Brachytherapy for prostate cancer

Overview

Brachytherapy for prostate cancer is a specialized form of radiation treatment. It works by inserting small radioactive implants directly into the prostate, close to the cancerous tumors.

This article specifically discusses permanent (low-dose rate) brachytherapy. In this method, the implants gradually emit low levels of radiation over a period of 10 to 12 months and then remain in the body. Radiation oncologists may refer to these implants as “seeds” or “capsules.”

Reasons for undergoing the procedure

Prostate brachytherapy is a treatment method for prostate cancer that involves placing radioactive materials directly inside the prostate. This targeted approach ensures that the cancerous tissue receives the majority of the radiation while minimizing exposure to the surrounding healthy tissue.

For early-stage prostate cancer that is less likely to spread beyond the prostate, brachytherapy might be the sole treatment required. In cases where the cancer is larger or has a higher risk of spreading beyond the prostate, brachytherapy may be combined with other therapies, such as External Beam Radiation Therapy (EBRT) or hormone therapy.

However, prostate brachytherapy is generally not recommended for advanced prostate cancer that has metastasized to lymph nodes or other distant parts of the body.

Risks

Permanent or low-dose-rate brachytherapy can lead to immediate, short-term, and long-term side effects.

Immediate side effects

• You can experience pain and swelling in the treatment area.
• You might see bruises.

These are minor adverse effects that disappear within two or three days.

Short-term side effects

• You’ll probably experience the urge to urinate immediately or more frequently than normal. Urine passage may also cause a burning feeling. For the next six to eight weeks, these side effects normally go away.
• There can be a small amount of bleeding. If you notice huge clots of blood in your urine or if you’re bleeding more than you think, call your doctor.

Long-term side effects

• Radiation exposure: The radioactive implants used in brachytherapy emit very small amounts of radiation. While it is unlikely that this radiation will pose a risk to others, especially small children or pregnant individuals, it’s advisable to limit their time on your lap. To be cautious, avoid having a child or pregnant person sit on your lap for more than 20 minutes at a time for the first two months following your procedure. Each case is unique, so consult your radiation oncologist for specific recommendations.
• Erectile dysfunction: Studies indicate that about 25% of individuals undergoing this treatment may experience erectile dysfunction, which involves difficulties maintaining an erection. It’s worth noting that prostate cancer usually affects those over 50, and many individuals live for several years after treatment. Erectile dysfunction might develop independently of the prostate cancer treatment.
• Radiation proctitis: This rare complication affects fewer than 3% of people who receive radiation in the pelvic area, including the prostate. It involves inflammation and bleeding in the rectum following radiation therapy.
• Radiation cystitis: You might notice blood in your urine, though this occurs in less than 3% of individuals who undergo brachytherapy for prostate cancer. If you experience this symptom, contact your doctor.

Before the procedure

Your radiation oncologist will first see you, go over the course of treatment, and address any questions you may have. Following that, tests such as blood work, an Electrocardiogram (EKG), and a chest X-ray will be performed to verify that you are a candidate for anesthesia. You will receive instructions from your anesthesiologist the day before the operation.

During the procedure

• When you arrive, the pre-operative nursing staff will get you ready for the surgery. To help you feel at ease throughout the treatment, your anesthesiologist will administer medication to you that will induce sleep.
• The radiation oncology staff will assist you onto the treatment table once you’re in the operation room. The anesthetic will subsequently be started by the anesthesiology staff.
• The radiation oncologist will place an ultrasound probe in your rectum to visualize your prostate gland on a monitor. This helps them determine where and how many implants to place.
• They will insert very thin needles through the skin of your perineum to position the implants.
• Between 50 and 100 implants will be placed in your prostate by your radiation oncologist. The precise number varies depending on the size and location of the tumor.

The course of treatment could last an hour or ninety minutes.

After the procedure

You will be brought to a recovery room after treatment so medical staff can keep an eye on you while the anesthesia wears off. That could take up to two hours.

Doctors may apply an ice pack to the location where implant delivery needles were inserted while you’re sleeping. The ice pack will aid in any edema that may develop following your treatment.

The information regarding possible side effects that you and your radiation oncologists discussed prior to your treatment will be reviewed by the doctors.

Outcome

Most individuals are able to resume their normal activities within one to two days after treatment. However, it’s advisable to take things easy initially and inform your doctor if you encounter difficulties with your daily routines.

For the first two months following your treatment, you should avoid activities that could exert pressure on your groin, such as horseback riding or cycling.

Brachytherapy can be an effective treatment for prostate cancer. For instance, a long-term study found that 97% of patients who underwent permanent/low-dose-rate brachytherapy were still alive 17 years after treatment. Research indicates that brachytherapy might be more effective than other prostate cancer treatments. Nonetheless, individuals who undergo this therapy should continue to have regular prostate cancer screenings. Your doctor will advise you on the appropriate frequency for these screenings.