Thanks to advances in modern medicine, prostate cancer is no longer a death sentence. Nowadays, modern medicine has many treatment methods for this disease and one of the most effective and sparing treatment methods for prostate cancer therapy is brachytherapy.
- The essence of the technique
- Benefits of brachytherapy
- Clinical indications for brachytherapy
- Types of brachytherapy
- How is brachytherapy carried out?
- Prices for brachytherapy in different countries are as follows
- Where can I undergo brachytherapy?
- Selection of the hospital for brachytherapy in prostate cancer
- How to undergo brachytherapy abroad?
The essence of the technique
What is brachytherapy? It is a method of interstitial irradiation of the prostate gland. The principle of treatment is based on the introduction of radioactive microcapsules into the prostate tissue. Microcapsules emit radiation that destroys cancer cells. Due to the small radius of irradiation, healthy tissues near the prostate are not exposed to radiation.
The microcapsule for brachytherapy is a closed source of low activity radiation. The capsule is made of titanium, and contains radioactive substance inside, namely isotope of iodine or iridium. It looks like a grain of rice. Microcapsules can be single or fixed to each other with an absorbable thread (like a necklace).
Benefits of brachytherapy
Brachytherapy is an effective but at the same time sparing treatment method for prostate cancer. Brachytherapy can be used as the main treatment or in combination with other methods (external beam radiation therapy, hormone therapy).
Brachytherapy in prostate cancer has the following advantages:
- High efficiency of the procedure. The results of brachytherapy are the same as in surgery and external beam radiation.
- Reduced number of possible complications. Urinary incontinence, erectile dysfunction, and bowel problems are less common than after other treatment methods.
- Short rehabilitation after brachytherapy. It is a minimally invasive procedure, after which patients recover very quickly.
- Suitable for all patient groups. It can be used in the treatment of debilitated or elderly patients.
- Short hospitalization period. The entire procedure with the preparation will take no longer than 1-2 days.
Clinical indications for brachytherapy
There is no universal treatment plan for prostate cancer. The doctor designes an individual treatment strategy for each patient, taking into account the characteristics of the tumor. Surgical treatment will be preferred for one patients and brachytherapy – for others.
The main indications for brachytherapy in prostate cancer are:
- Localized stage I-III prostate cancer
- Prostate volume up to 50 cm3
- No signs of severe bladder disturbances (infravesical obstruction), which is determined by uroflowmetry
- PSA level in the blood is under 15-20 ng/mL
Brachytherapy is not performed in advanced prostate cancer with metastases.
Types of brachytherapy
Currently, leading foreign hospitals offer two methods of brachytherapy for prostate cancer. These are low dose-rate (LDR) and high dose-rate (HDR) brachytherapy.
Low dose-rate brachytherapy
The term "low-dose rate brachytherapy" means that the organ is irradiated for a long time with low doses. Low-dose rate brachytherapy involves the use of microcapsules with Iodine-125. These radioactive grains are implanted into the prostate tissue, where they remain. From 40 to 120 microcapsules are usually injected into the prostate.
The half-life of radioactive iodine is 60 days. This means that in 2 months the radioactivity of grains will be reduced by 50% and in six months the process of radioisotope decay will be almost completed. The implanted grains become safe and do not require extraction.
High dose-rate brachytherapy
Microcapsules with the Iridium-192 isotope are used in high-dose brachytherapy. This radioisotope ensures a more powerful irradiation and therefore is used for aggressive prostate tumors.
In this type of brachytherapy, catheters are inserted into the prostate through which radioactive grains are placed. After short-term irradiation (10-20 minutes), the granules are extracted. This procedure is repeated 2-3 times.
How is brachytherapy carried out?
Brachytherapy requires thorough preparation and careful calculations, because the final result will depend on them. The brachytherapy procedure consists of several stages:
- Pre-implantation preparation. At this stage, a transrectal ultrasound of the prostate is carried out. The obtained image is processed with the help of the computer program. The doctor calculates the volume of the prostate, determines the required number of radioactive capsules, their location in the gland, and the total radiation dose.
- Implantation of capsules. The procedure is performed under anesthesia. An ultrasound probe is inserted into the rectum in order to visualize the prostate gland. Then, the cannulas are inserted through the skin of the perineum. The radioactive microcapsules are injected into the prostate through these needles. They remain there forever (LDR brachytherapy) or are extracted after a certain time (HDR brachytherapy).
The patient can leave the hospital the next day. During the first months after brachytherapy, it is necessary to follow the doctor's recommendations, particularly, it is necessary to avoid heavy lifting and active sports, to follow a diet.
After brachytherapy, patients have to undergo an examination at regular intervals, which includes determination of the PSA blood level and prostate ultrasound. According to the examination results, the doctor will be able to assess the effectiveness of the procedure performed and control the course of the disease.
Where can I undergo brachytherapy?
Currently, only a few hospitals in the CIS are engaged in prostate cancer brachytherapy. While in Europe and the USA, this treatment method has been used for a long time – since the 90s. During this time, foreign hospitals have gained extensive experience in prostate cancer brachytherapy.
You can undergo brachytherapy for prostate cancer in the following countries:
Brachytherapy is performed by world-renowned oncologists in leading foreign hospitals. They have worked out the brachytherapy to perfection and the possibility of complications is reduced practically to zero.
Prices for brachytherapy in different countries are as follows
Selection of the hospital for brachytherapy in prostate cancer
Leaders in the treatment of prostate cancer are the countries of Central and Western Europe, in particular – Germany. According to objective statistical data from the Robert Koch Institute (Berlin, Germany), the relative 5-year survival rate of patients with malignant prostate neoplasms in this country reaches 93%. At the initial stages of cancer, the rate is even higher – about 95%.
Brachytherapy for prostate cancer is performed in the Departments of Urology, whose specialists cooperate closely with radiologists and nuclear medicine physicians. Thanks to the interdisciplinary cooperation, brachytherapy in German clinics has the highest efficiency and a low percentage of complications.
The following German hospitals are the most authoritative in this medical field:
- HELIOS University Hospital Wuppertal. Department of Urology. The cost of brachytherapy for prostate cancer (implantation of radioactive gold SEEDs) starts from 15,400 EUR.
- Charite University Hospital Berlin. Department of Adult and Pediatric Urology. The cost of the procedure starts from 21,800 EUR.
- University Hospital of Ludwig Maximilian University of Munich. Department of Adult and Pediatric Urology. The cost of the procedure starts from 17,000 EUR.
As a rule, children and adults are treated in the same department at the large university hospitals. This reconfirms the high qualification of operating urologists, oncologists and radiologists, who take into account the peculiarities of interventions in patients of different age categories.
How to undergo brachytherapy abroad?
Patients from all over the world can undergo treatment in leading foreign hospitals. However, the process of treatment organization abroad involves the number of difficulties. Namely, you need to select a suitable medical facility independently, submit an official request to it in a foreign language, wait for a long-awaited response, prepare the package of documents, etc. It is much easier to entrust the management of these issues to professionals.
The medical tourism operator Booking Health provides services for organization of medical treatment abroad. We will select the most competent hospital for the patient and make an appointment for treatment as soon as possible. Booking Health offers the most favorable treatment cost due to avoiding overpricing for foreign patients. Cooperation with Booking Health will save your time and money.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova