Brachytherapy for Prostate Cancer

Brachytherapy for prostate cancer is radiation treatment given from the inside of the prostate instead of from the outside by an external beam. There are two types of brachytherapy:

  • Low dose rate therapy. This involves seed or pellet implantation.

  • High dose rate therapy. This is given by thin tubes that contain radioactive material.

When the seed method (also called implant therapy) is used, 80 to 120 little pellets are placed into the prostate and left in place. Because the radiation does not travel far from the prostate, healthy, noncancerous tissues around the prostate receive only a small dose of radiation, which helps protect them from injury. The radiation fades away over the next few months. 

If the high-dose therapy is used, the thin tubes of radiation are removed after the treatment and there is no radiation left in the prostate when you leave the hospital. This type of treatment is followed by a course of radiation by an external beam method on an outpatient basis.

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  • Previous problems you or members of your family have had with the use of anesthetics.  

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RISKS AND COMPLICATIONS

Generally, brachytherapy for prostate cancer is a safe procedure. However, as with any procedure, complications can occur.

Possible short-term complications include:

  • Difficulty passing urine. You may need a catheter for a few days to a month.

  • Blood in the urine or semen.

  • A feeling of constipation because of prostate swelling.

  • Frequent feeling of an urgent need to urinate.

Possible long-term complications include:

  • Inflammation of the rectum. This happens in about 2% of people who have the procedure.

  • Erection problems. These vary with age and occur in about 15–40% of men.

  • Difficulty urinating. This is caused by scarring in the urethra.

  • Diarrhea.

BEFORE THE PROCEDURE

You will be scheduled for some tests, which may include an ultrasound, CT scan, or MRI. These tests don't hurt. A specialist in radiation treatment will meet with you and will decide which type of brachytherapy to use based on these imaging tests.

PROCEDURE

You will be placed under general anesthesia. A small probe will be placed in the rectum. Ultrasound waves will be used to guide the insertion of small tubes into the prostate in preplanned locations. If the seed method (low dose) is used, small pellets the size of a rice grain will be placed into the tube. The tube will then be removed, leaving the seeds in the prostate. If the high-dose method is used, the radioactive wires that are inserted will be left in for typically a few minutes until a specific dose of radiation is given. Then they will be removed. In both methods a catheter is usually placed into the bladder.

AFTER THE PROCEDURE

Follow-up depends on the type of treatment given. With the high-dose treatment, there is no radiation risk after the treatment. Usually additional treatment with external beam radiation will be provided. This will require a series of visits back to the clinic as an outpatient.

With the seed implant, some physicians recommend that close contact with children and pregnant women be limited because of the low dose of radiation still in the prostate. That radiation will be almost gone by 2 months, and by 4–6 months the levels will be almost undetectable.