Treatments and Technology

High Dose Rate Brachytherapy for Prostate Cancer


Prostate cancer is very common in the United States. The prostate is a small gland sandwiched between the bladder and rectum. Due to the prostate’s close proximity to the bladder, urethra, neurovascular bundles and rectum, the most common side-effects of any surgical or radiological treatment for prostate cancer include urinary, bowel, and sexual (erectile dysfunction) side-effects. There are several treatment options for men that are diagnosed with prostate cancer. However, preservation of quality of life should be an important goal in the treatment strategies used to treat prostate cancer. In addition to meeting with an urologist who is a surgical specialist, it is equally important to have a consultation with a radiation oncologist to fully understand all of the radiation therapy treatment options available for the treatment of prostate cancer.
HDR for ProstateThere have been several advances in the delivery of radiation therapy that have led to increases in our ability to deliver higher doses of radiation therapy more safely, thereby increasing cure rates and quality of life for our patients. Just as intensity modulate radiation therapy (IMRT) is a leap forward in our ability to more effectively and safely deliver external beam radiation for the treatment of prostate cancer, high dose rate (HDR) brachytherapy is a leap forward in the delivery of precise brachytherapy for prostate cancer.

HDR brachytherapy is the safest, most technologically advanced method to deliver a high dose of radiation therapy to the prostate while minimizing urinary, bowel, and sexual side-effects. HDR brachytherapy is most commonly used as a boost treatment and is combined with an abbreviated (5-week) course of external beam radiation therapy in patients who have intermediate or high risk prostate cancer.

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The procedure is performed by a radiation oncologist and urologist. Flexible afterloading catheters (15-20 catheters per patient) are placed using ultrasound guidance during a brief operating room procedure. These catheters are placed transperineally (through the skin between the scrotum and rectum) directly into the prostate gland.

A CT scan is then performed through the pelvic region. The images from the CT scan are used to precisely contour the outlines of the prostate, urethra, bladder, and rectum. Using sophisticated software, a radiation therapy treatment plan can be designed to maximize dose to the prostate gland while minimizing dose to nearby critical normal structures such as bladder and rectum. This ability to do precise treatment planning with CT scan information obtained after the catheters have been placed makes HDR brachytherapy one of the most exact and safe methods for treating prostate cancer.

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Once the treatment plan has been designed and approved by your radiation oncologist, 1 – 3 HDR brachytherapy treatments will be delivered in the radiation oncology department.  The patient remains in the hospital for 1 night while the treatments are delivered because each individual treatment is delivered at least 6 hours apart from other treatment. There are no residual radioactive sources or seeds left inside patients since all the radiation therapy is delivered during the HDR brachytherapy treatment, and there is zero radiation exposure to family members or hospital staff.

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