Prostate brachytherapy

Prostate brachytherapy (brak-e-THER-uh-pee) is a form of radiation therapy used to treat prostate cancer. Prostate brachytherapy involves placing radioactive sources in the prostate gland, where the radiation can kill the cancer cells while causing less damage to healthy tissue nearby.

Types of prostate brachytherapy

Prostate brachytherapy procedures vary based on the type:

• High dose rate (HDR) brachytherapy. HDR brachytherapy is a temporary type of prostate brachytherapy that involves placing radioactive sources in the prostate gland and delivering a high dose of radiation in a few minutes before the sources are removed. Typical treatment may involve several sessions.
• Low dose rate (LDR) brachytherapy. LDR brachytherapy is permanent prostate brachytherapy that involves placing radioactive seeds in the prostate gland permanently, where they slowly release radiation over several months.

What you experience during brachytherapy depends on whether you receive HDR or LDR treatment.

Prostate brachytherapy is used to treat prostate cancer. The procedure places radioactive sources within the prostate, so the cancer receives most of the radiation and nearby healthy tissue receives a minimal dose of radiation.

If you have early-stage prostate cancer that's less likely to spread beyond the prostate, brachytherapy may be the only treatment used.

For larger prostate cancers or those that have a greater chance of spreading beyond the prostate, brachytherapy may be used along with other treatments, such as external beam radiation therapy (EBRT) or hormone therapy.

Prostate brachytherapy generally isn't used for advanced prostate cancer that has spread to the lymph nodes or to distant areas of the body.

Common side effects

Prostate brachytherapy may cause side effects, including:

• Difficulty starting urination
• Frequently feeling an urgent need to urinate
• Pain or discomfort when urinating
• Needing to urinate at night
• Blood in the urine
• Not being able to empty your bladder completely
• Erectile dysfunction
• Bleeding from the rectum
• Blood in stool
• Urgent bowel movements
• More-frequent bowel movements

Doctors often use medications to reduce side effects of treatment. Many side effects of prostate brachytherapy become less noticeable over time.

Rare complications

Some serious complications can occur after prostate brachytherapy, but these are rare. They include:

• Narrowing of the tube that carries urine from your bladder to the outside of your body (urethra)
• Abnormal opening (fistula) in the wall of the rectum
• Cancer in the bladder or rectum caused by radiation

To prepare for prostate brachytherapy, you will:

• Meet with a doctor who treats cancer with radiation (radiation oncologist). The radiation oncologist will explain the available procedures and the possible risks and benefits of each. Together you can decide whether prostate brachytherapy is the best treatment for you.
• Have tests to prepare for anesthesia. To help your doctors prepare for your treatment, you may have blood tests and heart tests to make sure your body is healthy enough for the medicine that puts you in a sleep-like state during the procedure.
• Undergo scans to plan for treatment. Imaging scans of your prostate, such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI), help your radiation oncologist and other members of the treatment planning team decide the dose and positioning of the radiation. These tests can be done before your procedure or at the beginning of your procedure.

What you can expect during prostate brachytherapy depends on the type of brachytherapy treatment you'll receive.

Low dose rate (LDR) brachytherapy

LDR prostate brachytherapy involves placing radioactive sources in the prostate permanently, rather than being placed temporarily, as is the case with HDR brachytherapy. LDR brachytherapy is also known as seed implants.

During this procedure, you may be placed under anesthesia so that you aren't aware during the procedure and won't feel pain.

A wandlike instrument is inserted into your rectum. This instrument creates ultrasound pictures of your prostate. The pictures help to guide a long needle that's used to place many seedlike radioactive implants in your prostate. The needle is inserted through the skin between your scrotum and your anus (perineum) and into your prostate. The seeds, about the size of grains of rice, will give off radiation for a few months and will remain in your body permanently.

Once the seeds are placed in your body, you'll spend some time in a recovery area, and then you can go home. The low levels of radiation in the seeds generally aren't harmful to others, but as a precaution, you may be asked to avoid close contact with children and pregnant women for a short time. Your doctor may advise you to wear a condom during sex.

High dose rate (HDR) brachytherapy

HDR prostate brachytherapy involves placing radioactive sources in your body for several minutes at a time, compared with leaving them in your body permanently, as is done with LDR brachytherapy.

Before receiving HDR brachytherapy treatments, thin tubes are inserted through the perineum and into your prostate at precise locations. You'll be under anesthesia for this part of the procedure so that you aren't aware and won't feel pain. The tubes are kept in place until you've completed your treatments.

For HDR brachytherapy treatments, the tubes are connected to a machine that feeds wires containing radioactive sources into the prostate. The radioactive wires are left in place for a set amount of time, typically several minutes. You may hear clicking noises as the machine adjusts the wires. Then the radioactive wires are removed. The procedure may be repeated a few times, depending on your specific treatment plan.

The radioactive source is removed from your body after HDR brachytherapy, so you won't need any special precautions to avoid close contact with other people.

After the procedure

After prostate brachytherapy, you can expect some pain and swelling in the perineum. You may find relief by placing an ice pack over the area and taking pain medication prescribed by your doctor.

You can resume normal activities when you feel up to it. Your doctor may give you instructions for your recovery, such as avoiding vigorous exercise and heavy lifting.

After prostate brachytherapy, you may undergo follow-up blood tests to measure the level of prostate-specific antigen (PSA) in your blood. These tests may give your doctor an idea of whether treatment has been successful.

It's not unusual for your PSA level to rise suddenly after prostate brachytherapy and then decline again (PSA bounce). Your doctor will likely continue monitoring your PSA level to make sure it doesn't continue to rise.

Ask your doctor when you can expect to know whether your prostate cancer is responding to treatment.

Treatment for a rising PSA after brachytherapy

A persistently rising PSA level after brachytherapy may indicate that the cancer has returned. Your doctor may recommend imaging tests and a prostate biopsy to look for signs of cancer.

If your cancer has returned and is confined to your prostate, you have several treatment options, including treatments to freeze the cancer cells with very cold liquid (cryotherapy), heat the cancer cells with high-intensity focused ultrasound, or surgery to remove the prostate (salvage prostatectomy).

If your cancer has spread beyond your prostate, other treatments, such as hormone therapy, may be considered.