Frequently Asked Questions
When considering brachytherapy for prostate cancer treatment, we prefer patients be presented with all their options before making their decision.
What is Jefferson's implant consulting process?
Used as a treatment option for prostate cancer, brachytherapy is a procedure that involves implanting tiny radioactive seeds at the site of the tumor, which, compared with external radiation for prostate cancer, allows for a higher dose of radiation to be safely administered.
What kind of physician typically performs the radioactive seed implantation procedure and in what kind of setting?
Radioactive seed implantation is performed in our hospital setting by a team consisting of a radiation oncologist, urologist and a radiation physicist. This is a highly operator dependent procedure and can reflect on the experience of the team.
What should a patient look for in an implant program?
The implant process is the summation of the skill and expertise of the team, which includes a radiation oncologist, urologist and radiation physicist. Because achieving optimal results with this type of radiation for prostate cancer requires substantial technical skill, patients should look for a program with a proven track record.
At Thomas Jefferson University Hospital we have devoted a great deal of time and energy to our implant program, which is recognized nationally and internationally for the research that has resulted from our work.
Describe the planning procedure.
Imaging of the prostate is the first step, which is performed with a CT and /or ultrasound. These images are used to estimate the number of radioactive seeds that will be required for a successful implant.
On the day of the implant, the radiation oncologist, urologist and physicist perform an ultrasound study of the prostate in the operating room to determine the exact location of each needle and seed. A prostate brachytherapy treatment plan is generated carefully based upon this information.
After a careful review of the treatment plan by each member of the team, a coordinate map of the prostate is created, which describes the location coordinates for needle and seed. This treatment plan is used in the operating room and followed closely. Needle and seed placement is confirmed with both ultrasound and fluoroscopy during the procedure. Additional seeds are available in order to make adjustments at the time of the implant.
Describe the length of the procedure and the type of anesthesia.
Typically, the procedure takes about 1½ - 2 hours and is done under general anesthesia. We prefer general anesthesia because our patients seem to tolerate it quite well. Generally, there is no sensation of pain after the procedure and painkillers are unnecessary.
What can the patient expect to feel like after the brachytherapy procedure?
Patients can expect to feel some tenderness and bruising in the affected area. Most patients require no prescription pain medications. After brachytherapy, most prostate cancer patients are somewhat tired and want to relax. Patients are not limited in their activity level after the procedure.
What side effects might occur days after the brachytherapy procedure and how long do they last?
As a result of the brachytherapy procedure, some men experience mild discomfort in the groin area for two to three days, which is managed very effectively with mild analgesics. Some blood may be seen in the urine and sperm for a few days after the procedure. This is normal and stops after two to three days. The scrotal and perineal area can also become swollen/bruised or black and blue.
The side effects of the radiation from the seeds usually begin one to two weeks after seed implantation. The main symptoms are urinary difficulties, such as frequency, urgency, weak stream or slight pain. These can last for two to six months. These can usually be effectively managed with simple medications.
What are the advantages of permanent seed implantation as compared to other treatment options?
For most patients, seed implantation is a one-time, non-surgical, low-impact procedure. Patient can return to normal activity, including work, within one to three days, with little or no pain.
When else might permanent seed implant therapy be considered?
This procedure is an alternative for men who have early-stage prostate cancer with a low risk of disease outside the gland. Permanent seed implantation is also an attractive option for men whose poor health precludes radical prostatectomy.
Does the radiation from permanent seed implants pose any danger to organs or tissue surrounding the prostate?
Because seeds are implanted accurately into the prostate, they pose little risk to surrounding organs or tissue. The radioactive isotopes used in this procedure (Iodine and Palladium) decay over a period of a few months.
Men usually develop prostate problems only when they're older.
Fortunately, most prostate problems are not life threatening. However, prostate cancer is serious and can be fatal if left untreated. Currently, a man dies from prostate cancer every 16.4 minutes. Your doctor can do a simple annual exam and blood test that can detect prostate cancer early. Below are answers to some frequently asked questions about prostate problems.
What is the prostate gland?
The prostate gland is located inside the body, right beneath the bladder and in front of the rectum. The urethra is the tube that carries urine from the bladder. The urethra passes through the center of the prostate. The prostate gland is one of the male sex glands. It produces semen, the substance that carries sperm.
What are symptoms of prostate problems?
Some prostate problems can cause trouble with urination. That's because the prostate gland is near the bladder and urethra, the tube that carries urine out of the body. Visit your healthcare provider as soon as possible if you:
- Are unable to urinate
- Need to go to the bathroom more often, especially at night
- Have difficulty starting or stopping the stream of urine
- Have a weak stream of urine
- Feel pain or burning when you urinate
- Have blood in the urine
- Have painful discharge of semen (ejaculation) during sex
- Feel pain in the lower back, pelvis or upper thighs that does not go away
These symptoms may mean you have a prostate problem or other urinary tract issue that may or may not be cancer. In most cases, the symptoms of prostate cancer do not appear in the disease's early stages.
What are some of the prostate problems men may have that are not cancer?
Prostate problems that are not cancer include infections (prostatitis) or an enlarged prostate. Prostate infections affect men of all ages. Bacteria from infections in the urinary tract may cause this condition. Inflammation or congestion of the prostate may be due to aging or a buildup of prostate fluid in the gland.
An enlarged prostate, also known as benign prostatic hypertrophy (BPH), is quite common in older men. That's because the prostate gland usually grows larger as a man gets older. As the prostate grows, it may push against the bladder or close around the urethra. This can cause problems with urination. Urinary problems due to an enlarged prostate should not be considered a normal sign of aging, though. You should seek treatment. Without proper treatment, an enlarged prostate sometimes can interfere with a normal lifestyle, and sometimes can cause severe bladder or kidney damage.
Are some men at greater risk for getting prostate cancer?
Men get prostate cancer more than any other type of cancer. Men who are over 50 are more likely to have the disease than younger men. Men with a father or brother who had prostate cancer are also at greater risk than men with no family history of the disease.
What about African-American men and prostate cancer?
African-American men have a higher risk of developing prostate cancer than white men, and more African-American men die from this disease. The reason is not clear, but when prostate cancer is found in African-American men, it is more likely to be late-stage cancer, which is hard to cure. But African-American men who have regular screening exams and who are diagnosed with prostate cancer have a better chance of surviving. Regular screening exams can catch tumors when they're smaller and more curable, and should start at age 40 if you are African-American.
How can I tell if I have prostate cancer or a benign prostate condition?
You can't make a diagnosis on your own. Early-stage prostate cancer usually has no symptoms, which is why regular screenings are so important. Urinary difficulties could be a sign of either prostate cancer or another, benign condition. That's why you should see your doctor as quickly as possible if you have any urinary-related symptoms.
How is prostate cancer detected?
Prostate cancer screening is done by a rectal exam and a prostate specific antigen blood test also known as a PSA blood test. During the rectal exam, your doctor places a gloved finger in the rectum and feels the prostate, checking its size and shape. A prostate with a hard spot may indicate cancer. The PSA blood test measures the level of a protein produced by the prostate. A high PSA level could be a sign of an enlarged prostate or inflammation of the prostate, or it may indicate the presence of cancer. These tests are quick and easy and can help find prostate cancer early when it's more treatable. Prostate cancer can only be diagnosed by a prostate biopsy. Your doctor may recommend a prostate biopsy to make the diagnosis. Discuss with your doctor at what age you should begin having yearly prostate cancer screenings as well as the risks and benefits of the screenings.
What causes prostate cancer?
No one knows what causes prostate cancer. Researchers are looking at heredity, diet (especially fatty foods), hormones, and environmental factors. There is no definite way to prevent prostate cancer, so early detection is key.
What are the stages of prostate cancer?
Once prostate cancer has been found, more tests must be done to determine if cancer cells have spread outside the prostate gland. The size of the cancer and the extent to which cancer cells have spread are described in terms of "stages." Stage T1 and Stage T2 are early stages of prostate cancer, which means the cancer is probably within the prostate gland and has not spread. T3-T4 stage prostate cancer suggests the tumor has grown beyond the prostate gland but is confined within the surrounding areas. Stage N0-N2, M0-M1 means the cancer has spread, usually to lymph nodes on distant sites. This process is called metastasis. You and your doctor need to know the stage of your prostate cancer to determine the best treatment plan.
What is the treatment for prostate cancer?
Prostate cancer treatment is based on how aggressive the cancer is and how far it has spread. The good news is that today, most cases of prostate cancer are found early, before the tumor spreads widely. The most common forms of treatment today are careful observation, surgery, radiation therapy and hormonal therapy.
Careful observation is also called "watchful waiting" or "active surveillance." If the cancer is not aggressive, or if you are older or in poor overall health, this treatment for prostate cancer may be considered. It involves periodic exams and blood tests to see if the cancer changes over time.
Surgical treatment options for prostate cancer include radical prostatectomy (complete prostate removal) or cryotherapy.
Because prostate cancer is often found is several different areas of the prostate, a radical prostatectomy or complete removal of the prostate may be necessary. Sometimes, your doctor may decide to also remove the surrounding lymph nodes to see if the cancer has spread. The benefits of radical prostatectomy are that the entire prostate is removed, the extent of the cancer can be clearly identified, and the PSA level should be undetectable after a successful operation. The risks include infection, bleeding and reaction to the anesthesia. Impotence (inability to get an erection) may be a side effect but is less likely with modern techniques that use "nerve sparing." Incontinence (leakage of urine) is also possible but not common using the latest techniques.
There are several ways to perform a prostate removal procedure. The standard technique uses an incision in the lower abdomen below the belly button. Laparoscopic prostatectomy, which was first performed in the Philadelphia region by Jefferson urologists, requires smaller incisions and telescopes. The next advance uses a robot to assist the surgeon in performing the laparoscopic prostatectomy known as the "robotically assisted laparoscopic radical prostatectomy," or the "da Vinci® Prostatectomy." These minimally invasive techniques offer the potential of less blood loss and more rapid convalescence. Jefferson has several urologic surgeons who have advanced fellowship training in laparoscopic and robotic prostatectomy techniques.
Cryosurgery kills cancer cells through deep freezing. The procedure is available but is not considered a primary surgical treatment for most patients.
Radiation therapy for prostate cancer uses high-energy form of X-rays to kill cancer cells and shrink tumors. Radiation for prostate cancer may be delivered externally or by placing radioactive seeds (“brachytherapy”) into the prostate directly. The benefits of radiation therapy as a prostate cancer treatment are that it does not involve a major operation and can usually effectively treat the cancer. The side effects are usually mild and can include irritation of the bowels and bladder. Loss of sexual function can also be seen.
The external-beam radiation is done on a daily basis over six to seven weeks. Sidney Kimmel Cancer Center – Jefferson Health radiation oncologists in the Philadelphia area use the state-of-the-art technique known as Intensity Modulated Radiation Therapy (IMRT), which delivers tightly focused radiation to the prostate while minimizing the dose to the surrounding normal tissues. The latest in image-guided therapy, also used at Jefferson, involves the placement of tiny markers in the prostate that allow the radiation beam to be even more precisely aimed at the prostate. Studies have also shown that some men may benefit from a short course of hormonal therapy along with the radiation to improve the tumor killing.
If you have early stage prostate cancer and no severe urinary symptoms, brachytherapy as a prostate cancer treatment may be an option. This one-time procedure is performed under anesthesia and delivers a high dose of radiation directly into the prostate to kill the tumor.
Most often used when the cancer has spread beyond the prostate, hormone therapy can slow the growth of prostate cancer. Hormone treatment for prostate cancer is also sometimes used along with other treatments, such as radiation, to shrink the prostate and improve the results of the treatment. Hormonal treatments are drugs that reduce the body's production of the male hormone testosterone, a hormone that acts like a fertilizer to help prostate cancer grow. These drugs are usually given as some type of shot – sometimes, along with pills. Some men can experience loss of sexual desire, reduced muscle strength and hot flashes as side effects of the treatment.
Chemotherapy is used if hormonal therapy stops working. It is not currently considered a primary treatment for prostate cancer.
What is the prognosis for prostate cancer patients?
The prognosis for prostate cancer patients has improved steadily over the years. The death rate has fallen dramatically over the last 10 years. Doctors now have a better understanding of how to diagnose this disease early. Better treatment methods have improved survival rates. Today, most men with prostate cancer can be treated effectively and resume their normal lifestyles.
What are clinical trials?
When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols. By participating in a clinical trial, you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.
To find out more about current clinical trials that you may be able to participate in, ask your doctor or call either the Sidney Kimmel Cancer Center at Jefferson's Research Management Office at 215-955-1661 or 1-800-JEFF-NOW.