The process for your brachytherapy will be slightly different depending on if you are having High-Dose Rate (HDR) or Low-Dose Rate (LDR). At the time of your initial consultation your radiation oncologist will explain the process to you, and answer any questions you may have.
Step 1: Initial consultation
Before you proceed for treatment your radiation oncologist will explain the brachytherapy process to you, and answer any questions you may have. Discussion will also take place with regards to treatment options and any potential short or long term side effects. An examination may be required at this appointment, along with review of any relevant X-rays, scan and test results, so please bring them along if you have them.
Your next appointment will be for a prostate volume study, which may, or may not be on the same day.
Step 2: Volume Study
This is an important step in the prostate brachytherapy process, where the size of the prostate is measured and evaluated for treatment suitability. This involves a transrectal ultrasound and only takes a few minutes.
If prostate is a suitable size, then the brachytherapy implant is scheduled. If the prostate is too large, hormone therapy may be recommended to shrink the prostate and then the volume study repeated in a couple of months' time.
Step 3: Treatment setup
This is a general anaesthetic, day patient procedure that requires the co-ordinated effort of a multi-disciplinary team; urologist, radiation oncologist, anaesthetist, nurse, radiation therapist and medical physicist.
Pain management is administered prior to procedure commencement and a urinary catheter inserted for image visualisation. Procedure involves the positioning of the prostate gland and urethra guided by transrectal ultrasound and calibrated reference plate so that a series of ultrasound images can be captured.
Step 4: Treatment planning
This step is performed without the patient present. The information gained from the volume studies and scans is used by your radiation oncologist with the assistance of radiation therapist and medical physicists to develop an accurate and customised treatment plan. Every plan is unique and tailored to the specific requirements of each patient. Once the treatment plan has been completed, approved by your Radiation Oncologist and had all required checks completed, your treatment is ready to commence.
Step 5: Brachytherapy treatment
This step will vary depending on whether you are having LDR or HDR.
In HDR an X-ray is taken to check the position of the catheters and if required physical adjustments are made to the catheter position by your Radiation Oncologist.
Each individual catheter is connected to its corresponding transfer tube which is connected to the motorised unit which controls the radioactive source. During the treatment the source enters and stops in planned positions to deliver the required radiation treatment. The treatment delivery is painless.
This step is repeated routinely three times, with 6-8 hours between each treatment.
LDR is a surgical procedure that requires the same multi-disciplinary team present at your treatment set up. Pain management is administered prior to the procedure and a urinary catheter inserted for bladder management and visualisation. The procedure involves the insertion and deployment of the radioactive seeds inside the prostate gland through the perineum (area between anus and scrotum) guided by transrectal ultrasound.
Step 6: After Treatment
For HDR patients the catheters and reference plate are removed. Generally, you will feel no effects of the treatment; however patients may experience tenderness and soreness where the catheters were inserted and reference plate positioned.
For LDR, the seeds will remain in the prostate and gradually decrease in radioactivity. Care instructions are provided and follow up CT scans scheduled for a month's time.
Step 7: Follow up consultation
An appointment will be made for you to see your Radiation Oncologist at the completion of your treatment regime. The effectiveness of your brachytherapy treatment will be evaluated over time. The treatment is designed to stop the growth of the tumour and therefore it may take weeks to months before the full benefit of the treatment may be assessable. Often imaging and diagnostic tests are required prior to this appointment, you will be provided with details if these are necessary.