Prostate Surgery

Prostate Brachytherapy: What You Need to Know

In cases of high risk of cancer progression and treatment relapse, surgical intervention may be necessary. Brachytherapy is a type of radiotherapy that is used to treat localized and locally advanced prostate cancer. It reduces the risk of prostate cancer progression and mortality.

However, like other treatments for prostate cancer, brachytherapy has side effects. You may experience erectile dysfunction, urinary problems, and bowel complications.

Many factors influence the effectiveness of brachytherapy, including cancer stage, age, and general health.

However, other treatment options, radical prostatectomy, external beam radiotherapy, hormone therapy, and chemotherapy may be more suitable for your case.

These approaches also cause side effects, some of which are similar to the side effects of brachytherapy. Therefore, lifestyle changes and natural supplements may be useful in reducing your prostate cancer, its progression, and treatment side effects.

We generally are against any invasive surgery, but we also think our readers should be informed, which is why we would share this

Here, we describe vital information about this treatment option. We also discuss some of the alternative approaches to consider for your specific disease.

What is brachytherapy?

Brachytherapy involves implanting radioactive material inside the body to target and destroy cancer cells with doses of radiation. Radiation therapy uses high-energy rays to damage the genetic information (DNA) in the cells of the patient.

There are two main types of radiation therapy (brachytherapy and external beam radiation), depending on the position of the radiation source.

Brachytherapy (internal radiation) uses radioactive implants placed near or inside the target area to kill cancer cells.

Brachytherapy implants are either permanent or temporary. In permanent brachytherapy, the radioactive implants stay inside the body until their radioactivity finish.

Conversely, temporary brachytherapy usually involves multiple radiation treatments within a short time. Both approaches effectively destroy the tumor, but not the nearby healthy tissues.

This targeted approach delivers a higher radiation dose more precisely to tumors. Unlike external beam radiation therapy, it is invasive and requires the insertion of implants under anesthesia.

What diseases is brachytherapy used for?

Brachytherapy treats numerous types of cancer and some non-malignant diseases. It is useful for the early stages of prostate cancer, cervical cancer, and other gynecological cancers. Internal radiation therapy also works for cancer of the brain, breast, head and neck, and soft tissue.

Brachytherapy is an effective way to treat cancer, providing a safe local treatment alternative to surgical removal of the prostate gland. It reduces the risk of some treatment side effects.

For localized or locally advanced prostate cancer, brachytherapy may cure the disease. Further, it useful for destroying residual tumors remaining after surgery.

What are the different types of brachytherapy?

Brachytherapy is characterized by the duration of irradiation, positioning of the radioactive materials, and the dose rate.

Duration

  • Permanent: when the radioactive sources remain in the body, but the radiation gets weaker over time.

  • Temporary: when the radioactive sources are removed after a predetermined time.

Position

  • Interstitial: when the radioactive sources are inserted in the tumor.

  • Contact: when the radioactive sources are placed close to the tumor, intracavitary, intraluminal, endovascular, and surface contact.

Dose

  • Low-dose-rate (LDR)

  • Medium-dose-rate (MDR)

  • High-dose-rate (HDR)

  • Pulsed-dose-rate (PDR)

Your doctor, in conjunction with a clinical radiologist, will help you determine the best combination of these features based on your unique characteristics.

How does brachytherapy work?

Brachytherapy uses radioactive implants placed directly in or next to the tumor to kill cancerous cells. Cancer cells exposed to radiation can die either by direct or indirect mechanisms.

Direct action occurs when radiation physically breaks the bonds holding DNA bases. Indirectly, the action of free radicals created by radiation can damage this chemical bond. Free radicals are highly reactive and form oxidative compounds.

These compounds initiate a harmful cascade of chemical processes in the cells. These chemical processes can cause structural and functional changes that lead to cancer cell death.

As a result of the damaged genetic material, cancer cells stop growing and multiplying, leading to disease control.

Further, the speed of cell growth influences how quickly the cell will die from radiation. Cancers cells tend to divide quickly, making them more sensitive to radiation compared to healthy cells.

However, it also affects the dividing cells of healthy tissues, which causes unwanted side effects. Essentially, radiation therapy is a balance between killing cancer cells and reducing damage to non-cancer cells.

Irradiating the tumor from inside the body allows the treatment to be precise and effective. It also reduces the risk of any unwanted damage to healthy tissue surrounding cancer, reducing the risk of side effects.

When should you consider brachytherapy treatment?

Suitability for the different types of brachytherapy depends on:

  • The stage of prostate cancer (Gleason score)

  • The size of the tumor

  • The level of prostate-specific antigen (PSA).

It may also depend on other clinical characteristics, including

  • Suitability for an anesthetic

  • The prostate volume

  • The severity of current urinary symptoms, and age.

Low dose rate brachytherapy is recommended for localized disease or early prostate cancer.

High dose rate brachytherapy is recommended for locally advanced disease or when the tumor has higher grade or higher volume.

Unfortunately, some men will not benefit from either type of brachytherapy. It would help if you discussed your circumstances with your doctor to identify an effective treatment option.

Who should undergo brachytherapy?

As stated, the suitability of brachytherapy depends on your clinical presentation, unique features, and disease history. Unfortunately, you cannot decide to have brachytherapy without considering these factors.

Your medical team will help you decide whether your circumstances allow for brachytherapy and determine a treatment plan. They must collect and evaluate all relevant information about your general health to determine your suitability.

Expect to undertake additional tests to confirm that prostate cancer is at the right stage for brachytherapy.

Why is brachytherapy used?

Brachytherapy is an effective way to treat a variety of cancer, including:

  • Prostate cancer

  • Rectal cancer

  • Breast cancer

  • Head and neck cancers

  • Lung cancer

  • Cervical cancer

  • Other gynecological cancers

For prostate cancer, brachytherapy is suitable for a variety of cases, including to:

  • Treat low-grade localized prostate cancer.

  • Support other treatment methods, such as hormone therapy or chemotherapy for metastatic prostate cancer.

  • Slow the progression of advanced prostate cancer.

  • Relieve symptoms.

Effectiveness of brachytherapy

What groups of people are brachytherapy most suitable for?

Brachytherapy is most suitable for younger men whose cancer has not spread outside the prostate gland. Usually, these men have a medium or high risk of cancer progression and treatment relapse.

You may have a medium risk of prostate cancer progression if you have one or more of:

  • PSA level between 10-20 ng/ml

  • Gleason 7

  • Tumor stage T2B

For high risk of prostate cancer, you may have one or more of:

  • PSA level above 20 ng/ml

  • Gleason above 7

  • Tumor stage above T2B

What stages of cancer respond best to brachytherapy?

Most cancers have four stages, described as stage 1 to stage 4, depending on whether the cancer is localized or metastatic.

Brachytherapy is most effective for stage 1 and 2 tumors that have not spread to other organs in the body. For early-stage cancers, the outcome of brachytherapy is comparable to surgery.

Here, it has no increased risk of side effects and may reduce certain side effects. Specifically, brachytherapy is useful in tumors that are difficult to reach for surgery.

How does the effectiveness of brachytherapy compare to other cancer treatments?

Prostate brachytherapy is one of the most effective treatments for localized or locally advanced prostate cancer (Chin et al., 2017). It has comparable 10-year survival rates to radical prostatectomy (prostate surgery) (Chin et al., 2017).

Studies have reported a lower incidence of impotence and incontinence after brachytherapy compared to surgical treatment (Skowronek, 2013).

Further, brachytherapy benefits patients with existing cardiovascular diseases, which increases the risk of a severe adverse event from surgery.

However, radiation may damage surrounding healthy tissues leading to side effects, including;

  • Erectile dysfunction – may cause you to experience an erection problem and possible impotence.

  • Urinary incontinence – rarely may experience frequent urination and symptoms of the irritated urethra.

  • Bowel side effects – may cause rectal irritation to diarrhea and rectal leakage.

  • Lymphedema – may affect lymph nodes, causing swelling and pain.

Alternatives to brachytherapy

When should you consider an alternative treatment to brachytherapy?
Radiation is not a viable option if you have had previous radiation therapy to your pelvic region or have bowel disease, which can deteriorate after radiation therapy.

Curative brachytherapy is only beneficial to younger men. In these circumstances, you may benefit from alternative approaches like;

  • Lifestyle changes

  • Natural anti-cancer agents

  • Watchful waiting or active surveillance

  • Radical prostatectomy

  • Hormone therapy

  • Chemotherapy or a combination therapy

What are the best natural treatments to consider in place of brachytherapy?

Currently, radiation therapy (brachytherapy and external beam radiation therapy) and surgical treatment are the only definitive treatment for non-metastatic prostate cancer.

However, you can take action to improve your prostate health, which will reduce your risk of developing prostate cancer.

Lifestyle changes are the best natural way to reduce your overall risk of developing cancer, including prostate cancer.

You should consider regular physical activity and a healthy diet.

  • Physical activity: Sedentary lifestyle and obesity increase the risk of developing several types of cancer. Lower daily calorie intake and regular physical activity can reduce the risk of prostate cancer and its progression. For men with a confirmed diagnosis of prostate cancer, healthy weight reduces the severity of their prostate cancer symptoms. It is also favorable for contemporary treatments for prostate cancer.

  • Healthy diet: Like physical activity, a low-fat diet rich in fruit and vegetables lowers the risk of prostate cancer. Green leafy vegetables are rich in antioxidants. As a result, they can help to reduce inflammation and the risk of prostate cancer.

    A placebo-controlled trial studied men with localized prostate cancer randomized to either a food supplement containing pomegranate, green tea, broccoli, and turmeric or placebo control for six months (Thomas et al., 2014). They demonstrated a significant reduction in PSA in the food supplement group compared to the placebo.

    A trial for mixed daily supplementation with 35 mg lycopene, 55 ug selenium, and 600 mg green tea catechins also reported clinical benefits (Gontero et al., 2015).

Certain vitamins and minerals found in plant-based foods like sesame seeds, tomatoes, avocados, walnuts, and pomegranate can improve prostate health and reduce the risk of cancer.

  • Zinc – is essential for your prostate health. Sesame seeds, almonds, and pumpkin seeds are good sources of zinc.

  • Lycopene – can lower the levels of PSA, a marker of prostate cancer activity. Lycopene supplementation is useful for reducing the risk of developing different types of cancers, including skin, breast, lung, prostate, and liver cancers, through reducing oxidative stress and inflammation (Khan et al., 2008). Lycopene-rich foods like tomatoes, watermelon, papaya, and apricots are beneficial to prostate health. In advanced prostate cancer, it modulates markers of disease progression and recurrence.

  • Beta-sitosterol – can reduce the severity of prostate cancer urinary symptoms. In some cases, the usual treatments do not work. Thus, natural approaches may be the best way to improve your symptoms. Beta-sitosterol improves urinary flow and reduces residual urine volume. Avocados, soybeans, and pumpkin, provides a safe, natural source of this therapeutic agent.

What natural supplements can improve the outcome of brachytherapy?

Lifestyle changes and natural supplements may help improve outcomes and reduce side effects. Yet, the benefits or harmful effects of taking natural supplements on brachytherapy outcomes remain controversial.

For instance, several clinical trials have demonstrated that cotreatment with antioxidants and radiation therapy can reduce treatment side effects through the protection of healthy cells from damage (Lawenda et al., 2008).

Conversely, other studies showed that antioxidants might protect both normal and tumor cells from radiation-induced oxidative damage, reducing the effectiveness of radiotherapy (Hasan et al., 2010; Lawenda et al., 2008).

Nicholas et al., in a retrospective study, investigated the effects of health supplements on the outcomes and toxicities in prostate cancer patients treated with radiation therapy.

The analysis showed that men who were taking a health supplement had better overall survival compared to non-supplement control (Zaorsky et al., 2016). However, adjusting for lifestyle factors and other diseases reduced this survival benefits.

There were no differences in rates of disease recurrence, metastasis, and cancer-specific survival between the groups. The toxicities of radiation therapy were similar for both groups (Zaorsky et al., 2016).

Therefore, careful assessment of your circumstances is an essential aspect of safe supplementation during brachytherapy. It would be best if you discussed the initiation of any dietary supplements with your doctor.

Sources

  1. Chin, J., Rumble, R.B., Kollmeier, M., Heath, E., Efstathiou, J., Dorff, T., Berman, B., Feifer, A., Jacques, A., Loblaw, D.A., 2017. Brachytherapy for patients with prostate cancer: American Society of Clinical Oncology/Cancer Care Ontario joint guideline update. J. Clin. Oncol. 35, 1737–1743.
  2. Gontero, P., Marra, G., Soria, F., Oderda, M., Zitella, A., Baratta, F., Chiorino, G., Gregnanin, I., Daniele, L., Cattel, L., 2015. A randomized double‐blind placebo controlled phase I–II study on clinical and molecular effects of dietary supplements in men with precancerous prostatic lesions. Chemoprevention or “chemopromotion”? The Prostate 75, 1177–1186.
  3. Hasan, Y., Schoenherr, D., Martinez, A.A., Wilson, G.D., Marples, B., 2010. Prostate-specific natural health products (dietary supplements) radiosensitize normal prostate cells. Int. J. Radiat. Oncol. Biol. Phys. 76, 896–904.
  4. Khan, N., Afaq, F., Mukhtar, H., 2008. Cancer chemoprevention through dietary antioxidants: progress and promise. Antioxid. Redox Signal. 10, 475–510.
  5. Lawenda, B.D., Kelly, K.M., Ladas, E.J., Sagar, S.M., Vickers, A., Blumberg, J.B., 2008. Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? J. Natl. Cancer Inst. 100, 773–783.
  6. Skowronek, J., 2013. Low-dose-rate or high-dose-rate brachytherapy in treatment of prostate cancer–between options. J. Contemp. Brachytherapy 5, 33.
  7. Thomas, R., Williams, M., Sharma, H., Chaudry, A., Bellamy, P., 2014. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the UK NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 17, 180.
  8. Zaorsky, N.G., Churilla, T.M., Ruth, K., Hayes, S.B., Sobczak, M.L., Hallman, M.A., Smaldone, M.C., Chen, D.Y., Horwitz, E.M., 2016. Men’s health supplement use and outcomes in men receiving definitive intensity-modulated radiation therapy for localized prostate cancer. Am. J. Clin. Nutr. 104, 1583–1593.

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