Brachytherapy, also known as internal radiation therapy, is a form of treatment for prostate cancer that involves placing a radioactive source directly into or near the tumor. This method allows for a high dose of radiation to be delivered to the cancerous cells while minimizing exposure to the surrounding healthy tissue. Brachytherapy is considered an effective and minimally invasive option for many men diagnosed with prostate cancer.
Types of Brachytherapy
There are two main types of brachytherapy used to treat prostate cancer: low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy.
Low-Dose-Rate (LDR) Brachytherapy
LDR brachytherapy involves implanting small radioactive seeds, typically made of iodine-125 or palladium-103, directly into the prostate gland. These seeds emit radiation at a low dose rate over a period of weeks or months. The implantation procedure is usually done under general or spinal anesthesia and takes about one to two hours. The seeds remain in the prostate permanently, although their radiation diminishes over time.
High-Dose-Rate (HDR) Brachytherapy
HDR brachytherapy, on the other hand, involves temporarily placing a radioactive source, such as iridium-192, into the prostate through catheters. This treatment delivers a high dose of radiation over a short period, often minutes to hours. HDR brachytherapy is usually administered in multiple sessions, each separated by a few days. The radioactive source is removed after each session, leaving no permanent implants in the prostate.
Procedure and Recovery
Preparation
Before undergoing brachytherapy, patients typically undergo a series of tests and imaging studies to determine the exact size and location of the prostate and the cancer within it. These tests may include a transrectal ultrasound, MRI, or CT scan. The treatment plan is then tailored to the patient’s specific anatomy and cancer characteristics.
Implantation Procedure
During the procedure, the patient is positioned under anesthesia, and imaging guidance is used to accurately place the radioactive seeds or catheters. In LDR brachytherapy, needles are inserted through the perineum (the area between the scrotum and the anus) to deliver the seeds into the prostate. In HDR brachytherapy, catheters are similarly placed, but the radioactive source is temporarily inserted and then removed after each treatment session.
Post-Treatment Care
After the procedure, most patients can go home the same day or after a short hospital stay. Recovery is usually quick, with most men resuming normal activities within a few days. Mild side effects such as bruising, mild pain, and urinary symptoms (e.g., frequency, urgency, or discomfort) may occur but typically resolve within a few weeks.
Effectiveness and Benefits
Brachytherapy has been shown to be highly effective in treating localized prostate cancer, with success rates comparable to or better than those of external beam radiation therapy (EBRT) and surgery. The targeted nature of brachytherapy allows for higher doses of radiation to be delivered directly to the tumor while sparing nearby healthy tissues, resulting in fewer side effects.
Advantages
- Minimally Invasive: Brachytherapy is a less invasive option compared to surgery, with shorter recovery times and less risk of complications.
- Precision: The precise delivery of radiation helps to minimize damage to surrounding healthy tissues, reducing the risk of side effects.
- Convenience: LDR brachytherapy typically requires only one procedure, while HDR brachytherapy involves fewer treatment sessions compared to EBRT.
- Effectiveness: High success rates in controlling localized prostate cancer.
Risks and Side Effects
While brachytherapy is generally well-tolerated, it is not without potential risks and side effects. Some men may experience urinary problems, such as increased frequency, urgency, or difficulty urinating. In rare cases, more severe complications like urinary retention or incontinence can occur. Bowel symptoms, including rectal discomfort or diarrhea, may also be experienced, although these are typically mild and temporary.
Sexual side effects, such as erectile dysfunction, can occur but tend to be less common and less severe than with other treatments like surgery. The risk of long-term complications is relatively low, and many side effects diminish over time.
Candidate Suitability
Brachytherapy is generally recommended for men with early-stage, localized prostate cancer. It is particularly suitable for patients with low to intermediate-risk disease. Factors such as the patient’s overall health, prostate size, and cancer characteristics will be considered when determining the best treatment approach.
For some men with higher-risk prostate cancer, brachytherapy may be combined with other treatments, such as EBRT or hormone therapy, to improve outcomes.
Nursing Care of a Patient with Brachytherapy for Prostate Cancer
Brachytherapy, an internal radiation therapy, is a common treatment for localized prostate cancer. This minimally invasive procedure involves placing radioactive seeds directly into the prostate gland. The nursing care of patients undergoing brachytherapy is crucial for ensuring optimal outcomes and managing potential side effects.
Pre-Treatment Care
Patient Education
Informing the Patient: Nurses play a key role in educating patients about the brachytherapy procedure, its benefits, risks, and potential side effects. This helps in alleviating anxiety and preparing the patient mentally and physically for the treatment.
- Procedure Overview: Explain the steps involved in the procedure, including the placement of radioactive seeds or sources.
- Expected Outcomes: Discuss the anticipated benefits, such as high success rates in controlling prostate cancer.
- Potential Side Effects: Provide information on common side effects such as urinary and bowel symptoms, and less common complications like erectile dysfunction.
Pre-Procedure Assessment
Health Assessment: A thorough health assessment is essential to determine the patient’s suitability for brachytherapy. Factors such as overall health, prostate size, and cancer characteristics are considered.
- Medical History: Review the patient’s medical history, including any previous treatments for prostate cancer.
- Physical Examination: Conduct a physical examination focusing on the prostate and surrounding areas.
- Diagnostic Tests: Ensure that necessary diagnostic tests, such as blood tests and imaging studies, are completed.
Post-Treatment Care
Monitoring and Managing Side Effects
Immediate Post-Procedure Care: After the procedure, monitor the patient closely for any immediate complications or side effects.
- Urinary Symptoms: Monitor for urinary problems such as increased frequency, urgency, or difficulty urinating. Provide interventions as needed to alleviate symptoms.
- Bowel Symptoms: Assess for rectal discomfort or diarrhea and provide appropriate care to manage these symptoms.
- Sexual Side Effects: Discuss the potential for erectile dysfunction and offer support or referrals to specialists as needed.
Long-Term Follow-Up
Regular Check-Ups: Schedule regular follow-up appointments to monitor the patient’s progress and manage any long-term side effects.
- PSA Testing: Regular PSA tests to monitor prostate-specific antigen levels and assess the effectiveness of the treatment.
- Health Monitoring: Continual assessment of urinary, bowel, and sexual health to address any emerging issues promptly.
Patient Support and Education
Emotional Support
Counseling Services: Provide access to counseling services to help patients cope with the emotional aspects of cancer treatment.
- Support Groups: Encourage participation in support groups for patients with prostate cancer to share experiences and gain support.
Lifestyle and Self-Care
Healthy Living: Educate patients on maintaining a healthy lifestyle to support their recovery and overall well-being.
- Diet and Nutrition: Offer guidance on a balanced diet to support immune function and overall health.
- Physical Activity: Encourage regular physical activity tailored to the patient’s capabilities and recovery stage.
REFERENCES
- American Brachytherapy Society. What is brachytherapy?https://www.americanbrachytherapy.org/resources/for-patients/what-is-brachytherapy/.
- Wein AJ, et al., eds. Radiation therapy for prostate cancer. In: Campbell-Walsh Urology. 11th ed. Elsevier; 2016. https://www.clinicalkey.com
- Zoarsky NG, et al. The evolution of brachytherapy for prostate cancer. Nature Reviews Urology. 2017; doi:10.1038/nrurol.2017.76.
- American Cancer Society. Getting Internal Radiation Therapy (Brachytherapy)https://www.cancer.org/cancer/managing-cancer/treatment-types/radiation/internal-radiation-therapy-brachytherapy.html. Updated 12/27/2019.
- National Cancer Institute (U.S.). Prostate Cancer Treatment (PDQ®) Patient Version. https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#_142. Updated 2/16/2023.
- Bekelman, JE, et al. Clinically localized prostate cancer: ASCO clinical practice guidelines endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology guideline. Journal of Clinical Oncology. 2018; doi:10.1200/JCO.18.00606.
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
