Low Dose Brachytherapy

This is a radiation therapy option for the management of a localized prostate cancer.

Criteria include:

• PSA less than 10
• Gleason 3,4 adenocarcinoma prostate,
• Higher grades may have extra-prostatic extension requiring combined External Beam Radiation
• Staging negative, (bone scan negative, CT negative)
• Not younger than 65

• It is the localized radiation of the prostate, by means of trans-perineal placement of Radio-active I-125 seeds.
• This is a nerve sparing procedure and patients have a good opportunity to maintain this.
• The procedure takes 2-3hours excluding the anesthetic time.
• This is an alternative to a Radical Retropubic Prostatectomy for low-intermediate risk prostate cancer. Prostates are generally smaller than 50cc.
• Could be ideal for those patients with excessive BMI and fitting the cancer specific criteria.

How is it done?

• Under a General Anaesthetic
• Presence of Radiation Oncologist and Physicist
• Lithotomy position
• Trans-rectal placement of an ultrasound probe
• Real-time accumulation of digital images to allow real-time placement of Radioactive Iodine seeds according to an intra-operative plan

PSA failure:

• PSA not dropping to a nadir value, preferably 0,2ng/ml.
• 3 consecutive PSA rises following RRP.

Complications

• Perineal hematoma
• Wound infections
• Urgency frequency and weak stream
• Limited Erectile Dysfunction, which may only surface after 18 months after treatment.
• Lower ejaculate volume.
• Testicular pain similar to vasectomy for 2-3 days

Post operative care:

• A post-procedure CT scan to account all the seeds and exclude migration of seeds.
• Normal diet
• A salt water or Betadine Douche is required after every stool for the first week
• A 3-month course of Flomaxtra to ease Lower Urinary Tract Symptoms
• Wounds generally heal in 7-10 days

Catheter care

• Your catheter will remain until you are awake.
• Post-operative review:
• Radio-Oncology will review a few weeks later.
• You will review with me at 6 weeks post-procedure to check if you are doing fine.
• Review PSA roughly 3 months after the procedure to assess PSA track
• You should reach your Nadir (lowest PSA) at 6– 9 months after the procedure. The lower the better.
• 6 monthly PSAs thereafter.
• Expect a PSA Bump at approximately 9-12 months after the procedure, The PSA should drop thereafter
• If stable with good PSA outcomes, refer back to GP for 6 monthly PSA review

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Wes Low Dose Brachytherapy