Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

i. Brachytherapy

The goal of brachytherapy, or seed implantation, is the same as that of external radiation therapy: to kill the prostate cancer cells where they live. The difference, however, is that brachytherapy does it from within the prostate itself and external radiation therapy does it using beams directed into the prostate from the outside.

With this approach, tiny little metal pellets containing radioactive iodine or palladium, each smaller than a grain of rice, are inserted into the prostate via needles that enter through the skin behind the testicles. As with 3D conformal radiation therapy, careful and precise maps are used to ensure that the seeds are placed in the proper locations. Over the course of several months, the seeds give off radiation to the immediate surrounding area, killing the prostate cancer cells. By the end of the year, the radioactive material degrades, and the seeds that remains are harmless.

Compared with external radiation therapy, brachytherapy is still less commonly used, but it is rapidly gaining ground—primarily because it doesn't require daily visits to the treatment center.

A twist on brachytherapy, known as high-dose-rate brachytherapy, does for brachytherapy what IMRT does for external radiation therapy: it allows radiation oncologists to deliver very high doses of radiation to very specific areas of the prostate while sparing other areas and minimizing side effects. Unlike IMRT, however, the advantages of the high-dose-rate brachytherapy approach are not so clear.

Instead of surgically implanting the seeds and leaving them in the prostate permanently, the high-dose-rate technique involves inserting hollow tubes into the prostate through which high doses of radioactive iridium are delivered to carefully mapped out locations in the prostate. The tubes, however, are not designed to stay in the prostate permanently. Rather, they are left in place for two to three days, and each day another dose of the iridium is delivered. After the final dose, the tubes are removed. This procedure is done on an inpatient basis, rather than an outpatient basis, and is typically followed by a short course of external radiation therapy. Because of the relative inconveniences of this technique over standard brachytherapy, high-dose-rate "temporary" brachytherapy hasn’t quite caught on as a standard treatment approach, and its use remains somewhat more limited.