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Veterans Health Administration

Treating Prostate Cancer with Brachytherapy

Penny and brachytherapy radiation pellets
Brachytherapy seeds (penny shown for scale). Photo courtesy of Oak Ridge Associated Universities

Prostate cancer is the most common type of cancer found in men in the U.S., second only to skin cancer. One man in six will get prostate cancer in his lifetime. The American Cancer Society estimates that in 2009, more than 192,000 men will be diagnosed with prostate cancer and more than 27,000 men will die from the disease.

Radiation therapy is one way to treat prostate cancer. This treatment uses high-energy rays to kill cancer cells and shrink tumors. Internal radiation, or brachytherapy, is a form of radiation therapy. In a brachytherapy procedure, small radioactive pellets are inserted into the prostate, delivering a concentrated radiation dose to the cancerous area.

To plan an implant, doctors analyze ultrasound images of the patient's prostate and determine how many pellets will be needed and where each pellet should be placed. Anesthesia is typically used during the implant procedure. Hollow needles are inserted into the prostate through a needle template guide. The pellets are distributed throughout the entire prostate. Two types of radioactive seeds, iodine-125 and palladium-103, are commonly used. The 60-minute outpatient procedure allows most patients to return to work within a few days.

Once implanted, the pellets emit radiation for several months. Depending on the state of the patient's health before treatment, approximately 80-90% of prostate cancer patients are still cancer-free 10 years after brachytherapy treatment. However, because prostate cancer is generally slow-growing, even 10 years is a short amount of time to monitor significant health changes. Patients can be more certain about the state of their cancer after 15-20 years.

General radiation side effects are unusual with prostate implants because the radiation is limited to a very small area of the body. Side effects of brachytherapy can include problems with the bladder and bowel, pain, impotence, and minimal fatigue.

Investigating Brachytherapy Treatments in Philadelphia

In May 2008, the Philadelphia VA Medical Center discovered irregularities involving either under-dosing or incorrect dosing of patients undergoing brachytherapy treatment. VA suspended the program while we investigated the situation. Independent, external physicians and physicists conducted examinations of patient scans, dosages, and medical records and identified 92 events.

It is VA's policy to actively seek out quality problems, discuss them openly, and find solutions. VA informed and treated all affected Veterans. Our outreach included certified letters, calls to these veterans and a toll-free number to address questions or concerns. VA is covering all costs associated with additional tests while continuing to monitor the affected Veterans' care at other VA and private facilities.

VA is currently conducting a comprehensive review to ensure the right policies and procedures are in place to protect Veterans while providing them the highest health care possible.