Public hospital prostate brachytherapy programme
Thanks to a successful joint prostate brachytherapy training workshop with Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Department of Radiation Oncology and Chris Hani Baragwanath Academic Hospital (CHBAH) Urology Unit last year, this year 50 early prostate cancer patients will be treated with prostate brachytherapy at CHBAH.
The first of the planned workshops was conducted in June 2021 at CHBAH and three patients with early stage prostate cancer were treated. Several specialist and training radiation oncologists, urologists and medical physicists got the opportunity of both observing and getting hands-on-experience doing prostate brachytherapy under expert guidance. BD, a medical technology company, agreed to sponsor the consumables, such as the radioactive seeds, for the procedure to be done on 24 prostate cancer patients at CHBAH. These procedures were done during six workshop sessions conducted in theatre, with proctoring from Dr Duvern Ramiah, the Head of Radiation Oncology at CMJAH, Dr Robin Friedman, urologist at CHBAH, and Mr Thekiso Khotle, medical physicist at CMJAH.
Although prostate brachytherapy has been available in private facilities, this was the first time it was done in a state, teaching hospital, while providing formal hands-on teaching. These patients also represent the first patients in the Gauteng state sector to have the opportunity to be treated with prostate brachytherapy.
Due to great feedback, CHBAH has agreed to pay for radioactive seeds to treat 50 patients this year at CHBAH which started in March. This will certainly make a life-changing difference to these patients with early prostate cancer.
What is prostate brachytherapy?
It’s a procedure where radioactive seeds are permanently implanted into the prostate under ultrasound guidance. The procedure is done in theatre, and involves a radiation oncologist, urologist, anaesthetist, medical physicist and an oncology theatre nurse.
The seeds remain permanently in the prostate and destroy cancer cells there, while providing little to no radiation to the surrounding structures, such as the bladder or bowel.
Due to this, it has a good side effect profile, and patients are usually discharged the same day or the day after the procedure is done. Possible side effects include burning on passing urine, blood in the urine, retrograde ejaculation, urethral stricture, erectile dysfunction, urinary incontinence, blood in the stools or discomfort passing stool (proctitis) and infertility. However, the rates of occurrence of some of these side effects is low compared to other treatment modalities.
Patients that are good candidates for prostate brachytherapy alone usually have early stage prostate cancer, which is confined to the prostate, and no spread to beyond the capsule of the prostate, seminal vesicles, lymph nodes or distant organs. Patients also should have good urine flow, the prostate can’t be too large, or the grade (aggressiveness) of the cancer can’t be too high.
In cases of slightly more advanced prostate cancer, brachytherapy can still be considered, but needs to be done in combination with androgen deprivation therapy (ADT) and external beam radiotherapy.
Other treatment options for early stage prostate cancer include a radical prostatectomy or external beam radiotherapy. The choice of treatment is often made due to consideration of factors, such as available resources, skills and patient preferences.
Patient follow-up
Patients are normally discharged the day of or the day after the brachytherapy is done. Patients are then followed-up by either their radiation oncologist or urologist with physical examinations and a prostate specific antigen (PSA) blood test for monitoring, done every three months over the next two years to assess the result of treatment. If the treatment has been successful, the PSA normally drops over this time. Follow-up monitoring then becomes less frequent.
Prostate brachytherapy represents an important treatment option for early stage, low- to intermediate-risk prostate cancer. It’s important for the disease to be diagnosed and treated at an early stage to gain the maximal benefit of the treatment.
