Professional Documents
Culture Documents
UNDERSTANDING
BRACHYTHERAPY
FOR
PROSTATE CANCER
This book is for men who have made a decision to have a specific
treatment or have already received treatment for prostate
cancer. It contains information about important issues to help
men who need to know about brachytherapy treatment and
prostate cancer.
PCFA provides a range of resources to support men, partners
and their families with prostate cancer. For further information,
please see www.pcfa.org.au.
NOTE TO READER
ACKNOWLEDGEMENTS
DISCLAIMER
PERIODIC UPDATES
It is planned that PCFA will review this booklet after a period of, but
not exceeding, four years.
This work is copyright. Apart from any use as permitted under the
Copyright Act 1968 no part may be reproduced by any process
without prior written permission from the Prostate Cancer Foundation
of Australia. Requests and enquiries concerning reproduction and
rights should be addressed to the Chief Executive Officer, Prostate
Cancer Foundation of Australia, PO Box 499, St Leonards, NSW
1590, Australia. Website: www.pcfa.org.au
Email: enquiries@pcfa.org.au
ISBN 978-0-9941841-8-4
Contents
Introduction 2
10
14
17
17
18
19
13 Glossary 21
Introduction
This booklet is for men who have made a decision to have
brachytherapy treatment or have already received brachytherapy
treatment for prostate cancer. It is also designed for men who
are in the process of deciding on their treatment option. It could
be helpful for significant people in your life, such as your partner,
family and friends, to read this booklet.
Survivorship
Detection
Diagnosis
Treatment
and managing
side effects
Follow-up
care
End of life care
Supportive Care
Prostate gland
Seminal
vesicle
Vas deferens
Urinary bladder
Urethra
Rectum
Anus
Ejaculatory
duct
Testicle
Scrotum
Penis
What is brachytherapy
an overview?
Brachytherapy is a type of radiation therapy (radiotherapy) in
which a radioactive source is placed directly into or next to an
organ or tissue with a cancer in it. In the case of prostate cancer,
one of two main types of brachytherapy may be an option
either low dose rate (LDR) or a high dose rate (HDR). Dose rate
refers to the speed at which the dose is delivered, not the actual
dose itself. Brachytherapy may not be available in all hospitals
and is not suitable for all prostate cancers.
MORE INFORMATION
Bladder
Seminal
vesicles
Seminal
vesicles
Bladder
Tumour
Prostate
Prostate
Tumour
Listed below are some questions you may want to ask your
radiation oncologist or members of your healthcare team
about prostate cancer brachytherapy.
W
hat are the benefits and how likely are they?
W
hat are the possible side effects and how likely are they
to occur?
H
ow will brachytherapy affect my quality of life?
H
ow will brachytherapy affect my sexual function or sex
life?
W
ill brachytherapy make me incontinent?
W
hat are the costs involved with brachytherapy?
H
ow may brachytherapy affect other health conditions
I may have?
W
hat are my options if I dont have brachytherapy?
Y
ou may be required to complete your health history online
Y
ou may be admitted the night prior, or the day of your
procedure
A
dmission to hospital date and time will be given
Y
ou will be told what personal belongings to bring with you
Y
ou will be given antibiotics to prevent infection.
Prostate
gland
Needle
Y
ou may be given stool softeners to avoid constipation.
Y
ou can usually resume eating and drinking once you are
awake.
A
dvise your healthcare team if you are experiencing pain, and
they can help manage this.
(E) Preparing to go home
There are a variety of ways that you can prepare yourself for
managing after you are discharged from hospital.
A
sk how long you are going to be in hospital. This will vary
based on your individual situation and your healthcare team.
They will guide you with what to expect.
Ultrasound
probe
E
nsure that you have arranged transport to and from the
hospital as you will be unable to drive for a period of time
following your procedure. If you are having a day only
procedure you will need to have someone drive you home that
day. Ask your healthcare team about when you can expect to
return to driving.
C
onsider support or assistance you may need when you
first go home from hospital. You may wish to organise meals
or house cleaning. For example, stock up on pre-cooked or
frozen meals to cover a day or so. The healthcare team social
worker will be able to advise on arranging support including
costs.
Needle
releasing
seeds
Y
ou may need time off work. Discuss with your radiation
oncologist or urologist when you can expect to return to work.
(F) Radiation aftercare
It is normal for you to be concerned about radiation safety but
it is important to remember that whilst the seeds are radioactive,
you are not. Most of the radiation is absorbed by the prostate.
Normal social contact will not put you or anyone around you at
risk. However, for the first couple of months you should, as a
precaution, avoid having small children on your lap for continual
periods of time, as well as prolonged physical contact with
pregnant women. Your healthcare team will give you specific
instructions regarding this issue.
U
sually minimal side effects are experienced around the time
of treatment
M
inimal post procedure recovery time required
Disadvantages
A
short hospital stay is usually required
N
ot available in all centres
H
aving to lie flat while the implant catheters are in place,
sometimes overnight, which can be uncomfortable. A spinal
anaesthetic is given to minimize movement and discomfort.
S
ide effects affecting bladder, bowel and erectile function can
occur in the longer term
P
ossible cost and travel
Listed below are some questions you may want to ask your
radiation oncologist or members of your healthcare team
about prostate cancer brachytherapy.
W
hat are the benefits and how likely are they?
W
hat are the possible side effects and how likely are they
to occur?
H
ow will brachytherapy affect my quality of life?
H
ow will brachytherapy affect my sexual function or sex
life?
W
ill brachytherapy make me incontinent?
W
hat are the costs involved with brachytherapy?
H
ow may brachytherapy affect other health conditions
I may have?
W
hat are my options if I dont have brachytherapy?
10
YOUR TREATMENT
Expect to be in hospital for one to two nights. This will vary based
on your individual situation and the length of your treatment. Your
healthcare team will guide you with what to expect.
Y
ou may be admitted the night prior to, or the day of, your
procedure.
Y
our admission to hospital date and time will be given.
Y
ou will be told what personal belongings to bring with you.
You healthcare team will advise you on:
f asting time (when to stop eating and drinking before your
procedure)
m
edication, x-rays, scans that you are required to bring with
you
m
edication you need to stop before the procedure e.g. anticoagulants, anti-inflammatories, herbal or complementary
supplements
t he medication or an enema to clear your bowel prior to this
procedure
a
ppointment time with your anaesthetist either before your
hospital stay or on the day of your procedure.
(B) Admission to hospital
You may be admitted directly to a hospital ward or to a presurgery area. Following your preparation, you will be taken to the
operating theatre for your procedure.
There are a variety of ways that you can prepare yourself before
your procedure.
C
onsult with your healthcare team about any health issues
that should be managed prior to your treatment. Further tests
or examinations may be needed to assess your health before
treatment.
V
isit your hospitals prostate cancer nurse, urology nurse
or continence advisor for further information, advice and
support.
T
here are certain medications that you may need to stop
taking temporarily before the procedure, for example anticoagulants and anti-inflammatories. Discuss this with your
healthcare team.
Y
ou can usually resume eating and drinking once you are
awake, though you are usually restricted to a clear fluid only
diet for the course of your treatment.
W
hile the implant catheters are in place you will be lying flat on
your back.
Y
ou will have a catheter to drain urine and this is usually left in
place overnight.
Y
ou will be given antibiotics to prevent infection.
Y
ou will have an intravenous infusion (IV) in place to give you
fluids.
S
peak to the healthcare team if you experience any pain or
discomfort during your treatment stay. The epidural infusion
(or a PCA device) will remain in place for the duration of your
treatment.
HDR BRACHYTHERAPY
Prostate gland
Implant
catheters
12
T
he amount of pain experienced afterwards is usually not
significant. However you may need mild painkillers for a day or
two. As you recover you will find you can reduce your intake of
pain relief tablets. It is important however to have an adequate
amount of pain relief to allow you to perform normal daily
activities comfortably such as showering, dressing and taking
gentle walks.
PREPARING TO GO HOME
N
ursing staff will explain how to care for your wound.
There are a variety of ways that you can prepare yourself for
managing after you are discharged from hospital.
E
xpect to have swelling and bruising of your scrotal area,
which will resolve in the weeks following your procedure.
Wearing supportive underwear can make things more
comfortable.
Ask how long you are going to be in hospital. This will vary
based on your individual situation and your healthcare team.
They will guide you with what to expect.
You may need time off work. Discuss with your radiation
oncologist or urologist when you can expect to return to work.
MANAGING AT HOME
13
m
aintain regular activity as per your hospital healthcare team
advice
Urinary symptoms
Stinging, burning, poor stream, urgency in passing urine,
frequency of urination or needing to pass urine more at night
are very common after brachytherapy over a few months. These
symptoms occur as the prostate swells and the urethra gets
irritated. Talk to your healthcare team about how to manage
these. Tips include:
E
rectile dysfunction your healthcare team can advise on this.
More information is available in the booklet Understanding
sexual issues following prostate cancer treatment available
from PCFA (1800 220 099).
B
owel symptoms less common with LDR brachytherapy.
More information is available in the booklet Understanding
bowel disturbance following prostate cancer treatment
available from PCFA (1800 220 099).
Y
our surgeon may prescribe medication called an anticoagulant (prevents clot formation), which is generally given
as an injection following your procedure.
Y
ou will be given anti-embolic stockings to wear just before
and after the procedure.
Constipation
Constipation can be a problem for up to four weeks after the
procedure, mostly from the drugs given for anaesthesia and pain
relief. It may also be partly due to the radiation which may cause
inflammation to the prostate gland, which in turn presses on the
bowel. Preventing constipation and achieving regular soft bowel
motions can be achieved with the following tips:
T
he leg pumps applied in theatre will help reduce this risk.
DVT AND PE SIGNS AND SYMPTOMS
Equipment
Reason
A
s prescribed by your healthcare
team.
Fluid replacement.
U
ntil you are drinking normally.
U
ntil your vital signs (blood
pressure, pulse, respirations) are
stable.
T
ime required is variable.
A
s prescribed by your healthcare
team.
F
or the duration of your treatment.
F
or the duration of your treatment
F
or the duration of your treatment
15
Reason
Anti-embolic stockings
Below knee Above knee
L
ength of your hospital stay
A
s prescribed by your urologist
F
or the duration of your treatment
16
A
t home until you are fully
recovered
10
Your healthcare team will also ask you about any side effects
you are experiencing and will be able to refer you to other
specialists to investigate and help you manage these side effects
if necessary. Tell your doctor or members of your treating team
if any symptoms are getting worse, or if you have developed any
new symptoms.
17
11
C
ontinence Nurse: Helps you manage any problems related to
continence (urinary or bowel) care after treatment
Pharmacist: Dispenses medications and offers medication
advice
Dietitian: Recommends the best eating plan while in treatment
and recovery
S
ocial Worker: Advises on support, practical and legal
matters, and provides strategies to cope with emotional,
social and spiritual challenges
When working with your healthcare team, you may see the
following health professionals:
P
alliative Care Specialist: Expert in pain and symptom control
who works closely with the treatment team
S
ex Therapist: Helps with sexuality issues by identifying the
level of sexual functioning available, and enhancing sexual
and relationship functioning
F
ertility Counsellor: Specialises in helping people with fertility
concerns and issues, and can advise on fertility preservation
options before starting treatments.
18
12
Cancer Councils:
Cancer Council ACT
Tel: (02) 6257 9999
Email: reception@actcancer.org
www.actcancer.org
19
12
FURTHER READING
Other resources
For more information about prostate cancer and symptom
management, PCFA has a number of resources. Please visit
PCFA website www.pcfa.org.au
or call: (02) 9438 7000/1800 220 099 (freecall).
Please note: If calling from overseas, the country code for Australia is +61
20
13
Glossary
Abdomen
The part of the body that includes the stomach, intestine, liver, bladder and kidneys.
The abdomen is located between the ribs and hips.
Treatment given after the primary treatment to increase the chances of a cure. In cancer,
adjuvant treatment often refers to chemotherapy, hormonal therapy or radiotherapy after
surgery, which is aimed at killing any remaining cancer cells.
Prostate cancer that has spread to surrounding tissue or has spread to other parts of the
body.
Alternative therapy
herapy used instead of standard medical treatment. Most alternative therapies have not
T
been scientifically tested, so there is little proof that they work and their side effects are
not always known.
Anaesthetic
drug that stops a person feeling pain during a medical procedure. A local anaesthetic
A
numbs only a part of the body; a general anaesthetic puts a person to sleep for a period of
time.
Bladder
sac with an elastic wall of muscle; found in the lower part of the abdomen. The bladder
A
stores urine until it is passed from the body.
Brachytherapy
Cancer
Carer
Catheter
A hollow, flexible tube through which fluids can be passed into the body or drained from it.
Cells
The building blocks of the body. A human is made of millions of cells, which are adapted
for different functions. Cells can reproduce themselves exactly, unless they are abnormal
or damaged, as are cancer cells.
Chemotherapy
The use of drugs, which kill or slow cell growth, to treat cancer. These are called cytotoxic
drugs.
Clear Margin
When a malignant tumour is surgically removed some surrounding tissue will be removed
with it. If this surrounding tissue does not contain any cancer cells it is said to be a clear
margin.
Clinical trial
Research conducted with the persons permission, which usually involves a comparison of
two or more treatments or diagnostic methods. The aim is to gain a better understanding
of the underlying disease process and/or methods to treat it. A clinical trial is conducted
with rigorous scientific method for determining the effectiveness of a proposed treatment.
Complementary therapy
Therapy used together with standard medical treatment. Examples include counselling,
relaxation therapy, massage, acupuncture, yoga and meditation, aromatherapy, and art
and music therapy.
Constipation
Cultural engagement
Diagnosis
Diarrhoea
Dietitian
21
13
Glossary
Erectile dysfunction
Erection
Fertility
General practitioners diagnose, refer and treat the health problems of individuals and
families in the community. Also commonly referred to as family doctors.
Grade
Hormone
A substance that affects how your body works. Some hormones control growth, others
control reproduction. They are distributed around the body through the bloodstream
Hormone therapy/treatment
Treatment with drugs that minimises the effect of testosterone in the body. This is also
known as androgen deprivation therapy (ADT).
Incision
Impotence
Incontinence
Intravenous
Prostate cancer that is at an early stage and is still contained within the prostate gland.
Cancer which has spread beyond the prostate capsule and may include the seminal
vesicles but still confined to the prostate region.
Lymph nodes
Also called lymph glands. Small, bean-shaped collections of lymph cells scattered across
the lymphatic system. They get rid of bacteria and other harmful things. There are lymph
nodes in the neck, armpit, groin and abdomen.
Malignant
Cancerous. Malignant cells can spread and can eventually cause death if they cannot be
treated.
Small groups of cells have spread from the primary tumour site and started to grow in
other parts of the body such as bones.
Multidisciplinary team
Non-nerve-sparing radical
prostatectomy
Nerve bundles on both sides of the prostate are removed during surgery to remove the
prostate.
Palliative care
An approach that improves the quality of life of the person and their families facing
problems associated with a life-threatening illness. Prevention and relief of suffering is
provided through early identification and assessment and treatment of pain and other
problems such as physical, psychosocial and spiritual.
Pathologist
A person who studies diseases to understand their nature and cause. Pathologists
examine biopsies under a microscope to diagnose cancer and other diseases.
PBS
Pelvic
The area located below the waist and surrounded by the hips and pubic bone.
22
13
Glossary
Pelvic floor muscles
The floor of the pelvis is made up of muscle layers and tissues. The layers stretch like a
hammock from the tailbone at the back to the pubic bone in front. The pelvic floor muscles
support the bladder and bowel. The urethra (urine tube) and rectum (back passage) pass
through the pelvic floor muscles.
Perineal (Perineum)
Penis
The male reproductive organ consists of a body or shaft which starts deep inside the body
and extends externally to the end of the penis at the glans (head).
Primary care
Primary Care is a sub-component of the broader primary health care system. Primary
care is provided by a health care professional who is a clients first point of entry into the
health system (for example: a general practitioner, practice nurse, community nurse, or
community based allied health worker). Primary care is practised widely in nursing and
allied health, but predominately in general practice.
Prognosis
Prostate cancer
Cancer of the prostate, the male organ that sits next to the urinary bladder and contributes
to semen (sperm fluid) production.
Prostate gland
The prostate gland is normally the size of a walnut. It is located between the bladder and
the penis and sits in front of the rectum. It produces fluid that forms part of semen.
A protein produced by cells in the prostate gland, which is usually found in the blood in
larger than normal amounts when prostate cancer is present.
Psychosocial
Treatment that is intended to address psychological, social and some spiritual needs.
Quality of life
Radical prostatectomy
The use of radiation, usually x-rays or gamma rays, to kill tumour cells or injure them so
they cannot grow or multiply.
Self-management
Integration of a patients values, goals and concerns with the best available evidence
about benefits, risks and uncertainties of treatment, in order to achieve appropriate health
care decisions. It involves clinicians and patients making decisions about the patients
management together.
Side effect
Stage
The extent of a cancer and whether the disease has spread from an original site to other
parts of the body.
Standard treatment
Support group
People on whom an individual can rely for the provision of emotional caring and concern,
and reinforcement of a sense of personal worth and value. Other components of support
may include provision of practical or material aid, information, guidance, feedback and
validation of the individuals stressful experiences and coping choices.
23
13
Glossary
Supportive care
Improving quality of life for people with cancer from different perspectives, including
physical, social, emotional, financial and spiritual.
Surgeon
Surgery
Treatment that involves an operation. This may involve removal of tissue, change in the
organisation of the anatomy or placement of prostheses.
Survivorship
In cancer, survivorship focuses on the health and life of a person with cancer beyond the
diagnosis and treatment phases. Survivorship includes issues related to follow-up care,
late effects of treatment, second cancers, and quality of life.
Testosterone
Nerve bundles on one side of the prostate are left intact during surgery to remove the
prostate.
Therapy
Another word for treatment, and includes chemotherapy, radiotherapy, hormone therapy
and surgery.
Urethra
The tube that carries urine from the bladder, and semen, out through the penis and to the
outside of the body.
Urologist
Urologists are surgeons who treat men, women and children with problems involving the
kidney, bladder, prostate and male reproductive organs. These conditions include cancer,
stones, infection, incontinence, sexual dysfunction and pelvic floor problems.
24
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A
CRASTRO. (2010). Practice guidelines
for the performance of High Dose Rate
Brachytherapy. www.acr.org/~/media/
b563249005d447da9c3cef1abcacbed2.pdf
American Cancer Society. (2012). Prostate
cancer. www.cancer.org/acs/groups/cid/
documents/webcontent/003134-pdf.pdf
Australian Cancer Network Management
of Metastatic Prostate Cancer Working
Party. (2010). Clinical practice guidelines for
the management of locally advanced and
metastatic prostate cancer. Sydney: Cancer
Council Australia and Australian Cancer
Network.
Harvard Medical School Prostate Knowledge.
(2011). What is a PSA bounce? Retrieved
from www.harvardprostateknowledge.org/
what-is-a-psa-bounce
Heidenreich, A., Bastian, P.J., Bellmunt, J.,
Bolla, M., Joniau, S., Mason, M.D., Matveev,
V., Mottet, N., van der Kwast, T.H., Wiegel,
T., Zattoni. F. (2012). Guidelines on prostate
cancer. European Association of Urology
Group for Prostate Cancer.
Khaksar, S.J., Laing, R.W., Langley, S.E.M.
(2005). Fertility after prostate brachytherapy.
British Journal of Urology International. 96,
p915.
National Health & Medical Research Council.
(2003). Clinical Practice Guidelines: Evidence
based information and recommendations for
the management of localised prostate cancer.
Canberra.
Prostate Brachytherapy Advisory Group,
UK. Treatment options for localised
prostate cancer: An introduction to prostate
brachytherapy Information for nurses.
www.prostatebrachytherapyinfo.net/docs/
NURSES%20SUPPLEMENT.pdf
Royal Australian and New Zealand College of
Radiologists, Faculty of Radiation Oncology
web-resources for patients, carers and health
professionals: www.targetingcancer.com.au
WP Holman Clinic, Launceston General
Hospital. High dose rate brachytherapy
procedural orders and patient information.
The Clatterbridge Cancer Centre NHS
Foundation Trust. (2013).
www.clatterbridgecc.nhs.uk.
25
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