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Treatment of Prostate Cancer

Alternative Prostate Cancer Treatments

Deciding on the best treatment option for prostate cancer

Prostate Seed Institute’s founder is Dr. Gregory Echt, a leading radiation oncologist has professionally committed his life to providing cancer patients with the most effective treatments available. To that end, Dr. Echt and his team of experts at Prostate Seed Institute provide patients with the best state-of-the-art radiation therapy available in the U.S.; methods that are on par with those offered in world-renowned medical centers.

Dr. Echt and his team have provided treatment to over 4,000 men using these highly effective methods including brachytherapy (prostate seed implantation), high dose radiation implants, and external beam radiation with image-guided (IGRT) and intensity-modulated (IMRT) capabilities.

The team at the Prostate Seed Institute believes in working closely with the patient and his family, along with a team of dedicated medical experts to decide on the best treatment option available. Many factors are considered when making this decision – factors that include the patient’s diagnosis including the grade and stage of cancer, his overall health, age, and what he considers to be most important in terms of maintaining a certain quality of life during treatment and the potential side effects of each treatment. 

Prostate Cancer Treatment Options

Radiation therapy is one of the more commonly used treatments for prostate cancer – offering options for safely and effectively treating prostate cancer and many other cancers. Goals of radiation therapy include curing cancer, controlling cancer growth, or relief of cancer symptoms including pain. Radiation therapy damages cancer cells in such a way that cancer cells cannot reproduce. When damaged cancer cells die, the body naturally eliminates them. Radiation affects normal cells, but they are able to recover from the treatment in a way that cancer cells cannot.

Prostate Seed Implantation (Brachytherapy or Internal Radiation): During this procedure, tiny radioactive “seeds” are placed in the prostate cancer tumor site. Over time, the material of the seed begins to disintegrate and, as it does, a low dose of radiation is released. When the seed eventually disintegrates entirely – over the course of several weeks or even months – there is no radioactive material left behind in the prostate.This precise placement allows for nearby tissues and organs to be minimally effected. The procedure itself is minimally invasive and only takes about an hour. Following the procedure, the patient is able to go home the same day and resume his normal routine within just a few days. With over a decade of research data accrued on brachytherapy, it has been shown to be a highly effective method for treating prostate cancer.

High Dose Radiation Therapy (HDR or Temporary Brachytherapy): HDR is another form of internal radiation. This therapy involves placing radioactive seeds temporarily in the prostate. These seeds contain more radioactive material than those used in traditional prostate seed implants. The procedure involves a hospital stay during which a template is fitted to the area to be treated. The patient is treated with seed placement two or three times initially, then two weeks later the treatment is repeated. More…

External Beam Radiation: External beam radiation therapy generally involves treatments at a radiation facility once a day, Monday through Friday for seven to eight weeks. The treatments cause no pain and each session lasts a few minutes. The primary target is the prostate gland itself. Dr. Echt offers intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), and 3D conformal radiation therapy. These treatments use the same technology found in major medical and academic settings. More…

Combination Therapy of Seed Implant and External Beam Radiation Therapy: Patients with advanced stage prostate cancer have a high risk of the disease spreading outside the prostate. In these cases, external beam therapy may be needed in addition to seed implants or HDR treatment. More…

Another treatment option, besides radiation, is hormonal therapy.

Hormonal Therapy: In many cases, if the cancerous tumor is large, hormonal therapy may be started at the time of radiation therapy and continued for several years. Hormonal therapy is treatment that suppresses, eliminates, or adds particular hormones to slow or stop the growth and/or spread of cancer.

Quality Assurance

Whether a patient undergoes a traditional seed implantation, HDR treatment, external beam treatment, or combined therapy, significant work is done to make sure the treatment is completed properly. The process that is set up is called quality assurance.

Each type of treatment requires trained staff and high quality equipment with an ongoing verification of periodic inspections, calibrations, and updates. Physicists specializing in medical application of radiation review every patient’s treatment. They also conduct the ongoing tests of all equipment used in planning and delivery of radiation treatments.

For traditional prostate seed implants, a CATScan is acquired about one month after the procedure and the images are used to determine the precise location of each seed within the prostate. The radiation dose distribution is calculated and the results are reviewed with the radiation oncologist. For external beam treatments using Intensity Modulated Radiation Therapy (IMRT) each treatment field is test run and compared to the intended pattern before treatments begin. For HDR treatments, independent cross checks of the radiation source positions and dwell times is verified prior to treatment.

Each treatment modality involves a team including a nurse, radiation therapists, and physicist in addition to the physician. Each team member is licensed by the state and ongoing training and continuing education is provided to keep up-to-date with the latest advances in treatment techniques. The goal of each is to provide a safe, effective treatment.

Prostate Seed Implantation or Brachytherapy

Dr. Gregory Echt focuses on prostate seed implantation as the preferred method of treatment for prostate cancer. It is the fastest growing method of treating prostate cancer in the United States. Dr. Echt has performed this
procedure on over 4,000 men over his 17 years in practice.

Criteria necessary for a patient to be considered for seed implantation alone (monotherapy):

If it is likely that cancer has spread outside the prostate gland, external beam radiation may also be required.

Advantages of seed implants:

  • The procedure takes about one hour, then the patient walks out of the clinic and is driven home by a friend or family member. Most patients are back to a normal routine within a day or two.
  • We have been collecting data on seed implantation for fifteen years and the data has shown that this form of therapy is a highly effective option for successfully treating prostate cancer. In fact, through a variety of medical studies, collected data has shown that seed implantation equals – and even exceeds – the cure rate associated with surgery.
  • Treatment is generally painless, as the patient is given a mild anesthetic.
  • Recovery is much quicker and has fewer complications because the procedure does not require major surgery.
  • Rates of sexual problems such as erectile dysfunction (ED) and urinary problems are very low. According to the American Cancer Society, a major study (CaPSURE), rates brachytherapy as having the lowest rate of sexual dysfunction of any treatment, even after five years.

Disadvantages of seed implants:

  • Following seed implantation, many men may experience an urgency associated with urination, as well as increased frequency of urination, and even a weakened urine stream. These are all temporary conditions that eventually resolve themselves. However, in a very small percentage of men – less than 5% – there can be a temporary inability to urinate. Medical intervention is necessary in this case and may require medication or temporary catheterization.
  • Following seed implantation, a patient’s PSA levels may decline for the next several years, requiring the medical team to keep a close eye on PSA levels. During this time, a PSA test will not be an accurate indicator of the presence of cancer or other conditions.
  • Erectile dysfunction and other sexual problems may occur as result of seed implantation in about 20% to 30% of patients. Age does tend to play a part in this, as younger patients are less likely to experience sexual dysfunction. If this becomes a problem, medications, such as Viagra, can be prescribed – which have been successful in treating up to 75% of patients with these side effects.

How does prostate seed implantation work?

Prostate seed implantation, or brachytherapy, is one of the fastest growing therapies for treating prostate cancer in the U.S. It is minimally invasive, fast, highly effective, and allows patients to return to their normal routine as quickly as possible.

prostate seed implantation

Here’s how it works…

The patient is first given a local anesthetic, after which small radioactive “seeds” – about the size of a piece of rice – are injected directly into the prostate using a needle that is inserted into the area between the anus and the scrotum. Doctors use ultrasound and computer technology to help guide them in their placement of the seeds. Images taken during the ultrasound are communicated to the computer which analyzes the images and determines the precise position of the prostate gland itself in a 3-D picture. This image allows doctors to precisely place the seeds to ensure that the entire prostate gland is exposed to radiation. This is necessary because in most cases there are several areas in the prostate gland where cancer has been identified.

The seeds are not removed but are rather left there permanently where they begin to disintegrate over the next few weeks or months.

As they disintegrate, the seeds give off a low dose of radiation – enough to target and kill cancer cells in that precise area without harming any nearby healthy tissue. Once the seeds have entirely disintegrated, there is no radioactive material left behind.

Prostate seed implantation only takes about an hour after which the patient is able to go home. A normal routine can be resumed within just a few days. There are no restrictions other than care being taken around pregnant women and newborn children who may be more sensitive to radiation exposure however minimal.

High-Dose Rate (HDR) Brachytherapy

High-dose rate brachytherapy (HDR or Temporary brachytherapy) is a newer form of brachytherapy involving seeds that are placed temporarily in the prostate gland. These seeds stay in place for less than an hour and contain higher intensity radioactive material than traditional prostate seed implants.

Using sophisticated computer and radiologic techniques, the patient is fitted with a template that holds tiny tubes, also called catheters, in place. The catheters are placed within the prostate and pelvis, with a length of the catheter remaining outside the body for connection to the high dose radiation machine. The fitting of the template and catheters is done in the operating room, followed by an overnight stay in the hospital. The catheters and the template remain in place for one to two days during each treatment.

A series of radiation treatments, usually three, are given the day after the fitting of the template. A computer-controlled device pushes highly radioactive seeds into the tubes one by one and controls the length of time each seed remains in place, thus controlling the radiation dose in different areas of the prostate. A higher dose can be targeted at the tumor, with a lower dose given in the areas near the urinary tract and rectum. The tubes are then removed and no radioactive material is left in the prostate gland. The patient returns in two weeks and the same treatment is repeated. The treatment is relatively pain-free.

Most prostate cancer patients are candidates for HDR brachytherapy, if so desired.

Advantages of HDR brachytherapy:

  • Treatment requires only minor surgery, therefore there are fewer surgery-related complications.
  • Treatment is generally painless, as the patient is given a mild anesthetic.
  • Recovery is much quicker because the procedure does not require major surgery.
  • There is the ability to modify radiation dosage after the catheters are in place to dispense radiation.
  • Impotence and incontinence rates, or urinary problems, are very low. According to the American Cancer Society, a major study (CaPSURE) rates brachytherapy as having the lowest rate of sexual dysfunction of any treatment, even after 5 years.

Disadvantages of HDR brachytherapy:

  • HDR treatment is demanding on the patient as he goes through multiple steps including template fitting, catheter placement, and radiation treatment. The template and catheters remain in place in the genital area during the entire nearly 24-hour process.
  • This treatment is inconvenient for patients in terms of time because it requires an overnight stay in the hospital for template fitting and a second day for treatment. In addition, two weeks after the initial treatment, the patient must return for another template fitting, including an overnight stay in the hospital, and a second day of treatment.
  • The patient may experience pelvic discomfort for several weeks after treatment due to the dose intensity. This can be treated with over-the-counter medication.

Other Prostate Cancer Treatment Options

While external beam radiation therapy or brachytherapy is often recommended for the treatment of prostate cancer, other treatments may be available in certain cases. They include:

  • Watchful waiting or active surveillance: Some patients may find this “treatment” option is available to them. This approach involves taking no direct intervention to address the tumor, and is generally only recommended for cancer that is deemed very low risk or for patients who are older and not likely to experience negative effects related to their tumors. The treatment involves regular monitoring to ensure that a tumor’s nature and aggressiveness has not changed. Routine testing will include PSA blood screenings, clinical evaluation and prostate biopsies. If cancer progression is detected, other treatment may be recommended.
  • Surgery: Two main surgical techniques are performed to completely remove a diseased prostate gland – Radical Retropubic Prostatectomy (RRP) and the Robotic Assisted Laparoscopic Radical Prostatectomy (RALP). Both procedures involve the complete removal of the prostate gland. RRP generally takes about 2 to 3 hours to perform and does require a hospital stay of up to about 3 days if no complications arise. The procedure requires a surgeon to make an incision into the lower abdomen through which the prostate is removed. RALP is considered a minimally invasive alternative. This procedure requires surgeons make five incisions that are roughly 1-cm in length. This procedure make take up to 3.5 hours to perform, but tends to have a shorter hospital stay associated with it.
  • Cryotherapy: Also known as cryosurgery or cryoablation, this procedure involves freezing cancerous cells. It is performed under general or spinal anesthesia and calls for the use of probes that are placed through small incisions in the skin between the anus and scrotum. The probes are generally guided using transrectal ultrasound. The procedure may be performed on an outpatient basis, but is sometimes associated with an overnight hospital stay.
  • HIFU: High Intensity Focus Ultrasound, or HIFU, involves the use of highly focused ultrasound waves that raise the temperature of targeted prostate tissue up to 195 degrees Fahrenheit. The increase in temperature is held for 2 to 3 seconds in an effort to destroy cancerous cells. This procedure may be an option for men diagnosed with localized prostate cancer.
  • Chemotherapy: This standard cancer treatment may also be used to treat prostate cancer. It involves the use of drugs that are either injected intravenously or taken by mouth to stop the spread and growth of prostate cancer. Chemotherapy is generally reserved for prostate cancer cases where the disease has metastasized or has been found to be resistant to androgen deprivation therapy. Chemo is typically delivered over the course of several days to a week. This will be followed by a brief rest period before a new round of chemo begins.