Brachytherapy

The prostate gland is located at the base of the penis, below the bladder and in front of the rectum. It produces fluid that helps transport sperm during ejaculation. The size of the prostate gland varies, but it is usually about the size of a golf ball.

Prostate cancer is the most commonly occurring cancer in males today, and is second only to lung cancer in causing cancer related deaths in men. Great emphasis has therefore been given to early diagnosis and treatment of the disease. If detected early, proper treatment may result in an increased rate of cure.

Normally in the prostate, as in the rest of the body, there is a continuous turnover of cells, with new cells replacing old dying ones. In the cancerous gland the balance between the new and old cells is lost, with many more new ones being made and older ones living longer.

Cancer of the prostate can be defined as uncontrolled prostate cell growth and differs from benign enlargement in that the cancerous cells can further spread (metastasis) to other areas in the body. However, sometimes the cancer can be detected before it has spread outside the prostate at a stage where it is curable.

In general, apart from occasional difficulty with urination, most men have no early symptoms and until recently the only way of detecting prostate cancer was by a digital rectal exam (DRE), whereby the prostate is examined by a gloved finger via the rectum. As the prostate lies immediately anterior to the rectum it can be easily felt, but this method of detection misses many early cancers.

There is now a simple screening that can be used in addition to DRE, which detects the Prostate Specific Antigen (PSA) in the blood. PSA is continually produced by the prostate gland, and a high level is seen with prostate cancer. However, as other non-cancerous conditions can also raise the PSA level, further testing is usually required.

Once prostate cancer has been confirmed there are currently three main treatments available:

• Radical prostatectomy - surgical removal of the prostate gland and seminal vesicles.
• External beam radiation therapy - cancerous cells are sensitive to radiation therapy. Radiation can be applied using a linear accelerator that emits a beam of radiation from outside the body tissue. The radiation dose is given in small increments spread over a number of weeks, to minimise damage to normal tissue.
• Brachytherapy or radioactive seed implant - this is also a form of radiation therapy, but the dose is given internally via tiny radioactive seeds, such as iodine-125, that are permanently implanted directly into the gland. The seeds remain radioactive for up to a year.

If you have any questions that are not answered here, please contact the Brachytherapy Co-ordinator at the Princess Grace Hospital on 020 7486 1234 - Bleep 53