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Radiation therapy, also sometimes referred to as radiotherapy, is a general term used to describe several types of treatment, including the use of high-powered X-rays, placement of radioactive materials into the body or injection of a radioactive substance into the bloodstream. Is also referred to as "seed therapy" or a "prostate implant." Brachytherapy involves the insertion of a radioactive material, commonly referred to as a source, into the body. There are two approaches to brachytherapy for prostate cancer: low-dose rate (LDR) and high-dose rate (HDR).
An ultrasound study may be performed prior to the day of the procedure to ensure there are no bones interfering with the placement of needles into the prostate.
Alternatively, HDR brachytherapy may be utilized to place a highly radioactive source temporarily into the prostate. Radionuclide therapy: Radioactive substances may also be used for treatment of prostate cancer that has spread to the bones. Radionuclide therapy: The principal side effect of radionuclide therapy is a decrease in blood counts following treatment. Many prostate cancer patients are benefiting from radiation therapy techniques that decrease side effects and may lead to higher cure rates. The emergence of EBRT as a treatment for prostate cancer occurred in the 1950s with the development of high-powered X-ray machines called linear accelerators. Usually several radiation beams are used to shape the radiation to the prostate, called three-dimensional conformal radiation therapy. Attempts to treat prostate cancer by placing radioactive materials into the prostate date back to the early 20th century. The ultrasound probe is placed into the rectum to obtain pictures of the prostate and surrounding structures. Narrow hollow plastic tubes called catheters are pre-positioned in the prostate using a technique similar to LDR brachytherapy. These radioactive drugs, known as radiopharmaceuticals or radionuclides, are injected intravenously (IV). Obstructive symptoms including difficulty with urination are somewhat more common, however, as the prostate usually swells due to the insertion of needles into the prostate for the procedure. These circumstances include primary treatment of localized prostate cancer, secondary treatment for cancer recurring within the region of the prostate and for relief of pain and other symptoms related to prostate cancer that has spread to other parts of the body. The intensity of each beam may be altered to further shape the radiation using a technique called intensity modulated radiation therapy (IMRT).


However, the lack of a reliable way to ensure that the radioactive materials were placed in their desired locations limited the use of brachytherapy to treat prostate cancer. Radioactive seeds (which are smaller than a grain of rice) are loaded in individual needles that are passed into the prostate gland through the skin between the scrotum and anus.
The patient is then awakened and typically two or three treatments are given over the next several days after which the catheters are removed. Less than 10 percent of men will experience complete urinary obstruction within several weeks of the procedure requiring use of a catheter. However, an increase in pain may occur in the first several days or weeks after radionuclide therapy but can be managed with increased use of pain medications until the therapy begins to have its desired effect. In the 1980s, a technique was developed using ultrasound to guide the placement of tiny radioactive "seeds" into the prostate. The seeds are temporarily radioactive as the radiation is given off gradually over a period of several weeks to months. The information obtained from the TRUS can also be used to generate a road map for seed implantation. As the needles penetrate the prostate they are seen on a monitor and can be accurately guided to their predetermined position. A remote control device is used to move the radioactive material, which rests for a calculated period of time at various positions within each catheter. The radiation given off is weak and does not penetrate very far into surrounding tissues and organs. Within one or two months following completion of treatment, most men notice that symptoms disappear. Proton beam therapy is another form of EBRT that is used in a few centers in the country to treat prostate cancer. Ultrasound imaging is typically used to define the prostate although newer approaches using CT scan or MRI may be used.
Once the position of the needle in the prostate matches the intended position, the needle is withdrawn leaving the seeds behind in the prostate. A computerized treatment-planning program is used to determine the required time the radioactive material must stay at each position and the sequential positioning of the radioactive material at each location needed to achieve coverage of the prostate with the prescribed radiation dose.
A single injection is given in the doctor's office after which the patient may return home.


Since the radioactive seeds are placed directly into the prostate, short-term bowel side effects are also relatively uncommon. Just as with a diagnostic X-ray, there is a brief exposure to the radiation, typically lasting several minutes.
HDR brachytherapy involves the temporary placement of a highly radioactive source into the prostate. The radioactivity of the seeds slowly decays during several weeks to months after the procedure, and there are few long-term risks associated with this treatment. Additional injections may be given after a period of a few months once the effects of the prior injection have diminished. About 20 percent of men, however, do experience more significant long-term bowel irritability.
However, as the front part of the rectum lies close to the prostate, over time bowel side effects similar to those of EBRT may occur. Recent clinical trials have shown that increasing the dose of radiation, either with photons or protons, can be done safely and leads to improved cancer control. The radiation treatment is given off over a period of minutes and typically repeated two or three times over the course of several days. Relatively rare complications include significant rectal bleeding, bladder irritability and urethral stricture.
The treatment is completely non-invasive, so there is no discomfort to the patient during the delivery of the radiation. Both LDR and HDR brachytherapy are usually used alone, but occasionally they may also be combined with EBRT. However, the risk of erectile dysfunction (ED) following radiation varies widely, depending on use of other treatments such as hormonal therapies and the presence of other medical conditions that may affect sexual function. Primary treatment for localized prostate cancer usually requires about eight weeks of treatment.



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