Brachytherapy for Prostate Cancer

What is brachytherapy for prostate cancer?

Brachytherapy for prostate cancer is a type of radiation therapy. It involves placing tiny radioactive implants near cancerous tumors in your prostate. There are different types of prostate cancer brachytherapy. This article focuses on permanent (low-dose rate) brachytherapy. The implants release low doses of radiation over 10 to 12 months and then remain in your body. Radiation oncologists may use the term “seeds” or “capsules” when talking about the implants.

How should I prepare for prostate cancer brachytherapy?

First, you’ll meet with your radiation oncologist, who’ll explain the treatment process and answer your questions. Next, you’ll have tests to confirm you can have anesthesia, including blood tests, an electrocardiogram (EKG) and chest X-rays. Your anesthesiologist will explain the steps you should take the day before your procedure.

What happens during brachytherapy for prostate cancer?

1. The pre-operative nursing staff will prepare you for the procedure when you arrive. Your anesthesiologist will give you medication that will make you feel sleepy so you feel relaxed during the procedure.
2. Once in the operating room, the radiation oncology team will help you onto the treatment table. The anesthesiology team will then start the anesthesia.
3. Your radiation oncologist will place an ultrasound probe into your rectum. The probe displays the inside of your prostate gland on a television monitor so your radiation oncologist can plan where to place implants and the specific number of implants that they’ll use.
4. They’ll insert very thin needles carrying the implants into the skin of your perineum.
5. Your radiation oncologist will place between 50 and 100 implants in your prostate. The exact number depends on factors like the tumor location and size.
6. The treatment may take an hour to 90 minutes to complete.

What happens after this procedure?

After treatment, you’ll be taken to a recovery room so healthcare providers can watch over you as the effects of anesthesia wear off. That may take two or more hours.

While you’re resting, providers may put an ice bag on the area where needles were placed to deliver implants. The ice bag will help with swelling that can happen after your treatment.

Providers will review potential side effect information that you and your radiation oncologists talked about before your treatment.

Side effects

Permanent/low-dose-rate brachytherapy may cause immediate, short-term and long-term side effects.

Immediate side effects

• The treatment area may feel sore and swollen.
• You may notice bruising.

These side effects are mild and go away within two or three days.

Short-term side effects

• You’ll probably need to pee more often than usual or feel like you need to pee right away. There may also be a burning sensation with passing urine. These side effects usually become less noticeable over the next six to eight weeks.
• You may have some slight bleeding. Contact your provider if you’re bleeding more than you expect or if you see large clots of blood in your pee.

Long-term side effects

• Erectile dysfunction: Research suggests 25% of people who have this treatment develop erectile dysfunction (trouble maintaining an erection). It’s important to remember that prostate cancer typically affects people age 50 and older and that people often live for many years after treatment. You could develop erectile dysfunction that’s not related to your prostate cancer treatment.
• Radiation exposure: The radioactive implants in your prostate will give off very small amounts of radiation. You may worry that you’ll spread radiation to other people, particularly small children or pregnant people. They may be around you as much as they like, but you should limit the amount of time that they sit in your lap. In general, it’s a good idea not to have a small child or pregnant person sit on your lap for more than 20 minutes at a time for two months after your procedure. But everyone’s situation is different. Ask your radiation oncologist for guidance.
• Radiation proctitis: This condition is an uncommon complication. It affects less than 3% of people who have radiation in their pelvic area, including the prostate. Radiation proctitis causes bleeding and inflammation in your rectum after radiation therapy.
• Radiation cystitis: You may notice blood in your pee. This doesn’t happen very often — less than 3% of people who have brachytherapy for prostate cancer experience radiation cystitis — but you should contact your provider if it happens.

What are the benefits of brachytherapy for prostate cancer?

This type of brachytherapy targets cancerous prostate tumors and reduces the chance that radiation will harm nearby healthy tissue. This treatment causes fewer long-term complications and side effects than other types of radiation therapy. Research suggests brachytherapy for prostate cancer is as effective as any other type of prostate cancer treatment.

When can I go back to my usual activity after treatment?

Most people can get back to their usual activity within one to two days after treatment. In general, it’s a good idea to take it easy and let your provider know if you’re having trouble with daily activities.

For the first two months after your treatment, you should avoid activities that could put pressure on your groin. (Think horseback rides or riding a bicycle.)

Is brachytherapy for prostate cancer successful?

Yes, it is. For example, one analysis of long-term success found that 97% of people who received permanent/low-dose-rate brachytherapy were alive 17 years after completing treatment. Research suggests brachytherapy for prostate cancer is more effective than any other type of prostate cancer treatment. That said, people who have this treatment should have regular screening tests for prostate cancer. Your healthcare provider will recommend how often you should have a screening test.

When should I call my healthcare provider?

Contact your provider if your side effects don’t go away as soon as you expected or are more severe than you expected. You should also contact them if you notice changes in your body that may be a sign that prostate cancer has come back.