Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate; High dose radiation (HDR)
Brachytherapy is a procedure to implant radioactive seeds (pellets) into the prostate gland to kill prostate cancer cells. The seeds may give off high or low amounts of radiation.
Brachytherapy takes 30 minutes or more, depending on the type of therapy you have. Before the procedure, you will be given medicine so that you do not feel pain. You may receive:
- A sedative to make you drowsy and numbing medicine on your perineum. This is the area between the anus and scrotum.
- Anesthesia: With spinal anesthesia, you will be drowsy but awake, and numb below the waist. With general anesthesia, you will be asleep and pain free.
After you receive anesthesia:
- The doctor places an ultrasound probe into your rectum to view the area. The probe is like a camera connected to a video monitor in the room. A catheter (tube) may be placed in your bladder to drain urine.
- The doctor uses ultrasound or a CT scan to plan and then place the seeds that deliver radiation into your prostate. The seeds are placed with needles or special applicators through your perineum.
- Placing the seeds may hurt a little (if you are awake).
Types of brachytherapy:
- Low-dose rate brachytherapy is the most common type of treatment. The seeds stay inside your prostate and put out a small amount of radiation for several months. You go about your normal routine with the seeds in place.
- High-dose rate brachytherapy lasts about 30 minutes. Your doctor inserts the radioactive material into the prostate. The doctor may use a computerized robot to do this. The radioactive material is removed right away after treatment. This method often requires 2 treatments spaced 1 week apart.
As men get older, they have a lot of new worries to deal with, from hair loss, weight gain, perhaps even erectile dysfunction. In addition, cancer is one of the biggest concerns that older men face, especially prostate cancer, which is the leading cause of cancer death in men over 75. Younger men may not be very familiar with their prostate, the walnut-shaped gland that wraps around the urethra, the tube that carries urine out of the body. But as they get older, the prostate can start to cause problems. Men over the age of 60 are at increased risk for prostate cancer, especially if they're of African descent, they have a father or brother with the disease, or they eat a lot of burgers and processed meats in their daily diet. It can be hard to pinpoint prostate cancer symptoms, because they usually start late in the disease and they can mimic symptoms of a benign, enlarged prostate, which is also more common in older men. Symptoms like a slow urine stream, dribbling, blood in the urine, or straining while urinating can be signs of either condition. An enlarged prostate can also confuse the results of a PSA test, which is used to screen for prostate cancer. So, if your doctor thinks you might have prostate cancer, you may need a biopsy, which is a procedure that removes a small piece of prostate tissue and sends it to the lab to check for cancer. Then a scoring system called the Gleason grade is used to tell how fast your cancer might spread. Your Gleason grade will help decide what treatment you get. Early-stage prostate cancers that haven't spread are often removed with surgery, and then treated with radiation therapy to kill any remaining cancer cells. Prostate cancer surgery may affect your ability to have sex and control urine, so talk about these issues with your doctor before you have the procedure. Because prostate cancer tends to grow very slowly, your doctor may want to just monitor you with PSA tests and biopsies, and avoid treatment unless the cancer starts to spread. Prostate cancer that has spread is usually treated with surgery, chemotherapy, or hormone therapy. If your doctor discovers prostate cancer in its early stages, before it spreads, it's pretty easy to treat, and even cure. Treatments can also slow down prostate cancer that's spread, and extend your survival. Before you have to deal with a prostate cancer diagnosis, ask your doctor for ways to prevent and screen for the disease. Eating a healthy, low-fat diet that's high in healthy omega-3 fatty acids might help lower your risk. There are also drugs called finasteride and dutasteride that are used in some men to prevent prostate cancer. Talk with your doctor about the pros and cons of these drugs, as well as the possible benefits and risks of having your PSA levels tested.
Why the Procedure Is Performed
Brachytherapy is often used for men with prostate cancer that is found early and is slow-growing. Brachytherapy has fewer complications and side effects than standard radiation therapy. You will also need fewer visits with the health care provider.
Risks of any anesthesia are:
- Allergic reactions to medicines
Risks of any surgery are:
Risks of this procedure are:
- Difficulty emptying your bladder, and the need to use a catheter
- Rectal urgency, or the feeling that you need to have a bowel movement right away
- Skin irritation in your rectum or bleeding from your rectum
- Other urinary problems
- Ulcers (sores) or a fistula (abnormal passage) in the rectum, scarring and narrowing of the urethra (all of these are rare)
Before the Procedure
Tell your provider what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.
Before this procedure:
- You may need to have ultrasounds, x-rays, or CT scans to prepare for the procedure.
- Several days before the procedure, you may be told to stop taking medicines that make it hard for your blood to clot. These medicines include aspirin, ibuprofen (Advil), clopidogrel (Plavix), and warfarin (Coumadin).
- Ask which medicines you should still take on the day of the surgery.
- If you smoke, try to stop. Your provider can help.
On the day of the procedure:
- You will likely be asked not to drink or eat anything for several hours before the procedure.
- Take the medicines you've been told to take with a small sip of water.
- You will be told when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
You may be sleepy and have mild pain and tenderness after the procedure.
After an outpatient procedure, you can go home as soon as the anesthesia wears off. In rare cases, you will need to spend 1 to 2 days in the hospital. If you stay in the hospital, your visitors will need to follow special radiation safety precautions.
If you have a permanent implant, your provider may tell you to limit the amount of time you spend around children and women who are pregnant. After a few weeks to months, the radiation is gone and will not cause any harm. Because of this, there is no need to take out the seeds.
Most men with small, slow-growing prostate cancer remain cancer-free or their cancer is in good control for many years after this treatment. Urinary and rectal symptoms may last for months or years.
D'Amico AV, Nguyen PL, Crook JM, et al. Radiation therapy for prostate cancer. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 116.
Nelson WG, Antonarakis ES, Carter HB, De Marzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.
U.S. National Library of Medicine, PubMed website. PDQ Adult Treatment Editorial Board. Prostate cancer treatment (PDQ): health professional version. Bethesda, MD: National Cancer Institute; 2002-2019. PMID: 26389471
Last reviewed on: 1/31/2019
Reviewed by: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.