Prostate Cancer

Prostate cancer begins when cells in the prostate gland start to grow uncontrollably. The prostate is a gland found only in males and is responsible for making some of the fluid that is part of semen. The prostate is below the bladder and in front of the rectum. The size of the prostate changes with age. In younger men, it is about the size of a walnut, but it can be much larger in older men.

Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, travels through the center of the prostate.

Signs and symptoms

In most cases, prostate cancer symptoms are not apparent in the early stages of the disease. The symptoms of prostate cancer may be different for each man or these symptoms may be caused by other conditions. As a result, screenings in the form of digital rectal exams and/or prostate specific androgen (PSA) tests typically lead to a diagnosis.

Burning or pain during urination
Difficulty urinating or trouble starting and stopping while urinating
More frequent urges to urinate at night
Loss of bladder control
Decreased flow or velocity of urine stream
Blood in urine (hematuria)

Brachytherapy for Prostate Cancer

Prostate brachytherapy is a form of radiation therapy used to treat prostate cancer. It involves placing devices containing radiation in the prostate gland close to the cancer cells. Brachytherapy procedures vary based on the type of radiation you will receive. HDR (High-dose rate) prostate brachytherapy involves placing radioactive wires in the prostate gland for several minutes before the wires are removed. LDR (Low-dose Rate) brachytherapy involves placing radioactive seeds in the prostate gland permanently where they will slowly release radiation.

For early-stage prostate cancer, brachytherapy may be the only treatment used. For intermediate or high risk prostate cancer, brachytherapy may be combined with other treatments such as external beam radiation and/or hormone therapy.

HDR Brachytherapy

You will be meeting with a radiation oncologist and urologist to determine the right treatment for you. If HDR brachytherapy is chosen, you will be scheduled to have a procedure to place needles into your prostate. This procedure is done under anesthesia using a wand-like instrument (transrectal ultrasound probe) which is inserted into your rectum. This instrument creates ultrasound pictures of your prostate. The pictures help guide the needles into your prostate. You will have a foley catheter inserted into your bladder during this time while thin tubes (needles) are inserted through the perineum and into your prostate at precise locations. These tubes are connected to a machine that feeds wires containing radiation into the prostate. Once treatment is finished, the radioactive wires are removed as well as the needles. If you will be receiving external radiation afterwards, fiducial markers are then placed into your prostate. These “gold” seeds are about the size of a grain of rice and are placed in the prostate tissue to show exactly where it is in the body on image checks during external beam radiation. Then, a hydrogel spacer (SpaceOAR) is injected between the prostate and rectum. This helps in reducing rectal injury in men receiving external radiation therapy. Once these procedures are completed, you will recover with anesthesia nurses and may go home shortly after. Your foley catheter will remain intact until the following day where you will have an appointment in urology to have it removed. The SpaceOAR substance remains in place for 3 months providing protection during radiation treatment and is naturally absorbed in approximately 6 months.

SpaceOar Hydrogel and Fiducial Marker Placement

SpaceOAR (OAR stands for “organ at risk”) is a temporary injectable gel designed to protect the rectum from radiation exposure in men undergoing radiation therapy for prostate cancer. This technique is designed to allow physicians to treat the prostate with less radiation exposure to the rectum and fewer complications.

The gel is injected between the rectum and prostate during a minimally invasive procedure to increase the distance between those organs. The gel stays in the body for about 3 months, and then is naturally absorbed and eliminated from the body in the patient’s urine. By separating the prostate from the rectum, SpaceOAR hydrogel is designed to reduce radiation exposure to the rectum during treatment and may reduce or possibly eliminate damage to the rectum. Fiducial markers are then placed into your prostate. These “gold” seeds are about the size of a grain of rice and are placed in or around the tumor to show exactly where it is in the body to help with alignment during daily external beam radiation therapy.

You will be placed under general anesthesia for these procedures. A wand like (trans-rectal ultrasound probe) instrument is inserted into your rectum which creates ultrasound pictures of your prostate. This helps guide the physician to insert the gel and fiducial markers in the correct place. The procedure itself will last approximately 15 minutes, but allow more time for preparation for anesthesia and recovery from anesthesia. You will be discharged home after this procedure.

LDR Brachytherapy (Seed Implant)

Again, you will be meeting with a radiation oncologist and urologist to determine the right treatment for you. If LDR brachytherapy is chosen, you will be scheduled to have a procedure to place seeds into your prostate gland. This will be done under anesthesia. A wand-like instrument (trans-rectal ultrasound probe) is inserted into your rectum which creates ultrasound pictures of your prostate and helps guide the needle that is used to place radioactive seeds into your prostate. The seed is inserted through the catheters and is placed by the physician wherever the team plans for them to go. The seeds which are about the size of grains of rice will give off radiation for a few months and will remain in your body permanently. The low levels of radiation in the seeds generally are not harmful to others, but as a precaution, you may be asked to avoid close contact with children and pregnant women for a short time. Your doctor may recommend that you wear a condom during sex. Once the seeds are placed in your body, you will spend some time in the recovery area, then you can go home.

What to expect after procedure:

Possible pain and swelling in the perineum where the radiation needles were inserted.
Blood in the urine, which will clear up after a few days.
Stinging, burning, weak stream, or urgency in passing urine.

Although everyone is different, these side effects usually resolve within a few days following the treatment.