How do I compare the different methods?
Since the treatment options for prostate cancer can vary from the extremely conservative active surveillance to the extremely radical surgical removal of the prostate (with multiple radiation options in between) it can be very confusing. Since tenors always sing tenor, and baritones always sing baritone it is not surprising that each medical specialty tends to favor their own approach. Keep in mind that the results are essentially the same with all the treatment modalities of surgery, external beam radiation, permanent seed implant or high dose rate brachytherapy but high dose rate brachytherapy has the lowest side effect profile. It is important to do your own due diligence and get different opinions. At some point though it is important to commit to a path and not be stopped by all the competing information. Go with what makes sense for you. (See Advantages of HDR)
What is Brachytherapy?
Brachytherapy (from the Greek word βραχυς brachys, meaning “short-distance”) is a form of radiation treatment where a sealed radiation source is placed inside or next to the cancerous tissue. The radiation sources may be inserted either permanently or temporarily. Brachytherapy is commonly used as an effective treatment for prostate, breast, uterus and cervix cancer, and can also be used to treat tumors in many other body sites. Brachytherapy can be used alone or in combination with other therapies such as surgery, external beam radiation (EBRT) and chemotherapy.
What is high dose rate (HDR) Brachytherapy?
High dose rate (HDR) brachytherapy also known as temporary brachytherapy is a technically advanced form of brachytherapy. A high intensity radiation source is delivered with millimeter precision under computer guidance directly into the tumor treating it from the inside out. This significantly avoids normal, healthy tissues, delivering the treatment directly to the cancer site. After treatment, the catheters and/or applicators are removed. No radioactive material is left inside the patient.
How is HDR brachytherapy different than external beam radiation treatment?
Unlike external beam radiation, which treats the tumor from the outside in, brachytherapy treats cancer from the inside out by using a sealed radioactive source inserted into hollow treatment catheters or specially designed applicators placed into, or a short distance from, the tumor. Under controlled conditions a computerized robot positions the source with millimeter precision at multiple points throughout the array of implanted catheters to give a high dose to a limited volume. This significantly avoids normal, healthy tissues, delivering the treatment directly to the cancer site. External beam radiation must penetrate all the pelvic tissue to get to the target so a much larger volume of tissue gets irradiated. (See Advantages of HDR)
How is HDR brachytherapy different than a permanent seed implant?
HDR brachytherapy is also called a temporary seed implant. A permanent seed implant is permanent. Once the seeds have been implanted they cannot be moved. The treatment doses are either done by a preplan or during the procedure but the doses are calculated AFTER the seeds are implanted. Permanent seeds are all of uniform strength so it is difficult to obtain ideal dose distribution. In contrast HDR brachytherapy positions a single source with millimeter precision at multiple points throughout the array of implanted catheters. The source strength can be tuned up or down at each point by controlling the time at that position. After treatment, the catheters are removed. There is no risk of seed migration. No radioactive material is left inside the patient so there is no need for radiation precautions with family members. (See Advantages of HDR)
How does radiation work?
Radiation treatment works by damaging the abnormal DNA of cancerous cells which tend to grow without control. Normal cell DNA on the other had can tolerate doses of radiation if the dose is given in divided doses spread over time. Radiation kills cancer cells either directly at the time of the treatment or when the cells attempt to multiply in the future. Normal tissue in the region is able to repair and recover because it has normal DNA.
Does insurance cover high dose rate brachytherapy?
HDR brachytherapy is typically covered by Medicare and most other major insurance carriers. Our financial coordinators can assist you in working with your insurance company to obtain authorization.