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Radiation:

There are two main forms of radiation treatment that are used in the treatment of prostate cancer.

With the permanent seed implantation, there are several different radioactive materials that may be placed into the prostate gland. These include iodine and palladium seeds. The major difference between these two is how fast the dose is delivered over the lifetime of the activity of the seed. With permanent seed implants you are temporarily radioactive. However, the dose is usually so low that it is absorbed by all the tissues prior to having any exposure to anyone around you. Please consult your doctor as to the precautions that may have to be taken if you have a permanent seed implant.

In the temporary seed placement, needles are again placed into the prostate gland, but they are left in place for a short period of time while the radioactive seeds are placed in the prostate gland. The needles are usually left in place up to 3 days and this procedure may be repeated up to 4 times. Upon removal of these radioactive seeds, these needles are removed.

Combined External Beam and Interstitial a newer way to treat early prostrate cancer (Stage 1 and 2) is to combine both external beam irradiation and the intersitial implant. If permanant seeds are to be used they are often completed first. The total dose for the implant will be less than if it were to be alone. This is because it will be followed by external beam treatment. With the external beam treatment begins about 3-6 months later. The external beam treatment will be reduced from 6-8 weeks to 4-5 weeks since the permanent seeds are already going close to the prostrate gland.

External Beam Irradiation:

The radiation treatment with the most experience is external beam irradiation. This treatment tries to concentrate the radiation on the prostate gland and seminal vesicle areas along with any suspicious lymph node regions. These treatments are usually given once a day for seven to eight weeks. This treatment can be used for all stages of prostrate Cancer.

Recently, 3DCRT (three-dimensional conformal radiation therapy) and iMRT (intensity modulated radiation therapy) techniques have been developed and are used to treat prostate cancer and other malignant tumors. These new techniques allow more precise delivery of external irradiation (conforming to the shape of the tumor), resulting in less dose being given to surrounding normal tissues like the bladder and rectum. Because of this, it is now possible to increase the dose of radiation to the tumor. Several reports have shown that this improves local tumor control and Biochemical (PSA) disease-free survival.

Interstitial Brachytherapy/Seed Implant:

The second type of radiation treatment is known as an interstitial implant. This is done in one of two ways. It can be done either by permanently placing radioactive seeds into the prostate, or by inserting needles into the prostate gland and using a temporary placement of radioactive sources into the prostate gland. This treatment is usually reserved for early staged prostrate cancers (Stage 1 and 2) with low to moderate gleasons scores.

With permanent seed implants, the transrectal ultrasound is used to help the needles that are used for seed placement to be appropriately placed so that the radioactive seeds will give a specific dose to the prostate.

Permanent seed implants usually involve several steps prior to treatment. Your doctor will need to do a volume study to determine how large the prostate gland is. This is done using the transrectal ultrasound. The doctor and the radiation physicist will then map out how many seeds need to be placed into the prostate and at which location in order to give the correct dose. Note: implants will usually not be done for patients who have had a TURP within the previous 6 months because of concerns of higher side effects and damage to the urethra that was operated on. Once you are ready for the implant it will usually take less than 2 hours and it can be done with a spinal anesthesia so your recovery time is lessened, as are potential anesthesia complication rates. You should expect to stay in the hospital overnight, however most patients are released within 24 hours of the implant.