High-dose rate brachytherapy procedure to treat prostate cancer

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Beaumont Hospital radiation oncologists have launched a research study to treat men with low to intermediate risk prostate cancer with a single dose of radiation.

Alvaro Martinez, M.D., FACR, professor and chair, Oakland University William Beaumont School of Medicine, department of Radiation Oncology, Beaumont Hospitals, performed the first-in-the-world one-dose, High-Dose Rate brachytherapy procedure Nov. 29 on a man from Beverly Hills, Mich.

The study, approved by Beaumont's Human Investigation Committee, builds upon 18 years of past research by Dr. Martinez and other Beaumont radiation oncologists on ways to kill cancer cells through powerful, targeted, short-term radiation treatment.

"In the future of cancer care, less is more," says Dr. Martinez. "Patients want treatments that are safe, effective and fast with a high chance of a cure, thus allowing them to move on with their lives as soon as possible. Through our research, we are hoping to develop treatments that achieve these goals for patients."

HDR brachytherapy involves the temporary implantation of a "smart seed" – an Iridium 192 radioactive pellet about the size of grain of rice – at the prostate tumor site. This technique delivers more radiation to the prostate, increasing cancer killing probability, while minimizing radiation exposure to surrounding tissues, such as the bladder, urethra and rectum. Unlike permanent radioactive seed implants, no radioactive material is left in the patient's body, eliminating the risk of radiation exposure for partners or family members.

The entire procedure to temporarily implant the seed takes about three hours, once spinal anesthesia has been administered. Plastic needles are placed into the prostate using ultrasound guidance. The needles are then loaded with a single radiation seed through a cable attached to a computerized machine that moves the "smart seed" at precisely timed intervals along the needles. Treatment with the "smart seeds" takes about 15 minutes.

Low and intermediate risk patients who qualify for study participation include those with T1c through T2b tumors (small size with no metastasis or lymph node involvement), a Gleason score of 6 or 7 (low-intermediate cell aggressiveness) and a prostate-specific antigen score lower than 15.

Current methods for treating prostate cancer confined to the prostate gland include surgical removal of the prostate (radical prostatectomy); up to eight weeks of external beam radiation alone or combined with permanent seed implants or HDR brachytherapy; or permanent seed implants and/or HDR brachytherapy. The methods are about equal in effectiveness with different side effects.

In 1992, Dr. Martinez and his Beaumont colleagues were the first in the U.S. to perform HDR brachytherapy as an outpatient treatment for patients with locally-advanced prostate cancer. In 1995, he developed a four-treatment protocol over two days for patients with low to intermediate risk prostate cancer. A total of 1,045 patients with high, intermediate or low-risk prostate cancer have been treated through HDR brachytherapy research at Beaumont since 1992.

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