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.
Skin is your body's largest and most visible organ. Among other functions, it protects our internal systems, regulates body temperature and acts as our sensory organ for touch. Since it is constantly exposed to the stresses of everyday living, your skin can take a beating. Some skin problems, such as dryness and thinning, occur naturally during the aging process and are mostly harmless. Other conditions, such as a rapid growth that may indicate skin cancer, are dangerous and potentially deadly. Protecting yourself with an effective sunscreen while outdoors and regularly checking your skin for any changes can help prevent sun damage and detect skin cancer early. Below are answers to some frequently asked questions about skin cancer.
What are the warning signs of skin cancer?
Skin cancer is the most prevalent of all cancers. Fortunately, the two most common types of skin cancer have well over a 95 percent cure rate because they can be readily recognized and successfully treated in their early stages. However, late detection and treatment can often result in a cosmetic disfigurement or internal spread, so watch for these warning signs and bring them to your doctor's attention immediately:
- Basal cell cancer, a nonmelanoma, is the most common type of skin cancer. This tumor may show up as a smooth, shiny lump which sometimes bleeds or develops a crust; as a flat, red spot; or as a firm, red lump.
- Squamous cell cancer, also a nonmelanoma, can be similar in appearance to basal cell skin cancer. It shows up as a rough, scaly patch or as a small, rounded lump that bleeds and does not heal. If not detected early, squamous cell cancer can spread to other parts of the body.
- Malignant melanoma is the most serious type of skin cancer and is rapidly becoming an epidemic in the United States. This tumor may prove fatal or spread to other organs if left untreated; it has a much lower survival rate than other skin cancers. Melanoma, like other skin cancers, is painless at the beginning. It often appears as a brownish-black patch with an asymmetrical shape, irregular border, and nonuniform pigmentation.
Also be aware of any changes in the surface or size of a mole, which could indicate melanoma.
What causes skin cancer?
Dermatologists agree that ultraviolet radiation from the sun is the leading cause of skin cancer. Even sunlamps and tanning booths emit ultraviolet rays that can contribute to skin cancer and premature aging and should not be considered safe alternatives to sunbathing. What's more, it's not just a week at the beach soaking up the sun that is potentially dangerous to your skin and your health. Ultraviolet rays are present all year long, and you're exposed to them daily and constantly doing the most routine things – exercising outdoors, eating lunch at an outside cafe, walking to and from work. Doctors expect the skin cancer scourge to worsen in the future because of the thinning of the earth's protective ozone layer, which filters out harmful ultraviolet rays. Other less important factors, but skin cancer contributors nevertheless, include radiation therapy, scarring from disease or burns, a family history of skin cancer and occupational exposure to certain compounds.
Who is at risk for developing skin cancer?
Anyone can get skin cancer; no one is immune. However, years of unprotected sunbathing dramatically increase your risk of getting cancer. People most susceptible to developing this disease spend much of their time in the sun without proper protection, have red or blond hair, blue or light-colored eyes and fair skin that tends to freckle or burn rather than tan. African Americans can develop skin cancer as well, although their incidence is much lower than light-skinned people because they have a higher concentration of melanin, which helps protect their skin from the harmful effects of ultraviolet radiation. Despite this innate protection, ultraviolet rays can still promote premature aging and wrinkles in dark-skinned people.
Melanoma poses the most serious risk for people with many moles. Researchers have also found that people who suffered a serious sunburn during their youth are twice as likely to develop melanoma later in life.
How is skin cancer treated?
Dermatologists use a variety of methods to remove skin cancers. Skin cancer can be treated with surgery, an electric needle, by freezing (cryosurgery) or with a highly specialized procedure known as Mohs micrographic surgery. Mohs surgery is one of the most advanced methods used to remove cancerous skin, with minimal loss of surrounding healthy tissue and little risk of leaving cancerous tissue behind. Other skin cancer treatment methods include radiation therapy and chemotherapy. Your doctor will recommend the treatment method that's best for you depending on the size of the tumor, its location and the type of cancer.
Researchers are working on immunological treatments for malignant melanoma. A vaccine has been developed that consists of the patient's own cancer cells modified with the chemical DNP. DNP changes the melanoma cells so that the body recognizes them as foreign and produces an immune response against them. Although the vaccine is still experimental, promising results have been seen in patients with melanoma that has spread to lymph nodes. Administering the vaccine following lymph node surgery has been shown to increase the chance of cure, compared with surgery alone.
How can skin cancer be prevented?
The best and most effective defensive measure against skin cancer is to reduce your exposure to the sun. Although skin cancer is most likely to appear in adulthood, sun damage is cumulative and begins in childhood, so the effects of the sun may be severe by the time a person reaches young adulthood. Less than 10 years ago, for instance, it was unusual to find skin cancer in a person under 50 years old. Today, however, dermatologists are diagnosing skin cancer in adults in their 20s. This may be due, in part, to the amount of time people have spent outdoors in recent decades, basking in the sun or not using the right amount of sun protection.
Because the sun can harm your skin and your looks year-round, doctors now recommend protecting your skin by applying a sunscreen daily, not just during the summer months. Whenever you go outside – to run errands, to walk the dog, to wash the car – always wear a sunscreen on exposed skin and choose a product with a sun protective factor (SPF) of at least 15. The higher the number, the greater protection from ultraviolet rays, although there's no need to buy a product with an SPF larger than 30. Also, look for sunscreens labeled “broad spectrum.” They block out ultraviolet B (UVB) rays, the light rays responsible for sunburns and skin cancer, as well as ultraviolet A (UVA) rays, which cause wrinkled, sagging, leathery skin. For maximum protection, apply sunscreen to dry skin 15 to 30 minutes before going outdoors. Reapply sunscreen after swimming or perspiring.
In addition to limiting your sun exposure time, doctors also recommend wearing protective clothing, such as wide-brimmed hats and long sleeves, when spending time in the sun. Ultraviolet rays are present during daylight hours but avoid midday sun especially, because UVB rays are strongest between 10 a.m. and 3 p.m. Examine your entire body once a month for the early warning signs of cancer and see a dermatologist immediately if you notice any changes in the color, shape, size or texture of moles or other growths. It's also a smart idea to have a dermatologist check your skin once a year.
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 215-955-1661 or 1-800-JEFF-NOW.