High and low-rate prostate brachytherapy

High doses of irradiation directed at the target of the prostate tumour.

Brachytherapy is a type of radiotherapy that allows high doses of irradiation to be delivered directly to the tumour. This avoids unnecessary irradiation of healthy tissues, reducing the risk of complications and increasing the probability of preserving erectile and urinary functions.

High-rate brachytherapy allows for the administration of high-intensity radiotherapy treatments with maximum precision and speed. The patient is discharged once all the prescribed dose of irradiation is administered.

Low rate brachytherapy is the pioneering technique in minimally invasive prostate cancer treatment. In low-risk tumours it offers control results comparable to those described with surgical techniques with a very good safety profile, documenting very low percentages of severe urinary and/or intestinal toxicity (less than 5%) and positive rates of erectile function.

The patient is discharged with radioactive seeds implanted in the prostate that carry out their action over a period of weeks.

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Prostate brachytherapy allows for high doses of radiation to be delivered directly to the tumour

We avoid unnecessary irradiation of healthy tissues, reducing the risk of complications and increasing the probability of preserving erectile and urinary functions.

Low-rate prostate brachytherapy, also known as permanent implantation or "prostate brachytherapy with seeds”, is a minimally invasive technique that allows to implement a radioactive material (radioisotopes Iodine125 or Palladium103) inside the prostate.

The radioisotope is encapsulated in titanium (seeds) and once the seeds are implanted, they remain permanently inside the prostate, releasing their energy over time (590 days for Iodine125 and 170 days for Palladium103). The energy released by these seeds will cause biological damage to the malignant cells, inducing their death and eradicating the tumour.

Low rate prostate brachytherapy is performed in the operating room, under epidural anaesthesia +/- sedation. The duration of the procedure is approximately two hours and a hospital stay is not necessarily required.

The prostate brachytherapy treatment with seeds consists of inserting a predetermined number of fine, hollow metal needles through the perineum and under transrectal ultrasound control, arranged and aligned with a separation between them of 0.5-1.0 cm. Once the needles are in place, the seeds will be implanted and remain permanently in the prostate. Once seeding or implantation is complete, the needles are removed.

High rate prostate brachytherapy for prostate cancer is a minimally invasive technique that allows irradiating the tumour area with Iridium192 during a limited time and then removing the radioactive source.

High-rate brachytherapy as a focal treatment allows for irradiation of only the target lesion visible on multiparametric MRI with a margin of safety.

This type of treatment can be performed exclusively in very carefully selected patients with organ-confined prostate tumours in which fusion biopsies confirm involvement exclusively in the target lesion and with histologies of low aggressiveness (very low and low risk tumours).

Focal treatment in these patients aims to eradicate the defined tumour by administering high doses of radiation to the smallest possible volume of tissue. This avoids the unnecessary administration of radiation to healthy tissue, reducing the risk of complications and increasing the probability of preserving erectile function.

High-rate whole-gland prostate brachytherapy is indicated in patients with organ-confined prostate tumours where fusion biopsy has confirmed the presence of tumour in both lobes, also with low aggressive histology (low risk or favourable intermediate risk) and the possibility of a treatment of differentiated intensity, i.e. 20-30% higher dose in the target lesion or biopsy positive area in comparison to the rest of the prostate gland where the presence of tumour has not been confirmed.

This brachytherapy for prostate cancer offers similar tumour control expectations to those described with conventional treatments (surgery, external beam radiation therapy or seed brachytherapy) with the possibility of improved rates of preservation of erectile function.

High-rate prostate brachytherapy is performed in three phases: implantation, planning and treatment.

HIGH RATE BRACHYTHERAPY

What is the process of prostate brachytherapy?

  • First phase (implantation): Performed in a surgical setting under epidural/sedation anaesthesia. This phase closely resembles the transperineal fusion biopsy process.
  • Planning: A multiparametric MRI is performed in order to verify the exact placement of the vectors in relation to the area to be treated and the areas to be preserved, proceeding to reposition them if necessary.
  • Treatment: Brachytherapy will be administered in a bunker or radiotherapy treatment room with the interval of at least 6 hours between two sessions. Once the treatment is completed, the implant is removed and the patient is discharged within the following hours.