Brachytherapy Overview | Why Brachytherapy? | Procedure Step by Step | Quality Assurance | ProQura
Why Brachytherapy/Brachysurgery ?
The three most important factors for cancer control with any type of radiation are DOSE, DOSE AND DOSE. It is well establish in all of the studies performed to date that the higher the dose that can be delivered to prostate cancer, the better the control rate. Seed implantation (prostate brachytherapy/brachysurgery) delivers as much as two to three times the dose that external beam treatments (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, while still covering the margin of possible spread beyond the gland. For example, 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. Compare the results of treatment by reviewing the results of the Prostate Cancer Results Study Group www.pctrf.org
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. Note that in all studies there is a mixture of different patients with different risks. 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. Also all surgical patients have a permanently shorter penis after surgery. These risks are not seen in either Seed implantation or IMRT radiation. One important aspect about side effects is that patients are different and aspects of their overall health and function can influence the risks. It is best to find a highly specialized physician in each treatment modality and ask what they expect for you regarding their treatment and experience. It is not recommended that you listen to inexperienced practitioners giving advice about another treatment in which they have little or no experience . In our experience, the advice is frequently incomplete or biased.
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 PCCS, you will receive a full explanation of the potential effects on bowel, urinary and sexual function from collective e experience we have had performing these treatments in over 10,000 patients ( Dr Grimm > 4,500) during the past 25 years. As most patients with prostate cancer will lead relatively normal lives without recurrence after treatment, our research efforts at PCCS focus on technical improvements, diagnostic imaging and therapeutic interventions that help minimize the risk of cancer recurrence and maximize your quality of life after treatment. The information we obtain from you benefits the next patient’s experience.
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Why Brachytherapy at the Prostate Cancer Center of Seattle?
Experience and Advanced Technology
Dr. Grimm has been a pioneer in the development and research of the newest applications in brachytherapy and has treated over 4,500 patients. He is currently working with the planning technology companies to improve the therapeutic benefits and outcomes. He has 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)
Dr. Grimm was 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. Our studies have shown that this smaller diameter needle/seed result in less trauma and pain and hopefully will improve long term potency over previous techniques .
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 needle/seed placement.
Mutiparametric MRI Imaging This new imaging technology has allowed us to examine carefully the internal architecture of the prostate and evaluate for disease outside the gland We are now using it to plan the implants as it has greater improved the ability to contour and outline the gland.
Transperineal Mapping Biopsies This biopsy technique has allowed us to precisely target suspect areas seen on the MRI scans and allowed us to perform focal brachysurgery and Cryotherapy for local recurrent disease
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)
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.