Brachytherapy effective as a cure

Henriette Lamprecht – One of every four men will have prostate cancer in their life time. This according to urologist, dr. Emmanuel Johnson, who now offers men in Namibian diagnosed with prostate cancer the chance to receive brachytherapy locally. According to Johnson men who have a family history of cancer are two and a half times more likely to be diagnosed with prostate cancer.

“For men who has a family history of breast cancer of a close relative like a mother or a sister, it can translate into prostate cancer for men,” he explains.

While in the rest of the world it is more prevalent in men over 60, the age drops dramatically in Namibia and the rest of the Southern African Development Community (SADC) which baffles scientists, says Johnson. It is for this reason that he suggests to his patients and men in Namibia to start getting a blood test once a year from the age of 40.

Contributing factors for prostate cancer also include obesity, environment as well as diet. In Asians like the Chines it is relatively rare but according to Johnson the incidence rates continue to rise in America and Africa.

Prostate cancer is treated in difference ways, which include surgery as well as external beam therapy as well as brachytherapy. Brachytherapy is a type of internal radiotherapy. This means that a radioactive source is put inside the prostate. The radioactive source releases radiation to destroy the prostate cancer cells. The source, also known as radioactive seeds, might stay inside your prostate permanently.

“Radioactive seeds are planted into the prostate without making big cuts or spending a long recovery time in hospital. About 30 to 50 seeds are planted all over the prostate. Over time it radiates the prostate, killing the cancer cells,” Johnson explains.

The survival rate is the same as surgery, but without the risks of cutting an organ or incontinence which often comes with the surgical removal of the prostate.

“You don’t have big cut, stay in hospital for one night, can work in two weeks and there is no risk of incontinence, cutting through the bowl or injuring other organs.”

Minimal disadvantages compared to surgery

To be considered for the procedure, patients should not have had previous radiation therapy to the specific area including the pelvis. The prostate must also not be either too small or too big.

“If it’s too big, it is sometimes behind the pelvic bones and one can’t get to it. The remedy is then to shrink the prostate over a period of 3 months and then insert the seeds. One of the risks is a burning sensation and you don’t want to put the seeds too close to the urethra, which is why the prostate can’t also be too small.”

The team for treatment consists out of an urologist, clinical oncologist as well as a physicist, explains Johnson.

“The clinical oncologist will look at your disease profile and determine if this will be good fit. The physicist will, based on the prostate, calculate how many seeds must be planted in, deciding on the strength of the radiation you need to get. In theatre the oncologist will be there to tell where to place the seeds, while I will be doing the procedure.”

Patients need a bowl preparation the night before the procedure, because the probe is inserted through the anus.

“You don’t want fecal matter in the way, you need to see the prostate and don’t want to put the seeds in the wrong place.”

The implantation takes two to three hours and the success rate is 92%, similar to removing the prostate.

Although the procedure is good for all statuses (mild/intermediate/severe) it might not be enough, says Johnson.

“It depends on how early you get it. For mild and intermediate, this will be all that is needed and nothing else. If it is however severe and or aggressive, you would also need external radiation to be sure you you’ve got everything.”

Johnson explains the prostrate is “very important” as it channels urine out of the body, while it is also important for reproduction.

“When a man ejaculates, only 5% comes from the testes (sperm), while the rest of the liquid comes from the prostate. The testes provides the sperm, while the prostate provides the liquid medium and nutrition.”

According to Johnson the seeds used in brachytherapy can stay in the prostate forever.

“The radiation however isn’t forever, it dissipates over time, about 9 months and it’s done. By then the cancer should also be well and truly gone.” – [email protected]



Did you know?

A study in Germany concluded HDR brachytherapy ensured 90% biochemical control in prostate cancer after 8 years and 97% metastasis-free survival.

STATS:

Advantages of brachytherapy:

• Effective as a cure: there are many studies that show patients continue to remain free of cancer after treatment with brachytherapy.

• Minimized side effects: The accurate and targeted nature of both low dose rate (LDR) and high dose rate (HDR) brachytherapy reduces the risk of side effects.

• Minimally invasive: Avoids the need for extensive surgery.

• Shorter treatment times and shorter recovery periods: brachytherapy is usually given on an outpatient basis and completed in a couple of days. Patients are usually able to get back to their normal activities within a week.