Seed Implantation: success depends on team experience

As one of the minimally invasive alternative procedures for the complete removal of the prostate, the brachytherapy has proven to be a successful procedure.

During the so-called seed implantation, the smallest radioactive iodine seeds are implanted into the prostate. These destroy the tumor from the inside. Dr. Gregor Spira, radiation therapist and chief physician at the West German Prostate Center, is with more than 2000 performed brachytherapies to one of the most experienced brachytherapist statewide.  He emphasizes that „our studies evidence that experience, competence, and permanency of the staff, strongly influences the quality of the radiation and the decreasing of the side effects in the performing of seed implantation: data of more than 500 patients gathered and analyzed over a three-year period confirm that the more experience a treating team has, the more precisely the planning of the radiation doses, and the better the optimal distribution of the seeds.

for the patient This means that all cancer cells in the prostate are destroyed through highest possible radiation, and that at the same time the urethra and the intestine, which are in direct vicinity of the prostate, are spared to the maximal extent. Above this, the increasing experience of the physician team has an additional advantage: the duration of the procedure is almost cut in half. Dr. Stephan Neubauer, urologist at the West German Prostate Center, stresses „A prerequisite for the best possible quality of the seed implantation is a close interdisciplinary cooperation between the radiation therapist and the urologist“. Without this interlocking of competence, an adequate treatment would not be possible.

Low risk alternative
Approximately about 58 000 are affected yearly by prostate cancer. In most of these cases, the organ will be removed radically. The results of this radical surgery are however at times fatal: 60 to 90 per cent of the patients are impotent after the surgery, up to 20 per cent of the patients must expect urethral incontinence. Brachytherapy, with an equal rate of a successful outcome, evidences an essential advantage in contrast to radical surgery:  The surrounding tissue will be spared for the most part, and according to Dr. Neubauer,  „most patients are spared of the feared impotence and incontinence“. In the United States, where brachytherapy has been performed since over 20 years, more patients are treated with brachytherapy than with radical surgery.

At the beginning of the treatment, the exact size and volume of the prostate will be determined with the help of ultrasound. Based on the data, an optimal radiation plan will then be designed by the radiation therapist. During the seed implantation procedure, the urologist implants up to 80 radioactive seeds, which are a few millimeter in size, with a hollow needle into the prostate. This is done under ultrasound guidance. Dr. Stephan Neubauer comments: „The seeds must be placed millimeter exact, in order to achieve the highest possible effect, and to spare surrounding tissues avoiding side effects, such as incontinence and impotence.“ If the prostate carcinoma is in an advanced stage or if, we are dealing with an aggressive type of cancer, the German Prostate Center uses the afterloading therapy with external radiation. Under short-term anesthesia, high dosed radiation sources are beamed into the prostate. In intervals of one week each, the treatment is repeated two or three times. Also for this procedure experience regarding the exact positioning of the radiation is of essence. „The broad spectrum of therapies allows us, depending on the size and type of the tumor, to decide for the most effective and at the same time most minimally invasive treatment strategy for each individual patient.

The German text of this article is available under OpenPR