Prostate Cancer Treatment with Brachytherapy: A Comprehensive Overview
Brachytherapy, a type of radiation therapy, is a common treatment option for prostate cancer. This procedure involves the placement of radioactive substances near a tumor to potentially kill more cancer cells than healthy ones. There are two main types of brachytherapy: Low Dose Rate (LDR) and High Dose Rate (HDR).
Long-Term Effects of Brachytherapy
Both LDR and HDR brachytherapy can have long-term effects on a person's urinary, bowel, sexual, and general health. Common urinary complications include incontinence, frequent urination, urinary urgency, and irritation, which can persist long term but often improve over time. Bowel dysfunction may also occur, leading to possible long-term irritation including diarrhea, urgency, or bleeding. Erectile dysfunction is another shared complication, with sexual function decline being common after prostate radiation. Some patients may also experience sustained fatigue following treatment, though this usually resolves within months post-therapy.
Lymphedema, or the accumulation of lymph fluid in legs or the perineal area, is reported but less common.
Specific Considerations for LDR Brachytherapy
LDR brachytherapy involves the permanent implantation of radioactive seeds that emit radiation over 1–3 months. The risk of radiation affecting nearby tissues depends on seed placement accuracy. The use of absorbable rectal spacers has shown to reduce rectal radiation dose and toxicity post-LDR brachytherapy, potentially lowering bowel side effects.
Specific Considerations for HDR Brachytherapy
HDR brachytherapy delivers high doses through temporary catheters inserted 2–3 times with short dwell times (~15 minutes). This type of brachytherapy is used for primary treatment and also reirradiation in some patients. While urinary and bowel side effects may be acute, they are generally manageable with careful planning.
Additional Risks
Both LDR and HDR brachytherapy carry a minimal increased risk of secondary cancers in the bladder or gastrointestinal tract due to radiation exposure.
Precautions and Follow-Up Care
People who have undergone LDR brachytherapy may be advised to strain their urine for a week after the procedure to catch any pellets that may migrate to the urinary tract. Using a condom during sex is also advisable for people who have undergone LDR brachytherapy. Pregnant people and small children should avoid contact with someone who has undergone LDR brachytherapy.
Brachytherapy is a surgical procedure that requires an anesthetic. After the treatment, catheters are removed, and a person may experience pain-relief medication before catheter removal, tenderness in the catheter area for a few months, and should avoid strenuous activities for several weeks.
Follow-up care is necessary after any cancer treatment, including brachytherapy, to monitor cancer progress, discuss side effects, and anticipate potential issues. Bone density testing may be recommended during follow-up care to gauge a patient's risk of bone fractures.
In conclusion, both LDR and HDR brachytherapy are effective localized treatments for prostate cancer with similar profiles of long-term urinary, bowel, and sexual side effects. The use of modern techniques such as rectal spacers and advanced planning aims to minimize these complications.
- The long-term effects of brachytherapy, whether it's LDR or HDR, can impact a person's health-and-wellness in various ways, including urinary incontinence, sexual dysfunction, and bowel dysfunction.
- LDR brachytherapy, which involves the permanent implantation of radioactive seeds, requires careful placement to minimize radiation affecting nearby tissues and potential side effects, but the use of absorbable rectal spacers can help reduce bowel radiation dose and toxicity.
- Both LDR and HDR brachytherapies carry a minimal increased risk of secondary medical-conditions like cancer in the bladder or gastrointestinal tract due to radiation exposure, and follow-up care is essential to monitor the patient's health, discuss side effects, and anticipate potential issues.
