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Prostate Brachytherapy
Prostate brachytherapy is a relatively new treatment option for prostate cancer. The technique was first trialled in Denmark in 1983 and has been modified and refined in the years since. This technique is now widely used in the United States and in other countries. The first procedure performed in New Zealand occurred in 1999 and is becoming more common here.
This information sheet deals with brachytherapy specifically. For more general information on prostate cancer and other treatment methods, read our Prostate Cancer information sheet.
What Is Prostate Brachytherapy?
Prostate brachytherapy involves the permanent implanting of radioactive seeds into the prostate gland in order to treat the cancer at its source. It is used to treat localised cancer of the prostate gland. If there is a risk of localised spread of the cancer then external beam radiation may be used in conjunction with prostate brachytherapy. If the cancer has obviously spread beyond the prostate gland then prostate brachytherapy is not appropriate and other treatment options need to be investigated.
The radioactive seeds are small - less than the size of a grain of rice - and are implanted directly into the prostate gland. The seeds contain either radioactive Iodine 125 or radioactive Palladium 103. The total number of seeds required will vary according to the size of the prostate gland. It is possible to implant over 100 seeds if required. The seeds remain in place permanently but gradually lose their radioactivity while treating the cancer over a period of approximately six months.
The procedure is performed by a specialist radiation oncologist (cancer specialist) and a specialist urologist (urinary system specialist). The implanted seeds deliver about twice the dose of radiation to the prostate gland than external beam radiation. Because the radiation is concentrated in a localised area, damage to healthy surrounding tissue is minimised and side effects are potentially less than those of external beam radiation.
Before the procedure it is necessary to assess the size and shape of the prostate gland. This enables the implant procedure to be accurately planned and for the number of seeds required to be determined. In order to achieve this a CT scan (computerised tomography) or MRI (magnetic resonance imaging), and a transrectal ultrasound scan will be performed.
Blood tests to measure the PSA (prostate specific antigen) and an ECG (a tracing of the heart’s electrical activity) will also be required. Bowel preparation, including a clear liquid diet and the administration of enemas, will be necessary on the day prior to the procedure to ensure that the lower bowel is clear.
The Implantation Procedure
The procedure is performed in an operating theatre using a spinal or general anaesthetic. A transrectal ultrasound probe is inserted into the rectum in order to locate the prostate gland and enable it to be seen on a monitor.
The seeds are placed into the prostate gland using needles inserted through the perineum (the area of skin between the scrotum and the anus). The transrectal ultrasound scan and x-rays are used to guide the needles and to assess the positioning of the seeds.
At the completion of the procedure a catheter (drainage tube) is inserted into the bladder to drain the urine. This is usually removed a few hours after the procedure.
Most people are able to be discharged from hospital within 24 hours of the procedure and a return to normal activity can usually be achieved within 2-3 days.
Side Effects And Complications
Common side effects of prostate brachytherapy include:
- Blood in the urine: This is normal and should resolve within a few days
- Bruising and tenderness of the perineum
- A burning sensation when urinating: Drinking plenty of fluids will help to minimise this and will help prevent urinary infection
- Difficulty passing urine, or an urge to pass urine quickly or more often
- A temporary increase in the frequency of bowel motions
- Pain or burning with ejaculation
- Discolouration of the semen
- Fatigue: This is common to all types of radiation treatment.
These side effects are at their most troublesome four to six weeks after the procedure. However, for most patients they will subside completely over a period of a few months.
More serious side effects can occur:
- Urinary incontinence (in less than 1% of cases)
- Rectal bleeding (usually just a few spots of blood) (<5%)
- Ulceration of the rectum (<1%)
- Impotence (30 - 50%): This risk of impotence increases over the age of 60.
Infertility is usual as a result of this treatment.
The risks and side effects of prostate brachytherapy should be discussed with the specialist(s) prior to treatment and should be a consideration when deciding whether or not to opt for this treatment. More detailed information about the treatment and radiation safety guidelines will be given by the specialist(s) performing the procedure.
In order to check the position of the seeds a CT scan will be conducted about one month after the seeds have been implanted. Follow up examinations are usually recommended every three months for the first year, then every six months after that. Rectal examinations and blood tests to measure the PSA levels are usually conducted in order to monitor the effectiveness of the implanted seeds in treating the prostate cancer.
For further information and support about prostate cancer and treatment options please contact:
Cancer Society of New Zealand Information Service
Ph: 0800 800 426
Prostate Cancer Foundation Of New Zealand
Freephone: 0800 62 72 77
Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2005) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby-Year Book, Inc.
Matthews, J. (1999) Trans perineal permanent implantation of radioactive seeds into the prostate for prostate cancer. Auckland: Dr John Matthews
MedicineNet (1996-2000) Prostate cancer Foothill Ranch: MedicineNet Inc http://www.medicinenet.com/Script/Main/Art.asp?li=MNI&d=295&f=456&ArticleKey=456
Wright. K. D (1999) Radioactive implants. In Gale Group (eds) Gale encyclopaedia of medicine (p2443) (1st ed.) Farmington Hills, MI: Infotrac Health Reference Center ¨C Academic
Last Reviewed - 13/12/06