Brachytherapy Overview

The prostate is a walnut-sized gland that surrounds the urethra. It sits between the bladder and the rectum and adds vital nutrients and fluid to the sperm. Aside from skin cancer, prostate cancer is the most common cancer in males today.

One in six men will develop prostate cancer in their lifetime. Nearly 100 percent of men diagnosed and treated five years ago will survive prostate cancer, according to the American Cancer Society. For men diagnosed and treated 10 years ago, 91 percent will survive. If you have recently been diagnosed, one treatment option available is brachytherapy.

Brachytherapy is a minimally invasive, internal radiation therapy for prostate cancer. Through this treatment, low-dose radioactive seeds are permanently implanted in the prostate gland. An average of 60 to 120 seeds, smaller than a grain of rice, are placed in a pattern designed by your physician that is specific to your prostate gland. The seeds work to destroy the cancer from the inside.

Iodine and Palladium are the two most commonly used radioactive isotopes for brachytherapy. Your doctor will determine which will work best for you. Brachytherapy is a one-time, outpatient procedure performed under anesthesia. Normal daily activity can usually be resumed within a day.

Benefits of Brachytherapy

Brachytherapy has several advantages compared to surgery, including:

  • Avoiding a major surgery
  • Shorter recovery time
  • No catheterization required in most patients
  • Minimal bleeding
  • Less erectile dysfunction
  • Precise placement of the seeds offers a more tailored treatment

Another benefit of brachytherapy is that it typically provides a much shorter course of treatment than external beam radiation. With this procedure, there is minimal exposure to the tissue surrounding the prostate. The main advantage of brachytherapy is that it delivers radiation in a localized area, minimizing the radiation dose to surrounding tissues.

What to Expect

There are two steps in a prostate brachytherapy procedure:

Step 1 – Treatment Planning

Treatment planning requires a prostate ultrasound, also known as a volume study, to measure the size and shape of the prostate. This creates a computerized 3D model, which is used to determine how many radiation seeds need to be inserted in the prostate to eliminate the cancer.

Step 2 – Implant

Your specialists will implant the seeds into the prostate as strands of several seeds linked together. The implant is performed under general or spinal anesthesia and takes about an hour. The urologist then performs a cystoscopy to look inside the bladder to ensure that the seeds are not protruding into the urethra or bladder. The seeds will release low level radiation for 9-12 months to treat the cancer. After a year, the seeds are no longer radioactive and do not have to be removed.

Before: Preparing for the Implant

Prior to your implant, an appointment will be set up, during which your doctor will use an ultrasound to measure your prostate and determine the type (Iodine or Palladium) and number of seeds needed to treat your cancer. Your medical team will work together to generate a plan or “map” for seed placement based on your prostate gland’s volume, shape and tumor location.

The seeds will be delivered to the doctor as close as possible to your procedure time since the radiation within the seeds decays over time. The seeds can be delivered in a variety of forms, depending on your doctor’s preference. The doctor can request loose seeds to load into needles themselves, or they might use a MickTM technique to implant the seeds in a more real-time method. The seeds might also come already inserted into long, thin needles and loaded according to the doctor’s treatment plan.

During: Implant Day

During the procedure, you will be positioned on the operating table with the needle template placed against the perineum. (The perineum is the area between the anus and scrotum.) You will most likely receive general or spinal anesthesia to ensure you feel no discomfort during the procedure. You will not feel the needles going in or the seeds being deposited. The doctor will use an ultrasound to guide the needles through the skin and directly into your prostate gland. Once the seeds are implanted the empty needle is removed.

The small size of the seeds causes no discomfort and allows them to stay in place as dormant titanium shells once their radioactivity has decayed. The implant is a half-day, outpatient procedure with only one to two hours needed for the entire surgery. Following two to three hours for recovery and observation, you will be released.

After: What to Expect

Temporary side effects might include mild discomfort, fatigue, diarrhea, rectal irritation and small amounts of blood and/or sperm in the urine for a few days. You might also experience an increase in urinary tract symptoms, such as frequency, burning and urgency. Other risks may occur but will be discussed prior to your discharge.

You should refrain from strenuous activity and heavy lifting, as well as applying pressure to the area.

Please consult your doctor regarding time frames on restrictions and when you may resume normal activities.

Frequently Asked Questions

Will I be radioactive after the procedure?

The prostate gland absorbs almost all of the radiation you receive. Therefore, there is no threat to other people. Objects that you touch do not become radioactive. Although a very small amount of radiation will escape your body, you should not worry about general radiation exposure to your family and friends. Your doctor will provide you with detailed guidelines and information regarding short-term precautions to take around young children, pregnant women and pets.

Will I have any discomfort?

Rates of complications are significantly less with brachytherapy than those associated with radical prostatectomy or external beam radiation. For two to three days after the implant, you may experience some soreness between the rectum and the scrotum. This can be managed very effectively with mild analgesics. The effect can be immediate or delayed.

What are the short- and long-term effects of seed implants on my potency?

As a treatment, brachytherapy lessens the risk of impotence and urinary incontinence when compared to other treatments. However, like any cancer treatment, side effects may occur. Approximately 25-30 percent of men who were fully potent prior to treatment will regain potency after the implant. Fifty percent will have some decrease in their ability but will still be able to enjoy intercourse. The majority of these men can be successfully helped with medication. Be sure to tell your doctor if you experience any significant or troublesome side effects.

Will I become incontinent?

Less than one percent of men will experience long-term incontinence. Some patients will experience a short-term feeling of urgency. This will resolve as the seeds lose their activity.

What type of follow-up do I need after my seed implant?

Your doctor will want to follow-up with you in 30 days for a post-implant exam. In most cases, you will then come in for PSA tests every six months, with annual exams recommended. Based on your doctor’s recommendation, after five years a PSA test may then be performed annually.

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