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Radiation Therapy
Brachytherapy
Technically, brachytherapy is more a form of therapy than a surgical procedure, but it does involve a surgical element - the implantation of tiny, radioactive implants into a cancerous prostate gland. Radiation emitted by the implants kills the malignant tumor. Men whose cancers are small and confined to the prostate (Stage 1 or 2) are candidates for brachytherapy.
The physician first uses an ultrasound device (TRUS) to create a three-dimensional grid map of the prostate. A computer then is used to calculate the volume of the gland, the number of radioactive implants (called "seeds") that will be needed and where they should be placed.
The procedure, performed on an outpatient basis, takes 45 to 60 minutes and is done under local (spinal) anesthesia. From 50 to 100 rice-sized seeds are then inserted by a special needle through the perineum and into the prostate in a preplanned pattern, guided by the TRUS and grid map. The seeds contain a radioactive isotope, usually Palladium 103 or Iodine 125, which emit radiation for about three months before decaying to an inert state.
Brachytherapy patients can be discharged the same day and usually resume normal activity within a day or two. A small proportion, generally those over 70, experience incontinence or impotence problems. But brachytherapy has been found to deliver a higher and better focused dose of radiation with fewer side effects and at substantially lower cost than external beam therapy. In a recent study of 111 brachytherapy patients, 100% were prostate cancer free after five years.