Ask the Doctor- Oncology

Could you explain brachytherapy and how it is used to treat prostate cancer?

Q: I'm due for my first colonoscopy, and I'm not looking forward to it. How important is this test in preventing colon cancer?

Q: Could you explain brachytherapy and how it is used to treat prostate cancer?

Prostate cancer is the second most commonly diagnosed cancer in men and the second leading cause of cancer death (behind lung cancer). In fact, one in six men will develop prostate cancer in their lifetimes. However, when caught early, prostate cancer offers a relatively good prognosis. Depending on the staging of the cancer, 91 percent of men diagnosed show an estimated 10-year life expectancy and 75 percent of men live for 15 years. Screening is advised after age 50, unless patients fall into high-risk groups, which include those with a family history of prostate cancer. In these cases, screening begins at age 45. Screening consists of an annual prostate-specific antigen (PSA) blood test in tandem with a digital rectal exam (DRE).

If cancer is diagnosed, an increasingly popular treatment is brachytherapy—or radioactive seed implants— placed into the prostate. For nearly a century, this method has been used in various incarnations. As advances have been made in imaging techniques, methods of distributing the seeds into the affected tissue, as well as using more specific radioactive isotopes, this treatment has grown in popularity. Currently 36 percent of men, depending on the stage of their prostate cancer, receive some form of seed implantation.

Using brachytherapy, anywhere from 75 to 125 radioactive seeds—which measure about the size of a grain of rice—are distributed and placed in the area of the cancerous lesion via ultrasound. These high energy isotopes then give off radiation for a specific amount of time to kill cancer cells. The seeds emit a focused, higher dose delivery of radiation that is targeted in one spot. This is an outpatient, same day procedure administered using general anesthesia. In cases of later stage cancer, brachytherapy may be combined with external beam radiation, as well.

Administering brachytherapy seeds is done in a team approach. The urologist works in tandem with the radiation oncology team at the Dale and Frances Hughes Cancer Center, in order to plan the treatment and place the seeds. The team uses a computer model of the prostate and ultrasound images of the affected area to determine the best placement.

There are several advantages to brachytherapy. As an alternative to surgery, it’s less invasive, is performed as an outpatient procedure, and is more convenient to many patients. The targeted radiation helps to spare healthy tissue, and it also has the benefit of shorter treatment and recovery times. The success rates are truly comparable to other, more invasive forms of treatment. Some side effects that may occur include frequency of urination or burning during urination as well as some rectal irritability. However, these issues generally resolve in a few months. 
In my practice, we have treated hundreds of patients with this procedure. The best candidates are those with a relatively small prostate, in early stage cancer without excessive urinary symptoms. However, each patient is examined on a case by case basis to determine the best course of treatment.

Michael Eufemio, MD, FACS, is a board certified urologist with Urology Associates of the Poconos. His specialties include prostate disease, kidney stones, urologic cancer treatment, and incontinence.

Q: I’m due for my first colonoscopy, and I’m not looking forward to it. How important is this test in preventing colon cancer?

Early detection is the key to treating colon cancer. If caught early enough, the survival rate of colon cancer is 85 to 90 percent. For patients with no family history of colon cancer, screening begins at the age of 50 and is repeated every ten years. Patients considered at high risk, those with a mother or father who had colon cancer or precancerous polyps, should start screening five to ten years before their parent was diagnosed. For example, if your mother was diagnosed at 40, screening should begin at 30.

The key concept to preventing colon cancer is to remove pre-cancerous colon polyps. Once polyps form, they go through a series of progressively abnormal changes usually over the course of ten or fifteen years. Left untreated, a polyp can become cancerous and invade through the bowel wall and spread to blood vessels, lymph nodes, and other organs in the body.

The best way to detect polyps is through a fiber-optic colonoscopy. Traditional colonoscopy remains the gold standard for screening, however virtual colonoscopies, which are essentially a CT scan, are available. A traditional colonoscopy offers several advantages to a virtual procedure. If a polyp is identified at the time of the colonoscopy, it can be removed. Patients should also weigh the long term risks of radiation exposure from these tests. For younger patients, it’s an important risk to consider if they are going to be screened repeatedly. Increasingly, these diagnostic tests are almost routine.

Both virtual and traditional colonoscopies require a complete bowel preparation, which involves consuming a significant quantity of liquids formulated to clear the bowel. Many patients find the preparation to be more uncomfortable than the colonoscopy itself. In order to address these issues, my office offers the convenience of weekend scheduling, allowing my patients plenty of time for prep, procedure, and recovery to make the process as easy as possible.

In addition to regular screenings, patients need to be proactive about their health. If you have any symptoms such as bleeding during bowel movements, changes in bowel habits, or abdominal pain, consult your healthcare professional. No one looks forward to a colonoscopy, but this very simple test can save your life.

Darell T. Covington, MD, FACS, FASCRS, is a board certified colon and rectal surgeon.


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