Frank's Story

In June 1999 Dr Mark Stevens, who practices at St Vincent’s Hospitals in Sydney spoke to the St Vincent’s support group on the two methods of brachytherapy offered at this institution. While the medical profession in Australia still considers brachytherapy as somewhat new technology and not as well proven a radical prostatectomy or conventional external beam radiotherapy, more patients are opting for it each year. One of the major reasons lies in the fact that the procedure is less invasive, allowing the patients to recover far more quickly with fewer side effects. A disadvantage is that the procedure is not covered by health funds, making the cost to the patients fairly high.

As Dr Stevens explained, brachytherapy involves introducing radioactive material into the prostate and using the radiation to kill the tumour without damage to other tissues, as inevitably occurs with surgery or external beam radiotherapy. Guided by ultrasound, hollow needles are inserted into the tumour in the prostate. If “low dose” brachytherapy is employed, small seeds of irradiated iodine are inserted via the needles into the prostate and left permanently in position. If the “high dose” method is used, a much more radioactive liquid is pumped briefly into the needles and withdrawn once sufficient radiation has been administered.

Of course, the whole procedure is vastly more technical than this brief description suggests, requiring a team of people including a trained nuclear physicist and a computer specialist as well as a surgeon, radiologist and physician. However, the patient is in hospital for only two or three days, suffers little discomfort, and usually can expect to return to normal life within days. Bladder or sexual dysfunction is largely avoided.

For those considering brachytherapy, here is an edited account of one man’s experience of treatment.

Frank is a builder, aged 67, normally active and out of doors, with no previous health problems. About 8 years ago his GP recommended PSA blood tests which were normal until November 1998 when the reading suddenly doubled with the year to 6.3ng/l. Frank was referred to an urologist for a biopsy. Fifty percent of the samples returned a Gleason Score of 9, confirming the diagnosis. His CAT and bone scans were clear, but the urologist considered the cancer grade and location to be unsuitable for surgery.

Frank was initially recommended to choose external beam radiotherapy. While investigating the options, Frank learned about brachytherapy, which was highly recommended by his daughter, a nursing sister. After a second opinion that surgery was inappropriate, Frank chose brachytherapy. Further investigation confirmed that high-dose brachytherapy was an appropriate treatment. By this time Frank felt very comfortable with his choice of medical team and the brachytherapy procedure.

During the afternoon of admission to hospital, nineteen needles and a catheter were inserted under general anaesthetic, a CAT scan was performed and he was returned to the ward for a comfortable night’s sleep. At 9.30 the next morning the first radiation dose was given and repeated at 2.30pm.

Immediately afterwards the needles and catheter were removed, bringing “great relief”. Frank felt only “some discomfort” during the procedure, but was determined to “stay focused” and was able to feel “100% positive” throughout. As an immediate follow-up, Frank had 25 doses of external beam radiation, five days per week for five weeks. "This was the easy part”, said Frank.

Throughout the whole experience Frank found great comfort in his religious beliefs and the prayers and company of his friends and relatives. All decisions about treatment were made by Frank and his wife, calmly without any “panic mode” on the basis of reason and good information. Frank thinks the impact of the diagnosis was probably more severe on his other family members.

He added, "In the few short months since diagnosis we have had great support and friendship from members of our local prostate cancer support group. We found this invaluable, so strongly recommend anyone in the same situation to get in touch as soon as you can and reap the benefits of a great group of carers. The saying “no man is an island” is never more true than when you are concerned and maybe confused about your health. There is great help and encouragement available to you, your spouse and family at the end of the phone."