2333 Buchanan, Level B
San Francisco, CA 94115
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Treating Prostate Cancer with Brachytherapy
Prostate cancer is one of the most commonly diagnosed cancers in men today. The treatment choices for prostate cancer depend on many factors including stage or extent of cancer, Gleason score aggressiveness measurement, prostate specific antigen (PSA) level, and patient's age and general health. Each treatment option offers comparable results with varying degrees of side effects. Certain patients may not be candidates for one or more of these prostate cancer treatment options. When diagnosed with prostate cancer, men should discuss all treatment options closely with their physician.
Gleason score: Prostate cancer is often graded using the Gleason score, on a scale of 2 to 10. The Gleason score is considered a powerful tool for predicting how aggressive a tumor will be. The higher the Gleason score, the more likely the tumor is to grow rapidly and spread (metastasize) to other parts of the body.
In the Radiation Oncology department we provide external beam radiation therapy, radioactive seed implants, also referred to as brachytherapy, and High Dose Rate (HDR) brachytherapy.
Prostate Brachytherapy is an alternative treatment to radical prostatectomy for men with localized prostate cancer. The radioactive seeds, enclosed in titanium capsules as small as grains of rice, permanently placed inside the tumor result in a high dose of radiation that is confined to the prostate. This is a non-surgical treatment option for prostate cancer that improves medical outcomes, minimizes side effects and controls tumor growth.
This sophisticated technique of prostate radiation therapy allows a high concentration of radiation where it is needed most, to the prostate gland. The radiation exposure then rapidly lessens in strength as the distance from the seeds increases, thereby reducing the radiation exposure to surrounding healthy tissues.
This avoids high doses of radiation to the bladder, rectum and urethra. It has been demonstrated that this technique of dose delivery translates to a higher chance of tumor control and a lower risk of side effects. Brachytherapy is performed on an outpatient basis in a same-day procedure, completed in approximately one hour under a spinal or general anesthesia. Hospital time is minimal, patients are able to leave the hospital within a few hours post-implant and, in many cases, resume their normal activities within a few days.
Prostate brachytherapy is a cost-effective, advanced technique of prostate radiation therapy, performed as a minimally invasive procedure.
- Prostate Cancer Treatment Choices
- More Information about Brachytherapy?
- Radioactive Seeds
- Brachytherapy Patient Handbook
High-dose-rate (HDR) Brachytherapy is usually given as a treatment prior to external beam radiotherapy, has become an accepted cancer treatment. HDR involves surgically inserted hollow plastic catheters in the cancerous organ to deliver radiation treatment at any point inside the catheter with millimeter accuracy. The HDR unit has a single radiation source of Iridium-192 welded to a long wire controlled by computer driven motor.
HDR treatment allows the most accurate delivery of radiation to an organ. The typical sites for treatment include: prostate, vaginal canal, rectal, bile duct, certain lung cancers, and brain tumors. HDR treatment may not be appropriate in every situation.
Patients typically receive three or four HDR treatments, lasting 10 – 15 minutes, spaced at least six hours apart. Once the final HDR treatment is delivered, the catheters are removed and the patient is discharged home when appropriate.
External Beam Radiation Therapy
External Beam Radiation Therapy directs radiation beams on the prostate gland. Using some of the newest technologies available, 3D conformal therapy and intensity modulated radiation therapy (IMRT), to direct and shape the radiation beams maximize radiation dosage to the prostate cancer while minimizing radiation exposure to the surrounding healthy tissues.
IMRT is an advanced type of high-precision conformal radiation using computer-controlled X-ray accelerators to deliver 3D radiation beams conformed closely to the shape of the tumor. This precise targeting enables physicians to control the intensity of the radiation beam dose distribution within a given area. Multileaf collimators or beams can be turned on or off, or be blocked during treatment, varying the radiation beam intensity across the targeted field.
Radiation therapy is carefully planned using 3D computed tomography (CT) with computerized dose calculations to determine the dose intensity pattern that best conforms to the tumor shape. IMRT combined with 3D CT, called inverse treatment planning, creates the custom-tailored radiation dose consisting of several hundred small beams of varying intensities that pass through normal tissue without doing significant damage, but converge to give a precise doses of radiation at the tumor site.
Cone Beam CT (CBCT) improves tumor targeting using high-resolution, low-dose digital imaging in the treatment room. This allows our radiation therapists to confidently manage treatment and target tumor movement, before and during treatments. The use of kV image technology can result in lower patient radiation dose and better image quality than megavoltage imaging.
Image-Guided Radiation Therapy (IGRT) coordinates the radiation treatment plan with 3D images to enhance radiation beam accuracy on targeted tumors. The high-resolution images produced by the IGRT On-Board Imager™ enables clinicians more precise treatment delivery and planning, improving radiation beam accuracy by pinpointing tumor location with unprecedented speed. Increased precision ensures targeted accuracy, avoiding surrounding critical structures. A tighter tissue margin spars surrounding healthy tissues and allows a bigger radiation therapy dose delivery rate directly to the targeted tumor. A larger radiation dose destroys cancer cells quicker without increasing treatment side effects. This application helps deliver adequate radiation for tumor elimination while minimizing radiation exposure of healthy tissue.
Tumors move during radiotherapy due to biological reasons such as breathing, swallowing and bladder filling. By combining scanning and radiation equipment to produce real-time images of the patient’s organs in treatment position at treatment time optimizes accuracy and radiotherapy precision. Using the IGRT On-Board Imager we verify tumor location prior to each treatment and make any needed adjustments.