Brachytherapy for Prostate Cancer

Brachytherapy has been a treatment modality for prostate cancer since the 1990’s. The technique matured over the next ten years to reach a pinnacle of excellence in the mid 2000’s. A real time dynamic feedback treatment, allowing the most accurate treatment of the gland without collateral damage to surrounding organs.

In comparison to external beam radiation therapy (EBRT), brachytherapy is a more favourable course of treatment. Instead of treating cancer by externally firing high-energy x-ray beams at the patient, brachytherapy is an internal radiation therapy. Therefore, doctors can administer a higher dose of radiation to a smaller area in a significantly shorter amount of time. Furthermore, the risk of collateral damage to surrounding tissue and organs is greatly reduced and so are the negative side effects.

Nuclear seed cartridge canister
Brachytherapy seed canister – Photo by Dr SM Cornish inc.
Image displaying instruments used to implant brachytherapy seeds
Brachytherapy surgical instruments – Photo by Dr SM Cornish inc.
Image displaying instruments used to prepare a surgical site, and those used during the administration of brachytherapy
Image of surgical instruments used during brachytherapy – Photo by Dr SM Cornish inc.
Brachytherapy and the practice

This practice was pivotal in setting this goal post. Prior to treating the first patients in South Africa, our team received training overseas. Initial procedures were overseen by the best practitioners of the art from the USA. That initial training stood the practice in good stead. We are proud of the high percentage of patients successfully treated with minimal side effects.

The Protect Study released last year in the UK shows that the outcomes for brachytherapy are as good as surgery for the treatment of prostate cancer. Treatment outcome is of vital importance. Brachytherapy, of course, allows almost immediate resumption of a patient’s normal activities, which is not the case with surgery. Incontinence is not an issue and nor is erectile dysfunction in the first ten to fifteen years after treatment.

The improving imaging modalities of the prostate have allowed us to move into the realm of focal prostate treatment where much of the prostate remains unaffected by the radiation treatment. Focal therapy reduces potential side effects of the treatment for improved patient satisfaction.

Image of a urologist positioning surgical needles during brachytherapy
Urologist positioning surgical needles during brachytherapy – Photo by Dr SM Cornish inc.
Image of a urologist and physicist during a brachytherapy procedure
Urologist and physicist working in conjunction during brachytherapy – Photo by Dr SM Cornish inc.
Image of physicist observing live dynamic feedback imagery during brachytherapy
Physicist observing live dynamic feedback during brachytherapy – Photo by Dr SM Cornish inc.

Frequently Asked Questions

What does minimally invasive surgery mean and entail?

Minimally invasive surgery in essence is doing the same procedure with less trauma which translates into less pain and a more rapid recovery. 

For example, instead of opening an abdomen to repair a structure, a small hole in the abdomen can allow a surgeon to insert a camera to visualise the interior. The camera projects an image onto a large high resolution TV screen. Ancillary instruments are inserted in the abdomen around the camera report and the surgeon can then operate on the area of interest.

Brachytherapy entails inserting radio-active seeds through the skin behind the scrotum into the prostate gland.

Anticipated level of pain during and after the procedure?

Almost no pain at all or slight discomfort.

Anticipated duration of hospital stay?

Half a day in most cases.

How long will the brachytherapy seeds be radioactive for?

If iodine is used, then the seeds are radioactive for one year.

how soon after the procedure can normal daily activities be resumed?

Normal activities excluding exercise can occur the day after the procedure. Running is prohibited for a month and cycling and rowing for two months

how soon after the procedure can i drive?

The day after the procedure.

how soon after the procedure will i be able to travel?

One should not travel for a minimum of twenty four hours after an anaesthetic. Most minimally invasive procedures would allow travel with a few days.

In the case of brachytherapy, one can travel the day after the procedure.

Will my sexual function and/or fertility be affected by the procedure?

Not in the short or medium term. Beyond ten years there is an acceleration in loss of sexual function that is normally associated with ageing. If additional therapies are used in conjunction with brachytherapy such as hormonal therapy then there will be an immediate impact on sexual function

Would this procedure have any affect on my quality of life going forward?

Brachytherapy can cause irritable voiding symptoms for several months. Very rarely this may extend into years. There is usually some form of treatment that can offset this irritation.

will i set off metal detectors?

No, but you can set off security systems that detect radiation. Almost every airport in the world is able to recognise patients that have had brachytherapy and not call them over for a physical check but exceptions do occur.

Frequent travellers like to carry a certificate stating they have had brachytherapy

how can I protect those around me from radiation?

For the first three months after treatment small pets, children and pregnant women need to remain a metre away from the patient. After three months the radiation levels being given off by the patient are no longer toxic to small organisms.

No other precautions need to be taken

What to expect at my follow-up visit.

Questions related to symptoms caused by the therapy. Monitoring of bladder function, prostate progress and PSA levels. Usually three monthly follow up visits in te first year after the procedure.

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