Patient Selection
Not everyone is suitable for prostate seed brachytherapy:
Primary, definitive, radical brachytherapy cases
- Patients with organ confined prostate cancer (i.e. not outside the prostate gland as adjudged on staging MRI)
- Patients with biopsy proven prostate cancer ( Gleason score totalling up to7)
- PSA under 20, (15) are good candidates for brachytherapy.
- Patients with obstructive urinary symptoms (slow urinary flow) are not good candidates because there is an increased risk of urinary difficulties (need for catheterisation) after the procedure.
- Patients with very large prostate glands may not be suitable for implantation for technical reasons. All this is checked at the 'volume study' that precedes the implant itself; the volume study is the time at which information is acquired such that each implant is individually planned.
- Patients who had a previous transurethral prostate resection (TURP) have a slightly increased risk of urinary leak (incontinence) after the procedure and are therefore not considered good candidates for the procedure.
- Patients must not be on anticoagulants or aspirin during the period of the procedure and be medically fit for a light anaesthetic.
Other cases:
- Some higher risk patients (e.g. PSA 20-25) may be offered a mixed radiation therapy protocol where there is first a five week course of external beam radiotherapy followed by a 'boost' to the prostate by brachytherapy implant - the perceived advantage here is that this combination approach has both the wider coverage advantage of external beam radiotherapy plus the extra internal huge radiation boost to the heart of the disease by the subsequent implant. This the chosen programme for selected patients.
External beam failure patients:
- Patients who have previously received external beam therapy and failed within the prostate gland only (manifest by a rising PSA and no disease outside the prostate) may elect and be suitable for an implant programme by brachytherapy instead of hormonal therapy and with a chance of long term control - although there is a higher risk of late side effects, usually urinary, in this group of patients.
