LDR brachytherapy, also known as “seed implantation”, is a modern variant of radiation treatment. It allows patients with localized prostate cancer to live without major restrictions even after treatment.
LDR” is the abbreviation for ‘low dose rate’ and ‘brachys’ comes from the Greek and means ‘short’. The term “seed” comes from English and means “grain”.
The name LDR brachytherapy therefore practically describes the procedure: Radioactive platelets the size of a grain of rice are inserted through the skin directly into the prostate with a needle and precisely placed there “The procedure is usually performed under general anaesthetic and takes around one to one and a half hours,” says Dr. Stefan Carl, explaining the process. “It is all done without a scalpel and without an incision, the patient remains unharmed on the outside and the prostate also remains in the body,” says the doctor, describing the advantages of brachytherapy.
The seeds are placed precisely with the help of high-resolution ultrasound, which provides a three-dimensional image of the prostate and neighboring organs (rectum and bladder).
The small “grains” unfold their effect in the prostate by irradiating the tumor in a targeted and precisely dosed manner and not simultaneously irradiating healthy tissue or other organs. This is because the radiation has a very short range. Thanks to the millimetre-precise placement of the granules, which is continuously monitored by a computer program, damage to the surrounding healthy tissue is prevented and only the tumor cells are killed. “We use radioactive iodine 125 with a half-life of two months,” explains Dr. Johannes Andreas. About a year after the seeds are implanted, their radiation activity ceases.
Although the procedure is nowhere near as stressful as a surgical removal of the prostate, brachytherapy is still a complex surgical procedure that requires a high level of technical expertise and equipment. Various specialists – from radiotherapists and urologists to medical physicists and anesthetists – make up the surgical team. Nevertheless, the patient can leave Emmendingen District Hospital on the second day after the operation.
Brachytherapy therefore has a number of advantages: It offers equally good chances of recovery, but is much gentler on the patient and has fewer side effects than conventional surgery or external radiation.
According to the medical guidelines of the European Society of Urology, the procedure can be considered for comparatively less aggressive tumors. It is also recognized for moderately aggressive tumours. The treatment concept in our department is adapted to each patient’s individual situation and the respective tumor stage.
Potential side effects
Possible side effects of seed implantation are almost exclusively of a temporary nature: traces of blood in the urine or seminal fluid, bruising in the perineal area due to the insertion of the hollow needles, an increased urge to urinate or residual urine formation may occur. Very rarely, inflammation of the urinary tract, prostate or rectum may occur. Involuntary loss of urine occurs extremely rarely (in less than 1% of patients) and radiation-induced erectile dysfunction (in less than 10% of patients) usually only occurs years after LDR brachytherapy. It can usually be treated well with medication.
“In more than a thousand patients treated by us, there was not a single case of serious events during or immediately after the operation. There was no post-operative bleeding, stroke or deep vein thrombosis,” says Dr. Michael Meilinger, explaining the results of a patient evaluation at Emmendingen District Hospital.
A key aspect of the therapy is rapid recovery and therefore the ability to quickly resume everyday activities within a few days. Rehabilitation measures are only rarely taken up by patients. They usually return to work just two weeks after treatment.
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Bladder catheter
Hollow needle for positioning the seeds
Rectal ultrasound probe for positioning the seeds
Contrast medium in the urinary bladder
Seeds inserted into the prostate
Rectum
