in the urine, which may last several days.

 

These side effects are temporary and caused either by the needles used to place the seeds, the catheter or other instruments used for the procedure.

 

You can return to work when comfortable.

 

Radiation Aftercare
Although the seeds are radioactive, you are not. There are no restrictions on travel or contact with adults. Most of the radiation is absorbed by the prostate. Normal social contact will not put you or anyone around you at risk. However, for the first couple of months you should, as a precaution, avoid having small children on your lap for continual periods of time (beyond a few minutes), as well as prolonged physical contact with pregnant women.

OUR TEAM

The following doctors in our practice perform LDR Brachytherapy:

Dr Glen Wood

Dr Glen Wood

Urologist

Book an appointment

Book an appointment to discuss this procedure with one of our doctors.