UAMS First in State to Offer Advanced Radiation Therapy for Prostate Cancer
| LITTLE ROCK – The University of Arkansas for Medical Sciences (UAMS) is the first in the state to offer real-time prostate brachytherapy, an advanced form of radiation therapy that can benefit some men who have been diagnosed with prostate cancer.
“The real-time method gives us more information and more flexibility in planning and performing prostate brachytherapy than we have with the conventional method,” explained Nikos Papanikolaou, Ph.D., a UAMS associate professor of radiation oncology, the branch of medicine that deals with the use of radiation to treat cancer, and a member of the Arkansas Cancer Research Center. “The real-time method has potentially fewer complications because it can more precisely target the cancer and protect surrounding healthy tissues from receiving radiation.”
When most people think of radiation therapy, they think of external radiation by which a machine delivers high-energy rays to the patient to damage cancer cells and stop them from growing and dividing. However, there is also an internal form of radiation treatment known as brachytherapy, which is the implantation of radioactive “seeds” into the cancerous area. The best candidates for prostate brachytherapy are men who have early-stage cancer.
Until recently, the only option was standard prostate brachytherapy, said Papanikolaou, who is chief of medical physics in the Department of Radiation Oncology in the UAMS College of Medicine. In the standard method, a rectal ultrasound probe is used to “map,” or locate, the patient’s prostate gland, seminal vesicles, urethra, bladder and rectal wall. Using these images, the health care team develops a treatment plan that specifies the number of needles required to implant the radioactive seeds, the number of seeds per needle and the locations for needle placement into the prostate.
About two weeks after the initial ultrasound, the patient is taken into the operating room for the standard brachytherapy. The rectal ultrasound probe is once again put in place to reproduce the map of the prostate gland and its nearby organs. Then, the needles are manually inserted through a template and into the prostate. The needles, which are hollow on the inside, contain the previously designated number of radioactive seeds. As the needles are manually pulled out, the seeds are automatically implanted in the prostate.
“Real-time prostate brachytherapy is conceptually similar to the standard method, but there is no preconceived notion of the treatment plan until the patient reaches the operating room,” Papanikolaou said. “The rectal ultrasound probe that we place in the patient immediately before the real-time procedure is motorized so that it can scan the area from side to side and collect three-dimensional data, rather than the two-dimensional data that the nonmotorized probe collects during standard brachytherapy. The computer system uses this 3-D data to build a model of the area to be implanted and to determine how to implant the radioactive seeds to most optimally treat the patient’s prostate cancer.
“During the actual procedure, we manually insert the needles into the patient’s prostate gland based on the optimized planning instructions we get from the computer. The needles are coupled to a driving device that’s connected to the computer, which loads the seeds into the needles and then retracts the needles to implant the seeds in the prostate. As the needles are being inserted, the computer is able to see if a needle bows or curves, if a needle doesn’t go into the prostate as deeply as planned, and if other differences from the original treatment plan occur. The computer can then recalculate the data and adapt the treatment plan to accommodate the variances that have occurred.
“Standard brachytherapy is based on a locked-in-time image because the anatomy must look the same in the operating room as it did two weeks earlier during the initial ultrasound. Real-time brachytherapy allows us to address the anatomy at hand right in the operating room.”
Real-time brachytherapy is performed under either general or spinal anesthesia and takes approximately two hours. Once the implanted seeds have emitted all of their radiation, they can safely remain inside the prostate gland. Most health insurance companies cover the procedure.
“We’re happy to finally have the expertise of Dr. Papanikolaou, as well as Dr. Vaneerat Ratanatharathorn, the chairwoman of radiation oncology at UAMS,” said Graham Greene, M.D., associate professor of urology and director of genitourinary oncology at UAMS and a member of the Arkansas Cancer Research Center. “Their presence at the university has enabled us to coordinate a brachytherapy program to offer men with organ-confined prostate cancer an option other than surgery. Brachytherapy continues to evolve and has gained the respect of many health care professionals treating prostate cancer as a valid treatment, with cancer control rates similar to surgery at 10 years and with less risk in terms of side effects, such as incontinence and impotence. Real-time brachytherapy will be the standard in years to come, and we’re glad to be the first to bring it to Arkansas.”
Prostate cancer is the most common nonskin cancer and the second-leading cause of cancer-related deaths in men who are 50 years of age and older. Last year in the United States, approximately 210,000 men were diagnosed with prostate cancer and almost 42,000 died from the disease.