By Andrew Gorosko

NEW MILFORD — Doctors at the New Milford Hospital-Columbia-Presbyterian Regional Cancer Center are using an advanced version of radiation seed-implant therapy to combat prostate cancer, a disease most commonly found in men in their 60s and 70s.

Men who have developed prostate cancer now have the treatment option of “transperineal prostate brachytherapy,” in which small radioactive particles, known as seeds, are placed in the prostate gland via needles inserted through the perineum. The perineum is the small area between the anus and the scrotum in the male. The chestnut-shaped prostate gland is a reproductive gland, which sits below the bladder. The gland helps create the fluid component of male ejaculate.

Dr Joseph Bargellini, a radiation oncologist at the New Milford treatment center, said radiation seed-implant therapy for prostate cancer is an alternative to the more conventional “external-beam radiation” therapy.

Seed implant therapy can be accomplished in one treatment session lasting several hours. It allows patients to go home from the hospital the same day as outpatients. “It’s another treatment option,” the doctor said.

 The radioactive seeds, which are the size of small grains of rice, need never be removed from the prostate gland. Men receiving such therapy are less likely to have potency problems than those receiving external beam radiation treatment, Dr Bargellini said. Seed implant therapy can be less expensive than external beam radiation treatment, he said. External-beam radiation therapy typically requires 40 treatment sessions, lasting five days per week for eight weeks.

Since it began performing the seed-implant treatment last summer, the New Milford cancer center has treated eight patients with the technique, about half of whom received a combination of seed implant and external radiation treatment, Dr Bargellini said. The cancer center opened last spring.

Besides radiation, prostate cancer also can be treated with surgery and hormones. The form of treatment is variable based upon the specific incidence of cancer, he said.

In seed-implant treatment, miniscule metal “seeds,” which contain prescribed amounts of either radioactive Iodine-125 or Palladium-103, are inserted into the prostate following a computer-derived three-dimensional pattern which is calculated to be the most effective pattern to treat the specific incidence of cancer, Dr Bargellini said. In the treatment, between 50 and 100 seeds are inserted into the prostate, depending upon the size of the prostate.

The seeds kill cancerous cells, while avoiding damage to nearby healthy tissues.

Unlike external-beam radiation therapy, in which the prostate only receives radiation when it is exposed to a radiation machine, the radiation emitted by the inserted seeds persists, requiring only a single treatment session, the doctor explained. The therapeutic effect of the implanted seeds lasts for several weeks.

Palladium-103 has a 17-day radioactive “half life” and Iodine-125 has a 60-day half-life, meaning that half the radioactive atoms in the substance disintegrate during those periods. Consequently, the level of radiation emitted by the seeds progressively diminishes.

 Medical personnel who perform the insertion procedure monitor progress with an ultrasound imaging system. A coordinate grid superimposed over the ultrasound image corresponds to a gridded template through which long needles inject the seeds into the prostate, thus physically guiding doctors in their placement of the radioactive particles.

Use of the corresponding electronic and physical grids allows doctors to perform a uniform, consistent procedure which is more precise than past procedures, Dr Bargellini said.

“The computer generates [an insertion] plan and the plan tells us where each seed should be placed,” Dr Bargellini said. 

“The majority of this is science, but there still is a lot of clinical judgement,” he said.

The fine insertion work is made possible by the use of a sophisticated mount, which allows doctors to make precise placements of the seeds through the needles inserted into the prostate via the perineum.

During the seed implantation, a number of medical personnel are present, including a radiation oncologist, a urologist, two radiation physicists, and an anesthesiologist, plus nurses.

Patients undergoing the procedure receive a spinal anaesthetic which numbs sensation below the waist, Dr Bargellini said. After the work is complete, patients typically aren’t aware that the seeds are present and usually don’t require pain medication, he said.

  “The results have been very, very good. They’re at least as good as conventional (radiation) therapy,” Dr Bargellini said. “Many people do well and have an improvement in the quality of life,” he said.

External beam radiation therapy is easier to administer to patients than seed implantation, but external beam therapy is a lengthy process, he noted.

Seed implantation is a less risky form of treatment than surgery, the doctor said.

Good candidates for seed-implant therapy are those men who have prostate cancer in its earlier stages, he said. Men with more advanced forms of the disease more commonly have external-beam radiation treatment.

Prostate cancer is often a slow growing cancer. Blood tests and digital rectal exams are used to discover its presence.

The side effects of radiation treatment can include a pain or burning sensation on urinating, blood in the urine, an increased level of urination, and, sometimes, an inability to urinate.

Prostate cancer is the most common cancer among men. In men over 60, it is the most common cause of cancer death.

 The onset of prostate cancer is highly variable and can occur as early as the 40s, but more commonly happens in the 60s and 70s. In advanced cases, the cancer may spread to the bone. Prostate cancer has no known cause.

The incidence of prostate cancer is noticeably higher in Western societies than in Eastern ones, indicating the higher rate of prostate cancer in the West may stem from lifestyle, Dr Bargellini said.

  Dr Bargellini holds a BS degree in chemical engineering from Yale University and is a graduate of the University of Medicine and Dentistry of New Jersey Medical School. He performed his internship in internal medicine at New York Hospital-Cornell Medical Center and his residency in radiation oncology at Mallinckrodt Institute of Radiology in St Louis and Columbia-Presbyterian Medical Center where he was also chief resident. Dr Bargellini has been in practice at Columbia-Presbyterian and is board certified in radiation oncology by the American Board of Radiology.