Why Brachytherapy?
Seed implantation (prostate brachytherapy) delivers as much as two to three times the dose that IMRT, proton beam, Tomotherapy or Cyberknife radiation can deliver to the prostate. It does this while delivering less dose to the surrounding normal tissues than these external beam techniques. In addition, seed implantation can be tailored to the prostate and deliver high doses to the region of microscopic spread which commonly exists just a few millimeters beyond the edge of the prostate. It is extremely unusual for cancer to recur in the prostate region after a high quality seed implant.
Comparing Side Effects of the Various Treatments
Multiple studies have been published that compare the side effects of the 3 standard treatment options. The best of these studies are Health Related Quality Of Life studies (HRQOL), in which patients answer questionnaires that are validated by expert panels. Multiple HRQOL studies have been performed with the 3 standard treatment options. Unfortunately, none of these studies are randomized, thus patients in the surgical (radical prostatectomy) arms are typically younger and healthier before treatment than those in the EBRT or brachytherapy arms. This is because many patients who are not candidates for surgery are still good candidates for EBRT or brachytherapy, so the average age and health of the surgically treated patient (before surgery) is more favorable than the average age and health of the EBRT or brachytherapy patient. Multiple studies prove that younger healthier patients recover from virtually any type of treatment better than older sicker patients. So, all these studies have a built in bias favoring the surgically treated patients.
Despite the slight selection bias favoring surgery, those patients treated with surgery suffer higher rates of incontinence and impotency than those treated with either seed implantation or IMRT radiation. Those treated with radiation have higher rates of (usually temporary) increased urinary frequency and bowel frequency. Prostatectomy patients face a small risk of stroke, blood clots to the lung (pulmonary embolus), cardiac or pulmonary complications, significant infections, Peyronies disease, bleeding or death. All surgical patients have a permanently shorter penis after surgery. These risks are not seen in either Seed implantation or IMRT radiation.
Quality of Life
The side effects from treatment affect the quality of your life. Each treatment option has a slightly different side effect profile. In addition these side effects can vary, depending on the technique used and the skill of the treating physician. The quality of life is an important aspect of treatment outcome. At PCTC, you will receive a full explanation of the potential effects on bowel, urinary and sexual function from the experience we have had performing these treatments in over 7,000 patients during the past 25 years. As most patients with prostate cancer will lead relatively normal lives without recurrence after treatment, our research efforts at PCTC focus on technical improvements and therapeutic interventions that help minimize the risk of cancer recurrence and maximize your quality of life after treatment. The studies we conduct provide information that benefit your and the next patient’s experience.
Why Brachytherapy at the Prostate Cancer Treatment Center?
Experience and Advanced Technology
Drs. Grimm and Sylvester have been pioneers in the development and research of the newest applications in brachytherapy and have treated over 7,000 patients. They have also been responsible for many of the technical improvements in seed implantation which include:
Rapid Strand (Oncura)
Seeds encased in an absorbable material allowing the radioactive seeds to be connected, preventing seed migration and improving post implant dose distribution.
Source Link Seeds (Bard)
A small absorbable link between seeds that connects the seeds while minimizing seed migration and improving dose distribution.
Thin Strand (Oncura)
Drs. Grimm and Sylvester were the first in the world to use this new technology. ThinStrands have a smaller diameter seed, similar to the Rapid Strand, which are also connected. Current studies are ongoing to determine whether this smaller diameter seed will result in less trauma, pain and improved potency.
Brachytherapy Condom (CIVCO Brachytherapy Standoff)
This condom is custom made for the probe used during the implant and volume study procedure. It is designed to improve the image and therefore improve the seed placement.
RTP (Now Owned by Best) Stepper Stabilizer
This stepper stabilizer system allows a full range of treatment angles, quick setup and adjustments and can be autoclaved (thus fully sterilized).
Image Guided Radiation Therapy (IGRT) as Monotherapy (+/- Hormone Therapy)
Elekta cone beam technology, Calypso technology and with gold seed fiducial marker image guidance. We have extensive experience with all these technologies. We will coordinate treatments for you even if you need care near your home. Each has its own advantages.
Combination IGRT Plus Brachytherapy
This combination of treatments has proven to be very effective. We are the first to publish 15 year outcomes with combination therapy.