Prostate brachytherapy at the London Clinic

The prostate brachytherapy service at the London Clinic is led by an experienced team of Urologists and Oncologists. Depending on the stage of the cancer, there may be a variety of treatment options,  however prostate brachytherapy is a popular, established and convenient treatment for early stage prostate cancer and quickly allows the patient to return to their normal daily routine. It is important to consider the suitability of all options in discussion with a urologist or oncologist.

The prostate and prostate cancer

The prostate is a small gland which forms part of the male reproductive system. It is about the size of a walnut and located below the bladder. The function of the prostate is to nourish the sperm and produce a milky white fluid which accounts for approximately 50-75% of the volume of seminal fluid.

The prostate may naturally enlarge with age and can result in the symptoms of reduced urine flow or a difficulty in emptying the bladder. This enlargement is normal and usually benign or non-cancerous. If the cells in the prostate grow uncontrollably (malignant growths) they can spread to other areas of the body (metastasise). This is known as prostate cancer. The tumour formed by these cancerous cells can grow slowly or rapidly, depending on the type of cell it originated from. When the cancer is detected it may still be confined to within the prostate or may have spread outside to other areas.

Benefits of prostate brachytherapy

Brachytherapy is a highly convenient treatment option which allows most patients to return to their normal daily activities within a few days. Unlike external beam radiotherapy, it can be carried out in a single session and does not involve four to seven weeks of daily treatment sessions. Furthermore recovery time is a great deal shorter than the alternative treatment option of prostate removal (radical prostatectomy).

Side effects of prostate cancer treatment may involve urinary retention, incontinence or impotence but occurrence rates are widely acknowledged as favourable for brachytherapy when compared to alternative treatment methods.

Iodine-125 (I-125) prostate brachytherapy

At The London Clinic early detected prostate cancer may be treated by inserting a number of small seeds directly into the prostate.  The implant is a convenient and minimally invasive procedure which is performed under general anaesthetic in the operating theatre.  The treatment may be undertaken as a day session (potentially with a single overnight stay) or as a two stage procedure (one visit to assess the prostate volume and a second visit for the seed implant).

Unlike external beam radiotherapy, in which high energy radiation beams are passed through the skin to deliver the required treatment dose to the prostate, I-125 seeds are placed within the prostate to deliver an increased and highly localised dose with the benefit of minimising dose to nearby organs at risk.

LDR I-125 brachytherapy seeds

Low dose rate radioactive iodine seeds are permanently inserted into the prostate during the procedure under ultrasound image guidance.  Each seed is approximately 4.5mm long and 0.7mm wide.  Depending on the size of the prostate, typically around 60-90 seeds in total are inserted during the implant.

The implant is conducted under ultrasound guidance and the distribution of seeds is carefully planned and monitored live using advanced treatment planning software. The seeds may be implanted using a single seed implant technique (using a "Mick" applicator) or as a connected strand of seeds.

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Treatment planning software calculates a bespoke distribution of radiation based on ultrasound imaging

The seeds will deliver a dose of radiation to the prostate designed to treat the cancer but over time the seeds become less radioactive. Most of the radiation is released from the seeds in the first 3 months after the implant and after about 9 months they are effectively non-radioactive.

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A fluoroscopic image of a successful seed implant