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Prostate Brachytherapy
| Date: |
12 July 2010 07:00 |
| Producer: |
Eugene Botha
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| Presenter: |
Derek Watts
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| Show: | Carte Blanche Medical |
In this theatre a high-tech procedure is taking place, which requires the utmost of precision. With long needles and the help of scans and computers the surgeons are carefully placing small bits of radioactive material into the body of a patient.
This procedure, which sounds like something from Star Trek, is actually a little known treatment for prostate cancer. It is called brachytherapy; a kind of radiation therapy. Dr Wayne van Niekerk is one of a handful of oncologists performing this procedure.
Derek Watts (Carte Blanche Medical presenter): 'Where do we get the name brachytherapy?'
Dr Wayne van Niekerk (Radiation oncologist): 'What it means is treatment to a close proximity. We have radiotherapy machines which are called teletherapy because we treat at a longer distance away from the tumour. Where with brachytherapy it is in direct contact with it, so that is where 'brachy' comes from.'
The prostate is a walnut sized gland located at the base of the bladder.
The prostate helps to control urination and the need to urinate. It supplies seminal fluid for sperm. It completely surrounds the urethra and crucial nerves runs through it. If localised cancer is present in the prostate it is extremely difficult to remove.
In the past the only cancer treatment available would be surgery, completely removing the prostate, called a radical prostatectomy. This is usually combined with heavy doses of chemo or radiation therapy. A radical prostatectomy has serious consequences.
Dr van Niekerk: 'It is a lot more invasive. The patient is in theatre for approximately an hour-and-a-half. The procedure itself can lead to a lot of bleeding. Afterwards, a patient is admitted into ICU for a day and into the ward for a couple of days and sent home with a catheter in position.'
Brachytherapy is an alternative to a radical prostatectomy and is fast becoming the treatment of choice to cure patients with localised prostate cancer, the most common cancer among men.
Brachytherapy is much less invasive, does not require surgery, and have very few negative side effects. The procedure in theatre takes only about 30 minutes.
Charles van Nuwenhuys is one of Wayne's patients and last year he received the news all men dread.
Derek: 'Charles, how did you discover that there could be a problem?'
Charles van Nuwenhuys (Brachytherapy patient): 'I go for annual medical check-ups with my GP. Part of the procedure obviously is to do a PSA test.'
The PSA test is a simple blood test which indicates if there is cancer in the prostate. His PSA count was alarmingly high. Charles had a biopsy and the urologist called him in with the dreaded news; he had cancer.
Charles: 'He then mentioned two options. The first one, which he wouldn't recommend, is basically the total removal of the prostate to get rid of the cancer. Or, what he then for the first time mentioned, brachytherapy, which is basically an implant of radioactive seeds into the prostate that will kill the cancer.'
Charles decided to try brachytherapy and had the procedure in February this year.
Wayne invited us into the theatre to witness a procedure. On this day he was assisted by Prof Addo van Rensburg.
Before the actual procedure is started, the size and position of the prostate is carefully established with an anal ultrasound probe.
The ultrasound images of the prostate and the location of nearby structures like the bladder, urethra and rectum are carefully mapped on a computer. This helps them to plan where the radioactive seeds will eventually be placed. Their exact locations are carefully mapped with the help of a grid.
Dr van Niekerk: 'This is our planning computer. So this is going to translate into a three dimensional picture for us of where needles and seeds should be going. So, you know, we're giving a therapeutic dose, but protecting the urethra, bladder and rectum at the same time. So this is the core of the procedure.'
A template with holes corresponding to the grid on the screen of the computer is then placed on the skin of the patient on the perineum: the area between his scrotum and rectum.
Dr van Niekerk: 'Needles will then be placed into about the mid part of the prostate and we'll be able to see that flash on the screen and we'll know that the needle has now come through at the desired area.'
The placement of the needles follows the grid on the computer.
Dr van Niekerk: 'I'll then go into a second view - a lateral view - in the ultrasound where I can then see exactly the extent of the prostate. I'll move the needles right into the base.'
These needles are hollow and act as guides to place the radioactive seeds. Wayne then loads a special delivery needle fitted with a cartridge containing the seeds. The seeds are about the size of a grain of rice and are made from radioactive iodine or palladium.
Dr van Niekerk: 'And we'll push the seeds into position. And in every position we will then be spacing it according to our plan of how many seeds are required in that area of the prostate to be dropped.'
Derek: 'Precision is the word here.'
Dr van Niekerk: 'Absolutely, we have to be very careful where we place the seeds, how many seeds we are using, our total activity.'
Derek: 'It sounds absolutely bizarre, having radioactive material inserted into your body right into your prostate. So, what are the dangers involved here?'
Dr van Niekerk: 'There are radiation protection rules in place. The shielding and the cartridges that they're in is protecting the staff from excessive amounts of radiation.'
Charles: 'They recommend that in the first couple of months you stay away from pregnant woman in this proximity. And you're not supposed to put a baby on your lap.'
Derek: 'Really?'
Charles: 'Ja, just as a precaution, you know.'
But as time goes by the radioactive seeds steadily lose their radioactivity. They are then non-toxic.
Charles: 'They never get removed, they stay in your body forever. Once they are there, they're there. You'll go to your grave with them. So, they remain there forever.'
Even with us in the theatre and Wayne answering questions, the whole procedure only took only about half-an-hour. The teamwork and the technology was impressive.
Derek: 'Well, as you saw, it was a relatively quick procedure; the patient has been wheeled out to the recovery room. He should walk out of the hospital today himself. But what about the follow-up for the next few weeks and months?'
After waking up, the patient has a CAT scan of the prostate gland and the catheter is removed.
Dr van Niekerk: 'The minute he's been able to pass a bit of urine he'll be ready for discharge.'
Derek: 'Pain for a while, a few weeks?'
Dr van Niekerk: 'To tell you the truth, a local irritation when the catheter is in is the biggest problem. Once it's removed they feel like there's a bit of burning on the first or second [passing] of urine. After that very little pain discomfort; a bit of swelling, feeling like they're sitting on a golf ball, that sort of sensation. But that last only a couple of days, but the majority of patients don't even know where we've worked.'
Brachytherapy does not result in erectile dysfunction or incontinence, but as it is in case with all cancer treatment, the earlier the cancer is detected, the better chances of the patient.
Dr van Niekerk: 'The earlier the better. Cure rates are much better the earlier we get them. PSA testing, digital examination, early on, as uncomfortable as it might seem, absolutely vital in detecting this disease early on.'
After his operation Charles is feeling well and the radioactive seeds in his body are slowly but surely killing the cancer.
Charles: 'My PSA is now down to 1.42.'
Derek: 'Way in the normal range.'
Charles: 'Which is a good indication that the cancer has nearly already been killed or maybe already killed.'
Derek: 'So, that is a good sign?'
Charles: 'Very good sign.'
So, even with brachytherapy killing off the cancer, Charles still feels that it was the early detection with the PSA blood test that actually saved his life.
Charles: 'It is alarming that still today very few men actually go for PSA or for an actual rectal examination. I, myself, would really recommend to any men, particularly 50 and over, it's vitally important. It is a necessity!'
IMPORTANT DISCLAIMER:While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.
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